We do not handle Social Security Disability (SSDI) claims.

How gaps in treatment can affect your long-term disability

Shawn E. McDermott

When you’ve suffered an injury or developed an illness that keeps you from working, you may rely on your long-term disability policy to keep you afloat.

Unfortunately, gaps in your medical care can put your benefits in danger. Whether you’re still trying to obtain the long-term disability benefits you’re due, or you’re trying to make sure your payments aren’t interrupted, it’s important to understand why treatment gaps can reflect so negatively on your claim. Here are three of the biggest issues:

You need documentation that your condition is disabling and ongoing

You may feel like you’re not getting very much out of your doctors’ visits these days, especially if your condition is intractable – but those regular visits help create proof that your disability is still ongoing. Each visit gives you an opportunity to provide your doctor with a narrative of your limitations, and that becomes part of your records.

Your insurer may accuse you of being purposefully non-compliant to stay disabled

Insurers see “red flags” everywhere on disability claims, and one of the biggest is noncompliance with a doctor’s treatment plan. Missed visits, a failure to follow through on physical therapy and refusals to follow a doctor’s recommended care can all be interpreted as a deliberate ploy on your part to stay on benefits.

Your insurer may think that you’re doctor-shopping for a “friendly” physician

As a patient with a chronic condition, you have a right to find a medical provider you trust to meet your needs – but that may require some gaps in your care as you schedule new intake appointments. Your insurer may decide that’s a signal that you’re looking for a doctor that’s more supportive of your disability claim.

Frankly, there are tons of reasons for gaps in care: lapses in medical coverage, a doctor’s retirement, religious objections to certain kinds of treatment, family issues and transportation problems can all play a role. When you have treatment gaps and are concerned it could affect your ability to receive ERISA benefits, find out how experienced legal guidance can help.

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