Answer
If your doctor refuses to complete your disability insurance paperwork, there are several options for you to get your benefits approved. Do not give up on the process: You will need to be persistent to secure eligibility for your benefits.
Background
When someone is affected by a disability and wants to apply for disability benefits, they will need to get a doctor to certify their medical condition to support their application for disability benefits. However, sometimes a doctor will refuse to complete the necessary paperwork. This may happen for several reasons: they may not think the patient’s condition is severe enough to support a disability determination, they may believe that a different type of medical specialist would be more appropriate to certify the patient’s disability, or they simply may not have time to complete the paperwork.
Long COVID
To qualify for disability benefits, an insurance company will require objective medical evidence of the patient’s disability. This can be challenging for people with long COVID, because physical examinations and laboratory tests may not always be able to detect or quantify some debilitating symptoms, such as chronic fatigue and cognitive impairment. Additionally, many long COVID symptoms share similarities with other illnesses, making it difficult to differentiate them and provide an accurate diagnosis.
Our understanding of long COVID continues to evolve, which makes it challenging for the medical and scientific communities to stay informed about how to properly diagnose and treat long COVID. To ensure they receive the appropriate care, some patients will need to be very proactive with their clinical care team to ensure they are equipped with the best information possible.
Reasons for Refusal
One of the most common reasons a doctor chooses not to complete a form is that they feel the patient does not qualify, even if they are experiencing disabling symptoms. Each disability insurance policy contains different eligibility criteria, and the doctor may not be aware of how the patient’s insurance policy defines “disability.” Alternatively, they may be aware of the requirements, but not think the patient is eligible because their symptoms are not severe enough.
Another reason that a physician may refuse to certify a patient’s disability could be that they do not want to get involved in a dispute between a patient and their insurance company or be called as a witness to testify about the patient’s medical condition. Also, a doctor may think there is a risk of liability for certifying a patient’s disability paperwork. Some doctors may not have time to complete additional paperwork or may not be willing to complete additional paperwork without being compensated for the extra time it takes to complete. Unfortunately, some doctors may not be aware that long COVID is a serious and debilitating condition, which may lead them to refuse to certify a patient’s disability. Additionally, some doctors may not be familiar with how to properly complete the paperwork, which may make them hesitant to complete it.
If your doctor has refused to complete your disability insurance paperwork, it may be helpful to determine the reason for their refusal. Understanding their rationale will ultimately help you move your application for benefits forward.
Solutions
Once you understand why your doctor is refusing to complete your disability insurance paperwork, you can strategize how to move forward:
- If your doctor does not provide a reason, consider bringing a friend or family member with you to your appointment. Ask your doctor to complete the paperwork during your appointment. If your doctor still refuses, you may wish to establish care with a different medical provider who is more receptive to your condition.
- If your doctor feels that you do not meet your insurance policy’s definition of disability, consider bringing a copy of your policy to your appointment and ask your doctor to describe how your condition does not qualify under the terms of the policy. Assure your doctor that the insurance company will ultimately determine whether you are eligible under the terms of your policy. You may wish to communicate to your doctor that their refusal to complete the paperwork is preventing you from obtaining important benefits that you are entitled to.
- If your doctor feels that there is not enough objective medical evidence to support your disability, inquire about different diagnostic tools or examinations that could be performed that would provide evidence of your disability. If your doctor does not have any recommendations, ask for a referral to a specialist who may be more knowledgeable about the tests that may be necessary.
- If your doctor is not knowledgeable about the disabling symptoms of long COVID, consider bringing medical literature with you to your appointment that describes the severity of long COVID and the symptoms you are experiencing.
- Some doctors are unable to certify a patient’s disability because it is beyond the scope of their licensure. For example, California will not allow a Doctor of Naturopathic Medicine (NMD) to certify a patient’s disability. Make sure you are obtaining a disability certification from the appropriate medical professional. Your disability insurance policy will specify any limitations on who can certify your disability.
With these strategies in mind, you should be able to move your application for disability benefits forward. If you continue to experience challenges obtaining a certification for your disability benefits, or if you need guidance on the types of tests or examinations that may help document the severity of your symptoms, consider reaching out to Pandemic Patients for help. See our COVID-19 and Disability Benefits page for more information.
