Alameda County
Bar Association

What You Need to Know About: Documenting A Long Term Disability Insurance Benefits Claim 

The Paper File

When filing a claim for long term disability insurance benefits, the most important and persuasive documents are going to be your medical records from your treating doctors which clearly lay out your medical condition and how it prevents you from doing your job.  The more medical records the better to ensure your long term disability claim is approved, since the application and/or appeal period may well be your only chance to document your disability during the entire time of your appeal process, including the lawsuit.

The paper file is the beating heart and soul of your claim.  Give the claims examiner for the insurance company all the medical records you can (of course you always have the option of keeping certain records private) which in any way validate your medical issue and work disability.  There will never be too many records, but leaving out documentation could be fatal to your claim.

There are other documents that may also play a vital role in a successful long-term disability claim.  Do you have any persuasive or compelling documents from your workplace?  Any documentation you can provide from your employer which (1) demonstrates the essential duties of your occupation and (2) documents your inability to perform your job will go a long way in getting your benefits claim approved.  Other job documents such as glowing performance reviews before the onset of a serious medical condition, followed by performance reviews noting the drop off in your ability can be very persuasive in demonstrating you cannot meet the essential job duties of your occupation.

Additional key documents may include (1) social security disability records of an approved claim, (2) functional capacity exams, and (3) vocational analysis reports.

The Personal Statement

Since testimony is generally not allowed in an ERISA governed long term disability insurance lawsuit, a personal statement which tells the story of your disability can be an essential part of your documents in the insurance claim file.  This may well be your only opportunity to tell your story concerning the disability and its impact on your work life.  Your personal story can also be told through a video and sent to the claim representative on a DVD.  This has the added benefit of bringing a real person to the judge in the event your claim proceeds to an ERISA governed trial.  Your own power point or video may be far more instructive to the judge than 30 to 60 minutes of undercover insurance company video showing you driving to the store to buy groceries, or attending a doctor’s appointment.

Realize that the documents, statements, reports and possibly video you submit to your disability insurance company are not only the foundation of your claim, but the entire structure, so build the strongest possible house  from the start when documenting your long term disability insurance claim.

By Randy Noah, a lawyer specializing in the representation of individuals denied long-term disability insurance benefits.  For more information please visit