Does My Doctor Have to Fill Out Disability Paperwork?

We get this question a lot from our clients: “How can I make my doctor fill out my disability forms? Don’t they have to help me?” Surprisingly, the short answer is no, the doctor does not have to fill out your forms. Often, though, they don’t realize what a tremendous impact this has on your claim. Those forms are not part of your claim, they ARE your claim. Without a doctor willing to tell the insurance company that you are disabled and explain why you cannot work; your claim has no chance. It’s really as simple as that.

Fortunately, once you explain this, most doctors will work with you. Sometimes, doctors think they are doing you a favor by stonewalling the insurance companies. They don’t understand the process that insurance companies use to evaluate claims, which starts with the foundational question of “What restrictions and limitations has the doctor given you?” If the answer is, “none,” it doesn’t matter why. The insurance company will say that you failed to provide proof that you are disabled, and your claim will be denied.

What if Your Doctor Still Refuses to Complete Your Claim Forms?

To put it bluntly, you need a different doctor. Your claim will not be approved without physician support. It’s that simple.

Today doctors are overwhelmed, we get that. Often times they have multiple people on staff just to deal with the paperwork the insurance companies insist they need (but will not pay for!). So, how can you make sure your paperwork gets the attention it needs? First off, being a great patient who follows directions, who is pleasant and who understands that this is “above and beyond” work you are asking for can help move the needle towards getting your doctor to cooperate.

Another tip is explaining to your doctor that for your disability case, there is zero chance that they would be drawn into a long-term court case because these cases are only ever about what pieces of paper are in the claim file. There are never any depositions, trials, expert testimony, etc. If your doctor has something to say about your case, they have to write it down and submit it to the insurance company. It’s possible that they would get a call back from an insurance company doctor to discuss your case, but that’s it.

Whether your doctor is filling out forms or talking to an insurance company representative, they need to convey one thing: why can’t you work? To answer this, of course, they will need to discuss your medical condition and how it restricts and limits you. The insurance company will want to know what your treatment plan and prognosis is. They will want to hear about what test and exam results support the doctor’s opinions.

If You Have More Than One Doctor, Who Supports Your Claim?

Great. Make sure they all get heard by the insurance company. Just be careful that the specialist for your condition is the loudest voice…meaning, if your disability is caused by a neurological condition, make sure your neurologist comments in support of your claim. It won’t matter what your primary care doctor, rheumatologist, etc. have to say if the primary doctor treating your disability doesn’t stand up for you.

We Can Help

If you and your doctor agree, we are happy to look at your forms after the doctor has filled them out and before they go to the insurance company to make sure your doctor is conveying what they really mean.

Often, words mean one thing to your doctor but something entirely different to the insurance company. For example, we had a client whose doctor said that they could “sit with no restrictions.” The doctor meant that our client could sit if he could manage it. But to the insurance company, “sit with no restrictions” means “can sit at a desk and work a full-time job.” So, the insurance company hears “can sit with no restrictions,” tells you “your doctor said you could work,” and terminates your claim. Now both you and your doctor are upset! But in this case, we just recommended that the doctor clarify: “sit with no restrictions as the condition allows, which is normally 2-4 hours per day and never greater than 5 hours per day. Must be able to take breaks as needed, for as long as needed, with the ability to lie down and elevate feet.”

Takeaway

Your doctor does not have to fill out forms, but if you are disabled and your doctor (even after hearing this information!) refuses to fill out the paperwork the insurance company says you need, then you have a choice: your doctor or your disability claim.

We are Here to Help

Call us at 703-591-9829 to discuss your case.

If appropriate, we offer a flat-fee consultation to help sort out the best course of action for you to take with your doctor and your insurance company.

Ben Glass
Connect with me
Ben Glass is a nationally recognized Virginia injury, medical malpractice, and long-term disability attorney