5 Tips for Filing Disability Insurance Claims
Filing a disability insurance claim is significantly different from other types of injury claims. It is a request for income assistance when a mental or physical injury or sickness prevents you from resuming your normal occupation or finding work. The following is a short list of tips DarrasLaw tells our clients as they prepare to timely a disability insurance claim.
Be Your Own Investigator
Whether your injury or sickness occurred on the job or prior to your employment, you will need proper and thorough documentation. An injury report, chart notes documenting your medical visits, prescriptions, objective tests, MRI, X-ray, CT scans from your doctor or healthcare provider must be accessible when preparing your claim. Photograph or scan paper copies and save them to a cloud database or centralized location, arrange them all chronologically so your disabling problems are easy to follow.
Your employer may have sponsored a group disability plan that covers you. Get a copy of your policy or certificate and review it thoroughly to understand if your condition meets the insurer’s definition of “disability.” These can be confusing, so review it with your human resources officer, bring questions and take notes or contact an experienced disability lawyer for help.
You may also have purchased separate coverage directly from an insurance agent or broker, so be sure to contact your agency to confirm what you bought along with an explanation of all of the policy features, benefits, time deadlines and coverage provisions.
Understand Long-Term Disability vs. Short-Term Disability
When talking to an agent or your HR manager, establish whether you have long-term or short-term disability coverage, or hopefully, both. Short-term policies often have a brief waiting period before they provide benefits, which is shorter than that of long-term disability policies. For example, there could be a 14-day period after an injury or illness for short-term disability and 180 days before you acrue benefits for long-term disability.
Long-term disability policies usually have a wait of 90 days to 180 days, but we have seen that period last up to 720 days (or two years). They are also more costly, but you get what you pay for; long-term disability policies can protect your income and wellbeing for decades.
Avoid Fatal Claim Form Mistakes
Though the short-term and long-term claims processes are essentially the same, you still need to be equally thorough when completing your claim forms, and your doctor needs to be thorough and concise on their attending physician statements.
Statements from the claimant (you), your employer, and the attending physician are needed, and you will have to sign the Authorization to Obtain and Disclose Information enclosed in the claim packet. Your doctor must complete the insurance company’s Attending Physician’s Statement form and if financial information regarding hourly wage or salary is requested, supply it.
The documentation you secured from Tip #1 comes in handy here, as it will support your claim that you are unable to work. These are just the basics, though, and remember to complete the form to the best of your ability.
And though we always advise clients to be completely honest, we also tell them to…
Prepare for a Denial
An injury or sickness–even one thoroughly documented–will not automatically qualify you for disability insurance benefits. An insurer will usually send a denial by mail. There are several reasons why your claim may be denied, from a late proof of loss or erroneous claim information to failing an independent medical exam or even because you revealed or were too active on social media.
Remember, just because you were denied does not mean the denial was legally correct. You can request reconsideration in an individual case or engage counsel to do your appeal with group coverage. You must act quickly and have comprehensive, thorough and compelling supporting evidence to back your claim. Visit the DarrasLaw blog for other reasons claims are often denied.
Find the Right Disability Lawyer
A general practice attorney should not handle cases involving individual or group disability benefits. Disability insurance law is extremely complicated and few attorneys find national success in this specialized field. A disability insurance lawyer will also be able to help you prepare for Social Security Disability filing, which will also almost certainly be a requirement in group cases.
These five tips are just a starting point because every disability claim situation has its unique complexities, which is why decisions should not be made lightly, including when you hire a lawyer. Be sure to hire a lawyer who focuses on individual and long-term disability insurance to handle your valid disability claim. Gather as much information and documentation as you can, collaborate and create a plan that will get you the benefits you deserve.
DarrasLaw can take care of your insurance claim so you can focus on managing your injury or illness. Call us today at 866-266-7186 or email us to schedule your free consultation.