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Inconsistent medical records are one of the most common issues that arise in long term disability (LTD) and CPP Disability (CPP-D) claims. If your medical documentation shows gaps in treatment, differing diagnoses, or medical notes that do not perfectly align with the symptoms you experience day to day, your disability benefits may be denied by your insurer on the basis that there is insufficient medical evidence to support your claim.
Complete and detailed medical documentation is the cornerstone of a successful LTD claim. Insurance companies rely on the medical evidence to determine whether you satisfy the definition of disability and whether your medical condition prevents you from working.
Insurers often seize on these inconsistencies to conclude that a claimant’s condition is not as severe, persistent, or disabling as reported. However, inconsistent medical history does not automatically undermine a disability claim. Claimants deserve the benefits they are entitled to, but inadequate or inconsistent documentation is the most common reason for claims denials. What matters is how those inconsistencies are understood, documented, and explained within the broader context of your condition.
This blog explores why inconsistencies occur, how insurers view them, and the steps you can take to have a successful claim.
Insurers evaluate medical records through a critical lens. Their objective is determine whether there is strong medical evidence to justify paying a claim. They look for:
Insurance companies require consistent, objective evidence proving the severity of a claimant’s condition and how it impairs their ability to work. They often give more weight to opinions from treating physicians who have consistently followed the claimant’s case, especially medical specialists such as neurologists, psychiatrists, and rheumatologists.
Most claimants have medical histories that reflect the natural complexity of illness – symptoms fluctuate and diagnosis can be difficult. Medical care can be inconsistent because of the lack of family physicians in the place you live. Common and legitimate reasons for inconsistency include:
Many conditions — including chronic pain, autoimmune disorders, mental health disorders, and neurological issues — naturally vary in severity.
Different physicians use different terminology, documentation styles, and clinical impressions. If you receive care through a walk-in clinic and cannot find a family physician, it is difficult to have a consistently documented medical history.
People miss treatment for many legitimate reasons, including:
Failing to provide a complete medical history or leaving out critical details can significantly harm your case and may lead to a denial.
Some illnesses take months or years to diagnose. Early records may reflect incomplete findings or working diagnoses.
Medical records often contain shorthand notes, templates, or incomplete commentary. These can be misinterpreted if taken out of context.
Discontinuing a treatment due to side effects or lack of effectiveness is common and medically appropriate. It is important to document the reasons for changing treatment.
However, it is important to follow prescribed treatments, such as physiotherapy, medication, or counseling, as recommended by your healthcare provider. If you are unable to follow prescribed treatments or need to discontinue or change them, make sure to properly document the reasons with your provider. None of these issues, on their own, invalidate a disability claim.
Gathering comprehensive medical records is essential to a successful LTD claim. Insurers rely heavily on the presence of detailed, accurate, and up-to-date medical documentation when making decisions about disability benefits. Incomplete forms or missing information can lead to unnecessary delays, denials, or even harm your chances of approval.
Your treating doctor plays a central role in this process. Their medical opinion carries significant weight, especially when it comes to describing your current symptoms, limitations, and the effect your condition has on your ability to perform daily tasks or work. It’s important to work closely with your doctor to ensure that all relevant medical information is included in your file.
When gathering your medical records, be sure to request copies of all reports, test results, appointment notes, and any correspondence related to your health issues. Double-check that each document is complete, includes the correct date, and accurately reflects your ongoing symptoms and treatment history. If you notice any gaps or incomplete forms, ask your doctor to provide additional details or clarification.
Organizing your medical records in a clear and logical manner can make it easier for both you and your doctor to review the information before submitting your application. This proactive approach helps ensure that your claim is based on thorough, objective medical evidence and reduces the risk of your claim being denied due to missing or insufficient documentation.
By taking these steps, you protect your rights and strengthen your case, making it more likely that your application for disability benefits will be approved.
Insurers frequently rely on:
Insurers may also monitor your social media activity to look for inconsistencies in your claim. They also ask your employer for information about any problems in your work and any interpersonal issues which may point to a non-medical reason for you submitting a LTD claim. It is crucial to be honest and consistent in all your communications, documentation, and representations to avoid giving insurers grounds to challenge your credibility.
These tactics are intended to create doubt around your credibility or the severity of your impairment. A proactive, well‑documented explanation can neutralize these arguments.
A combination of medical evidence, including specialist reports and test results and as well as chart notes, significantly strengthens your claim by providing a comprehensive and convincing picture of your impairments.
Below are effective steps to address and mitigate inconsistent medical history:
Do not ignore inconsistencies or hope the insurer will overlook them. Identifying them early and providing context can significantly strengthen your position.
A straightforward explanation is often sufficient.
If you discover errors or omissions in your medical records, request corrections in writing through your healthcare provider, and be sure to include specific details about the errors.
A well‑organized narrative can be extremely helpful. Include:
This creates a coherent picture that ties your records together.
Your doctor may be able to explain:
A clear medical clarification can resolve many insurer concerns. Doctors are human and make errors. If your doctor has made an error in your records, ask for a letter correcting the misstatement.
During appointments, accurately describe:
Doctors can only document the information they receive. If symptoms are understated, insurers may assume improvement.
Be sure to provide detailed evidence of your functional limitations and clearly document how your condition affects your ability to perform your job duties. A well-documented claim explicitly outlines these limitations and their impact on your work.
If you missed appointments, discontinued medication, or experienced delays in obtaining a referral or appointment, provide a brief explanation. Valid reasons might include:
Providing context prevents negative assumptions. Failing to follow prescribed treatments can negatively impact insurance claims, so it is important to document both the failure and the reasons for not following medical recommendations.
While past records cannot be changed, future documentation can be consistent, clear, and thorough. This helps strengthen your overall file.
Insurers may rely on inconsistencies to:
If you receive a denial letter, you may be offered an opportunity to dispute the decision through the appeals process. When disputing a denial, it is important to carefully review the denial letter to understand the reasons for the decision, gather additional medical records or new assessments, and obtain letters from your treating doctors that specifically address the insurer’s concerns.
Hiring an experienced disability lawyer can significantly improve your chances of a successful appeal or lawsuit, as legal professionals can identify gaps in your medical records, know what insurers are looking for, and present your case in the best possible manner.
These situations require careful handling. A disability lawyer can:
Often, the issue is not the inconsistency itself, but how the insurer chooses to interpret it.
Few people have a perfectly consistent medical history. What matters is whether your records, taken as a whole, support the reality of your condition.
With proper context and proactive explanation, inconsistencies can be addressed effectively. A well‑supported long term disability claim focuses on the overall pattern of impairment, not isolated notes, to prove that you have a disabling condition which prevents you from working.
If you have concerns about inconsistencies in your medical history or need guidance with the application process, consider hiring an experienced lawyer to assist you. Do your research and make sure that you choose the right lawyer for your case. Reach out to us today to schedule a free consultation and determine if we are the right law firm for you.
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