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You could face a medical exam as part of a disability claim

On Behalf of | Jan 9, 2020 | Long-Term Disability

When you file a claim for long-term disability insurance benefits from a private insurance carrier or through workers’ compensation, the insurance provider may require you to undergo a disability examination. This will not be a written test but rather a medical exam intended to determine whether the physical impairments that result from an illness or an injury have truly left you unable to care for yourself or continue to work.

If you will soon need to file a long-term disability claim or have already received notice that you must undergo a medical review or functional assessment for a pending claim, there are certain issues you should become aware of before you go to that appointment.

The exam is meant to qualify your limits and prevent fraud

The reason that applicants must overcome so many bureaucratic hurdles when applying for long-term disability benefits is to reduce the number of fraudulent cases that an insurance provider approves. Fraud increases the cost to insurance providers, which they typically pass onto to the people paying for coverage. Unfortunately, in their overzealous efforts to minimize fraud, they also inconvenience and stress people who have legitimate claims.

Insurance providers know that the people who commit fraud will typically exert substantial effort into making their claims seem realistic. That means that physicians and rehabilitation specialists who administer disability exams have a responsibility to screen for those faking their symptoms or exaggerating them in order to obtain benefits they don’t actually need.

The exam isn’t the only thing that the person doing the test will scrutinize

At many facilities, the person administering the test or a member of their staff will monitor the parking area and the entrance to the building to see how someone moves prior to entering the exam space. They will also watch how a person behaves after they exit, as someone who feels both tired and successful may let their guard down and stop pretending to need a cane.

Everything you do before, during and after the examination may wind up included in the report submitted to the insurance company by the professional involved. In other words, while your instinct might be to tough it out and hurry through the parking lot if you find yourself running late, you should try to remain aware of how your urgency or behavior may look to someone else.

You have options even if the insurance company denies the claim

Long-term disability benefits are often critical for those who get hurt or fall ill unexpectedly. Whether you or your employer have paid on a disability policy in your name, you have a right to those benefits if your medical condition justifies your claim. Insurance companies typically want to reduce how much they pay, which makes them eager to deny potentially legitimate claims. Knowing your rights can make it easier for you to stand up for yourself if you receive an unfair denial.


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