If I were handed a stack of medical records and told that a disability insurance company denied this patient’s claim, I could often point to the exact appointment they relied on. More often than not, it would be the one that says: “Patient improving.”
This can be one of the most damaging phrases in a Long-Term Disability (LTD) claim. It might sound like a good thing, as everyone wants to improve. The problem is that disability insurance companies often take that phrase and run with it.
“Improving” Compared to What?
In real life, improvement is relative. A person with chronic migraines who goes from twenty migraine days a month to fifteen is technically improving. Someone with severe depression who is able to run one errand per week may also be improving from their prior state. A patient with chronic pain who can sit for thirty minutes instead of ten is making progress too.
However, that doesn’t necessarily mean any of those people can go back to work full time.
Disability insurers often ignore that distinction. They see words like “improving,” “doing better,” or even “stable” or “symptoms controlled” and try to argue that the person is no longer disabled.
Sometimes the same office note will also say the patient still has severe fatigue, cannot sustain concentration, needs frequent rest breaks, or continues to have significant pain, but the insurer will barely mention those parts. That is how a completely normal medical record can end up being used against someone.
Doctors and Insurance Companies Are Often Speaking Different Languages
Physicians are appropriately focused on treatment and clinical progress. They document improvement because that is the goal of medical care. Disability insurance companies are focused on whether the claimant can reliably perform full time work. These are not always the same conversation.
A patient can be improving while still being unable to sit at a desk all day, stay focused, handle stress, or work without excessive absences. Courts have recognized that context matters. In one case, a claimant stated that she was pleased with the results of a surgery but less than two months later she claimed that she was dependent on a wheelchair for mobility. The insurance company argued that these two facts were in conflict, but the court disagreed, noting that such comments
needed to be viewed in light of the claimant’s “lengthy medical history.” Leger v. Tribune Co. Long Term Disability Benefit Plan, 557 F.3d 823, 833 (7th Cir. 2009). In this case, the court indicated that the claimant had undergone a significant amount of surgeries and procedures for her debilitating condition and statements about her progress had to be evaluated with that history in mind.
In LTD claims, the key question is not whether someone is “better” or “stable,” but it is whether they can work on a full-time basis. Insurers often attempt to isolate a few lines in the record while ignoring the broader evidence supporting ongoing disability.
Why Communication with Providers Matters
If you are receiving LTD benefits, it is important that your doctor understands and documents how your symptoms affect your day to day functioning your ability to work. Your doctor may genuinely believe that you are improving while also believing that you still cannot return to work. If that second part never makes it into the records, the insurance company may pretend it does not exist. Details in the record such as limited sitting tolerance, cognitive slowing, unpredictable symptom flares, and inability to maintain pace or attendance help create a more complete and accurate medical record. It is also important that a provider documents physical examination findings and any other objective medical evidence that supports these limitations. (See “More Than a Diagnosis: The Objective Evidence Gap That Sinks LTD Claims.”)
Don’t Fight a Cherry-Picked Denial Alone
A disability insurer may be looking to deny your claim and sometimes a single sentence in a chart note becomes the centerpiece of a denial. “Patient improving” does not necessarily mean “patient able to work.”
If your claim has been denied because the disability insurance company took a portion of your medical records out of context, contact an attorney to help with your appeal.