Permanently Total Disability (PTD) claims are often complicated and face several obstacles that could lead to denials. Recognizing red flags early on is crucial to improving your chances of approval. Here are five warning signs that could indicate trouble for your PTD claim and tips on addressing them.
Incomplete medical documentation
Incomplete medical documentation is a common reason for PTD claim denials. If your medical records don’t fully support your claim, insurers may reject it. This could happen if your doctor’s reports lack specific details about your ability to work or if your condition hasn’t been consistently documented.
Ensure your doctor provides detailed, up-to-date reports about your condition and how it impacts your daily life and work.
Lack of objective evidence
Your claim may be denied without sufficient objective evidence. Insurers need clear documentation, such as diagnostic tests and scans, to assess your condition. Subjective symptoms like pain are harder to prove without objective findings.
Undergo necessary tests and follow your doctor’s recommendations to strengthen your case.
Discrepancies in your work history
Inaccurate or inconsistent work history can raise doubts about the severity of your disability. If there are gaps in your employment record, insurers might question your ability to work.
Ensure your work history is accurate and provide explanations for any gaps. Keep your employment records current.
Failure to follow prescribed treatment plans
Not following a prescribed treatment plan could lead to a PTD claim denial. Insurers may argue your disability could be improved with proper care.
Follow your doctor’s treatment plan and document any alternative treatments if the prescribed ones are ineffective.
Delay in filing your claim
Filing your PTD claim late is another common reason for denial. Each state has strict deadlines for workers’ compensation claims, and missing them can jeopardize your case.
File your claim promptly and within the required time frame, keeping proof of submission.
The best way to protect your PTD claim is by addressing these red flags early. Seeking legal counsel can help you navigate the process, gather proper documentation, and meet deadlines.