Importance of Medical Restrictions and Limitations

From my perspective it is often true that insureds and claimants, and in fact their physicians, are completely unaware of the importance of medical restrictions and limitations in the evaluation of disability claims.

Although most insurers continually request patient notes, physicians rarely (if ever) include R&Ls in the notes. Lacking the specific information they need, insurers then keep asking for the same information over and over again, only to deny claims by citing, “there are no restrictions and limitations to preclude you from working.”

My reviews of most claims show that despite voluminous patient notes and recommendations there generally is not one R&L among them. Without specific R&Ls to support disability the door is left open for insurers to deny claims legitimately even when it’s clear from the combination of patient records there is no work capacity…

“Restrictions” are defined as work or life activities insureds should NEVER do. “Limitations” are defined as “work or life activities insureds can do, but only to a limited extent. And, all good intentions aside, many physicians themselves are not aware of these definitions and rarely write them in patient records or on disability forms…

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