What You Should Know Before You Read:
- Your medical records are the most important pieces of evidence in a long term disability claim and insurers scrutinize them closely for reasons to deny benefits.
- Innocent phrases, missing details, or inconsistent notes in your medical records can be taken out of context and used to justify denial or termination.
- Understanding how insurers interpret and often misuse medical records can help you avoid common pitfalls.
- Dabdoub Law Firm focuses exclusively on disability insurance claims, representing clients nationwide with a proven record of success. Our firm was built to win disability insurance cases.
Why Medical Records Matter So Much in LTD Claims
Medical records are the backbone of every long term disability claim. Insurers rely on them to assess your diagnosis, symptoms, treatment history, and functional limitations. Unlike personal statements or employer forms, medical records are considered objective evidence.
However, disability insurance companies do not simply review medical records. They analyze, dissect, and selectively interpret them to minimize your symptoms or contradict your inability to work. They look for ways to attack your credibility or the credibility of your doctors.
Even when treating physicians support disability, insurers frequently identify small gaps or isolated comments that they use to cast doubt on your claim. Understanding how medical records are weaponized by insurers can help you protect your benefits.
How Insurers Examine Medical Records to Deny Claims
Insurers rarely look at records holistically. Instead, they isolate language or patterns that can justify denial. Below are the most common tactics.
1. Highlighting Normal Findings While Ignoring Abnormal Ones
If a record shows both normal and abnormal results, insurers often focus exclusively on the normal findings. This happens frequently in conditions involving fluctuating symptoms such as chronic pain, autoimmune disorders, neurological illness, and Long COVID.
A note stating “normal gait” may be used to claim physical ability, even if the same visit documents severe pain, fatigue, or limited endurance.
2. Taking Benign Phrases Out of Context
Physicians keep medical records for their own reference and for that of the health insurance company. They often write quick comments such as “doing well,” “stable,” or “patient improving.” In medical language, these phrases usually mean the condition has not worsened. Insurers misuse them to argue that the claimant can return to work.
3. Pointing to Gaps in Treatment
Any break in care, even for legitimate reasons such as health insurance issues, appointment delays, or specialist waitlists, may be claimed as evidence that your condition has resolved. Disability insurance companies may claim you must not be that bad if you have a gap in your doctor’s visits.
4. Arguing That Your Treatment Is Too Conservative
If your doctor has not recommended surgery or aggressive treatment, insurers may argue that the severity of your condition does not justify disability. This is a flawed conclusion since many disabling conditions do not respond to aggressive treatment or do not qualify for surgery
5. Using Incomplete or Missing Documentation Against You
If your doctor does not specifically document functional limitations, insurers assume none exist. A medical diagnosis alone is not enough for disability. Insurers expect detailed notes explaining how symptoms interfere with daily tasks and work duties.
6. Misinterpreting Mental Health Notes
A single mention of anxiety or depression can lead an insurer to claim your disability is mental rather than physical. This is especially common in Long COVID, chronic pain, and autoimmune cases.
7. Ignoring Specialists and Favoring File Reviewers
Insurers often reject opinions from treating specialists and instead rely on their own hired reviewers who never examine the patient. These reviewers frequently interpret the medical records more favorably for the insurer.
Why Medical Records Often Fall Short Without Guidance
Treating physicians are focused on diagnosing and treating illness, not documenting disability. As a result, records may unintentionally:
- Leave out important functional details
- Understate symptom severity
- Fail to describe how symptoms fluctuate
- Focus on treatment rather than limitations
- Use short, vague phrases that insurers misinterpret
Physicians also operate under time pressure. A fifteen minute appointment cannot capture the full picture of a person’s impairment or their inability to work full time.
The discrepancy between medical care and disability documentation is often exploited by disability insurance companies.
How to Strengthen Your Medical Record Before a Claim Review
You cannot rewrite past records, but you can ensure future records support your disability claim accurately.
1. Be Detailed and Consistent at Every Visit
Describe your symptoms clearly and accurately. Avoid minimizing them just to appear polite or optimistic. Your physician cannot document what you do not share.
2. Discuss Functional Limitations Explicitly
Tell your doctor how your condition affects stamina, concentration, mobility, or ability to sustain activity. Insurers want functional evidence, not just diagnoses.
3. Report Fluctuations and Post Exertional Symptoms
Many conditions worsen with exertion. Explain these patterns so your physician can capture them in the record.
4. Keep a Symptom Log
This helps you provide consistent, specific information during appointments.You can also provide this to your long term disability insurance company as part of your proof of disability.
5. Confirm That Specialists Address Work Capacity
Ask your treating physicians to clearly state whether you can perform full time work, even at a sedentary level.
6. Avoid Gaps in Care When Possible
If you must miss appointments, document the reason.
What to Do If You Receive a Denial Based on Your Medical Records
A denial letter referencing your medical records does not mean your case is over. You have the right to appeal, and many denials are overturned when the appeal is carefully built.
1. Request Your Entire Claim File
You are entitled to see every record, note, and review the insurer used. This often reveals selective interpretations or misrepresentations.
2. Identify Misstatements and Omissions
Insurers frequently quote records inaccurately or ignore significant findings.
3. Strengthen Your Medical Evidence
Updated testing, specialist evaluations, and functional assessments can rebut the insurer’s reasoning.
4. Work With Your Treating Physicians
Ask them to clarify or supplement their earlier notes, especially regarding work capacity. This can be done in a letter or questionnaire completed by the doctor.
5. Consult a Disability Insurance Attorney Immediately
The appeal stage under ERISA is critical. It is your only chance to add evidence before the record closes. An attorney experienced in disability insurance knows exactly how to counter misused medical records and build a winning appeal.
How Dabdoub Law Firm Can Help
Dabdoub Law Firm was built to win disability insurance cases. We understand how insurers use medical records to deny claims, and we know how to correct the record, strengthen the evidence, and challenge improper interpretations.
We represent clients nationwide in:
- Long term disability claim denials
- Appeals under ERISA
- Litigation in federal court
- Negotiation of lump sum settlements
Our attorneys have taken on every major insurance company and have a proven record of success in federal court. Because most disability cases fall under federal law, we can represent clients in any state. You pay no fees or costs unless we win your case.
If your disability claim was denied based on your medical records, contact Dabdoub Law Firm at (855) 276 3760 for a free consultation.