Reasons Claims are Denied #2 – No Restrictions or Limitations
A common reason that a disability insurance company will cite to deny a long-term disability claim is that there are no “restrictions or limitations”. Essentially, the disability case manager has reached the conclusion that the medical condition the claimant is suffering from and the symptoms the claimant is experiencing are not severe enough that they would prevent the claimant from being able to work in their own job.
A “restriction” refers to tasks or actions which a person is unable to do as a result of a medical condition. For example, a person who suffers from a severely herniated disc may be restricted from bending, pulling, pushing or lifting over 15 pounds. A person with vision problems may be restricted from driving.
A “limitation” refers to a task or action which a person can only do for a certain period of time as a result of their symptoms. For example, a person suffering from musculoskeletal pain or fibromyalgia may be limited from remaining stationary in a sitting or standing position for more than 10 minutes. A person suffering from chronic fatigue syndrome may be limited from doing any type of strenuous physical activity for more than a very brief amount of time.
Thus, when the disability case manager finds no restrictions or limitations, he or she has made the judgment that the claimant is totally capable of performing his or her job duties, even if it is established without doubt that the claimant suffers from a sickness or has suffered an injury. However, the disability insurance company’s position may be unfounded and incorrect from a legal standpoint.
Firstly, the disability case manager may have unfairly underestimated or discounted the severity of the claimant’s medical condition. A disability insurance company will usually rely upon the opinion of internal medical staff to decide on restrictions and limitations. However, these professionals only conduct a paper-review and do not examine or even speak with the claimant. A court of law will most likely prefer the opinion of the claimant’s own doctors who have examined and treated the claimant.
Secondly, the disability adjudicator may have an inaccurate or incomplete understanding of the claimant’s job duties and their physical and mental requirements. This can result from wrong information provided by the HR department of the claimant’s employer – often when the employer is not supportive of the disability claimant’s inability to work.
If your short-term or long-term disability claim has been denied on grounds of “no restrictions or limitations”, contact my disability law office for a free consultation with a disability lawyer about your case. A court of law may strongly disagree with the insurance company’s position.