Posted on Tuesday, December 16th, 2025 at 8:27 pm
When your doctor says you cannot work due to a disability, you expect your insurance company to honor that medical opinion. Unfortunately, insurance ignored my doctor disability claims happen every day. Insurance companies have financial incentives to deny claims, and they routinely disregard treating physicians’ statements in favor of their own hired medical reviewers. Understanding why this happens and what you can do about it is critical to protecting your benefits.
If you’re facing a denied claim or need help appealing an insurance company’s decision, Capitan Law fights to hold insurers accountable when they ignore medical evidence.
How Insurance Companies Justify Ignoring Your Doctor
Insurance companies don’t simply reject your doctor’s opinion outright. Instead, they use specific tactics and policy language to minimize or dismiss medical evidence. They may claim they need “objective evidence” rather than relying on your treating physician’s subjective assessment. They hire independent medical examiners (IMEs) who review only your paper records without ever examining you. They also use discretionary language in policies that gives them broad authority to make their own determinations about disability.
The Conflict of Interest Problem
Insurance companies profit when they deny claims. This creates an inherent conflict of interest—the same company paying your benefits also decides whether you deserve them. Your treating doctor has no financial stake in denying your claim; the insurance company does. This is why understanding how insurance companies operate is essential to protecting your rights.
Understanding RFC Forms and Functional Capacity Evaluations
An RFC (Residual Functional Capacity) form is a critical document that outlines your physical and mental limitations based on your medical condition. Your treating physician completes this form to document what you can and cannot do. However, insurance companies often misuse RFC information to argue you’re capable of work you actually cannot perform. Understanding the fine print in long-term disability insurance policies can help you identify these misinterpretations.
How Insurers Misinterpret RFC Results
Insurance companies frequently argue that an RFC supporting “sedentary work” means you can work any sedentary job. They ignore the specific limitations documented in the form, such as restrictions on sitting for extended periods, cognitive limitations, or pain-related restrictions. A functional capacity evaluation (FCE) tests your abilities in a standardized, comprehensive assessment (typically 4-8 hours, sometimes over multiple days), but it doesn’t capture how your condition affects you over time or account for “post-exertional malaise” (worsening symptoms after activity).
Insurers frequently misuse FCE results to argue claimants are more capable than they actually are, ignoring the limitations documented by treating physicians.
Why “Objective Evidence” Arguments Fail Disabled Workers
Insurance companies frequently deny claims by claiming there’s insufficient “objective evidence” of disability. This tactic particularly harms people with conditions like chronic pain, fibromyalgia, ME/CFS, and mental health disorders, conditions that don’t always show up on imaging or lab tests. Your doctor’s clinical assessment, medical records, and treatment history constitute valid evidence, even without objective test results.
Learn more about the role of medical evidence in a long-term disability claim and how to strengthen your case. The best ways to document your disability can make the difference between approval and denial.
Common Insurer Tactics That Ignore Medical Evidence
Insurance companies employ several strategies to dismiss your doctor’s opinion:
Cherry-picking medical records: They highlight statements supporting denial while ignoring evidence supporting your claim. This is a common reason disability claims get denied.
Requesting repetitive forms: They send endless requests for updated physician statements, hoping your doctor will eventually refuse or provide inconsistent information. Understanding what paperwork your doctor needs to provide can help you prepare.
Peer-to-peer calls: They arrange calls between their doctor and your physician, framing these as “collaborative” when they’re actually designed to pressure your doctor into agreeing with the denial. Learn more about when insurance companies use IMEs against you.
Hiring biased reviewers: Their selected IME doctors are biased toward finding claimants capable of work, frequently downplaying disability severity. The importance of vocational experts in long-term disability cases cannot be overstated.
Why Choose Capitan Law
At Capitan Law, we understand how insurance companies operate and the tactics they use to deny legitimate claims. Our team has fought these battles for years, helping disabled workers nationwide recover the benefits they deserve. We know that your doctor’s opinion matters, and we build strong cases that hold insurers accountable when they ignore medical evidence.
Learn more about our approach to long-term disability claims and how we help clients appeal denied benefits. We work on a contingency basis; you pay nothing unless we win your case. Contact Capitan Law today for a free consultation.
What You Can Do If Your Claim Was Denied
If your insurance company ignored your doctor’s opinion and denied your claim, you have options. First, gather all medical records and your doctor’s statements supporting disability. Request a detailed explanation from the insurance company about why they rejected your physician’s opinion.
File an appeal within the required timeframe (typically 180 days under ERISA). Consider hiring an experienced disability attorney who can challenge the insurer’s reasoning and present a compelling case for reconsideration.
Navigating the appeals process for denied LTD benefits requires expertise in ERISA regulations and insurance company tactics.
Frequently Asked Questions
Can an insurance company really ignore my doctor’s opinion?
Yes. Under ERISA and most disability policies, insurers have discretion to make their own determinations about disability, even when your doctor disagrees. This is why understanding the impact of ERISA on your claim is critical.
What is an RFC form, and why does it matter?
An RFC form documents your functional limitations. Insurers misuse it by arguing that you can perform sedentary work despite documented restrictions that make work impossible. Learning about residual disability benefits can help you understand how insurers evaluate your capacity to work.
What’s the difference between an RFC and a functional capacity evaluation?
An RFC is a form your doctor completes describing your limitations. An FCE is a standardized, comprehensive assessment by an evaluator that insurers use to argue you’re more capable than you actually are. Understanding functional capacity evaluations is essential for disability claimants.
How can I appeal if my claim was denied?
Appeal the denial with additional medical evidence, request the insurer’s reasoning in writing, and consider hiring a disability attorney to represent you. Learn about the appeals process for denied LTD benefits. Long-term disability appeal letter samples and guides can help you prepare your response.
What should I do if my doctor won’t complete disability paperwork?
Contact an attorney immediately. We can help you obtain statements from your doctor or work with specialists who will document your limitations. Understanding what happens when a doctor refuses to fill out disability forms can help you plan your next steps.
Take Action Today
Don’t accept a denial when your doctor says you’re disabled. Capitan Law fights insurance companies that ignore medical evidence. Call (267) 419-7888 for a free consultation to discuss your case.
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