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How To Succeed When Filing a Long- Term Disability Insurance Claim

According to data from the US Bureau of Labor Statistics (BLS), 35% of civilian workers in the United States had access to long-term disability insurance coverage in the year 2020. Employees in higher-paying occupations were much more likely to enjoy and be offered this employment benefit.

While millions of Americans have disability insurance, only a small percentage will ever have to file a disability claim. If you’re unlucky enough to find yourself in this position, there are a number of important strategies that can help you minimize the risk of a wrongful claim delay or denial by your disability insurance provider.

Meeting Deadlines

Your insurance company will specify various deadlines you’ll need to meet as part of the claim process for your disability. The first will be the submission of your Notice of Claim, which usually comes 20 to 30 days after the initial onset of your disabling sickness or injury.

After that comes your Proof of Claim, or Proof of Loss, which is a detailed collection of documents containing information about your disability and your employment. Your Proof of Claim becomes due after the elimination or waiting period on your policy elapses. Elimination periods (the number of days after the onset of your disability that you must wait to start receiving monthly disability insurance benefits vary considerably from one policy to the next, so you should check your policy to see what deadline will apply in your case.

Missing a deadline can fatally damage your disability insurance claim, so be sure to record the relevant time frames carefully and submit all the required documentation with time to spare.

Collecting & Submitting All Relevant Evidence

Medical, occupational, financial, and other vocational evidence will be crucial to the success of your individual group or ERISA disability claim. Submitting all relevant records and reports as part of your initial filing will reduce the likelihood that you’ll have to do an appeal.

If you have an employer-sponsored (data) group long-term disability insurance policy, you will not have the chance to submit new evidence when you sue your insurer in federal court. Any relevant records or reports, as well as any case law you wish to use, must be included in your initial claim filing or your administrative appeal.

Making Your Case Subjectively

Objective evidence is not the only means you have of strengthening your disability insurance claim. A personal account of how your disabling condition has affected your ability to perform in the workplace is also important.

You should be able to describe in detail how your symptoms prevent you from doing the physical and cognitive requirements of your occupation. For example, if you suffer from chronic fatigue, are there particular activities that make you more tired than others? Is your fatigue mental or physical in nature or both? Do your symptoms get worse when you’re standing upright? Do you nap during the day because you don’t get refreshing sleep at night?

A description of how your individual symptoms affect your occupation is also vital. Continuing with the example of chronic fatigue, does your fatigue become unbearable after you work a certain number of hours? Are there certain essential tasks that are beyond your capabilities at any point in the working day?

The initial claim form may not give you much space to go into detail here. However, you can attach supplemental pages describing your symptoms and how they impact your working life. You should make a note of the attachment on the primary claim submission and always keep copies of all documents you send to the disability insurer.

Dealing With Insurance Company Interviews

Long-term disability insurers frequently request interviews with claimants, either over the phone or in person. There’s no need to be alarmed if this happens to you, but it is a good idea to prepare in advance so that you support your case during the conversation, rather than damaging it.

One tactic to watch out for here is broad questioning. Insurance companies like to phrase interview questions vaguely, inviting general, nonspecific answers. They can then interpret these answers in a way that supports the narrative they want to create.

You shouldn’t be dishonest during an interview, but you should remember that your insurer is likely trying to bait you into answering their questions in a way that will doom your claim. Don’t let them. Get help before you get interviewed.

Undergoing Independent Medical Examinations (IMEs)

Independent medical examinations have a somewhat misleading name. Your insurer gets to choose the physician you see for these examinations, so the examination isn’t truly “independent.” Physicians carrying out IMEs have a tendency to return diagnoses that discredit claims and play into the hands of insurers and lead to your denial.

However, an unfavorable IME report isn’t always decisive. If your legal team is able to make a strong enough case with other objective evidence and your own subjective explanation of your disability, along with negative information regarding the IME’s qualification, you can still collect on your long-term disability insurance claim.

Working With an Award-Winning National Long-Term Disability Insurance Law Firm

Many people wait until they receive an initial long-term disability insurance claim rejection to contact an attorney. While hiring a long-term disability lawyer at this point is indeed a good idea, you could save yourself a lot of hassle and maximize your chances of filing a successful claim by taking that step before you submit your claim.

As you can see from this guide, disability insurance claims are complex. Insurance companies add to this complexity deliberately as it increases the chances of you making a fatal mistake, allowing them to delay or deny your claim.

At DarrasLaw, we deal with confusing insurance claim documentation every day. If you let us handle the claim filing process on your behalf, you’ll stand a much better chance of securing monthly disability insurance benefits without going through an appeal process or a lawsuit. We can also help you prepare for an interview requested by your long-term disability insurance provider, guiding you through the questions you’re likely to face and minimizing the role nerves will play.

Contact us today to schedule a free initial policy or free claim analysis, or a free initial analysis of your potential appeal. If your ERISA group disability insurer has already denied your initial claim, it’s crucial that you return a comprehensive and timely administrative appeal.

DarrasLaw is Americas' most honored and decorated disability litigation firm in the country. Mr. Darras has seen more, evaluated more, litigated more, and resolved more individual and group long term disability and long-term care cases than any other lawyer in the United States.

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