Disability Insurance Claim

Filing a disability claim might seem like an easy process, but it can quickly become a complex mess if you aren’t familiar with how it works. There are some basics to filing a disability insurance claim that a qualified attorney can help you with to ensure your application will meet all the requirements. 

  1. Read and Review Policy and Application Prior to Filing a Claim

Most policies have their own unique definition of what qualifies as a disability. You need to look at that definition to determine if you might qualify for benefits. 

You need to get your disability diagnosis in writing from your doctor, which you will need to submit to your insurance company. It can be easier to have your doctor send the diagnosis directly to your insurer but make sure you keep a copy for your records. Almost every policy will require that you are under a physician’s continued care to qualify for disability benefits. 

Go over your application answers thoroughly 

Make sure that the answers you provided will match the medical records that your insurance provider will have. If there are any discrepancies between your application and the medical records, you must provide a detailed explanation of why those discrepancies exist. Any inconsistency in your application and medical records can quickly become grounds for a denial of your claim. For example: if you left out information that your insurance agent stated wasn’t important, like a minor problem or condition that came up after submitting the application, you will need to have a solid explanation. 

An experienced attorney will go over your application and, if necessary, help you to craft any explanations for discrepancies that might exist. 

  1. Elimination Period

Most disability policies have what is referred to as an “elimination period” which requires you to be disabled for a predetermined period of time before being eligible to collect benefits. Elimination periods are similar to deductibles, with the more expensive policies having shorter elimination periods. 

  1. File Your Claim Promptly

Once it is confirmed by a doctor that you would qualify for disability benefits, you need to file your claim. Even though you would still have to wait out the elimination period, your insurance provider needs to be informed of your disability and intent to file for benefits. Insurance companies love to deny claims that were not filed in a timely manner, so make sure you have your claim filed as quickly as possible following your diagnosis. 

  1. Get All Communication in Writing

It’s fine to talk with your insurance adjuster about your claim, but you need a letter documenting the nature of the conversation and the name of the adjuster. Make sure that you send your intent to file a claim via certified mail and request a return receipt. That way you know the letter was received, which will give you protection in the future if the insurance company tries to say they never received notice of your claim or any other important information.

  1. Maintain Detailed Communication Records

Keep a claim journal of all your correspondence with your insurance company. Make sure to list the type of communication (phone, email, etc.), date, time, who you spoke with, and the nature of the communications. Be as detailed as possible with these records because it is very easy to forget key details that could make or break your disability claim. 

You have the right to record any conversations, meeting, or doctor visits scheduled by the insurance company. Make sure to notify the insurance adjuster in charge of your claim if this is something that you decide to do.

Frequently Asked Questions

What if I can be trained to do another job? Can I still collect benefits?

The short answer here is yes. Many policies cover you for your specific job title. These are called Own Occupation policies and they cover you for the job you are currently doing, even if you are qualified to work at a different position. 

For example: If your job requires you to be on your feet, and your disability prevents you from doing this, you could still work in a capacity that does not have that requirement. You would still be entitled to collect benefits since you can no longer complete the duties of the job for which you were insured. 

However, if you have Any Occupation policy, you might only be paid for a specific period of time. After that period of time is up, you are only entitled to continue to collect benefits if you are considered disabled for other available jobs. 

It is important that you understand the terms of your policy. You need to understand the definition of disability as per the policy and what qualifies as a disability in the state. An experienced attorney can help you to understand the limits of your policy and how they apply to state disability laws. 

Am I required to continue to pay my insurance premiums while I’m disabled?

Many policies have a clause that deals with waiving premiums when you become disabled. This is why is it very important to thoroughly read the terms and conditions of your policy. The last thing you want is for your policy to be canceled because of nonpayment of premiums. If you are unsure, continue to make payments. Your insurance company is required to refund any premiums that did not need to be paid while you are disabled. 

What if my insurance provider terminates my benefits?

If you are still in need of benefits, you need to get a letter from your doctor stating that you are still unable to return to work. Make sure that you request a written response from your insurance provider for your request to extend benefits. If your benefits are refused, you will need to contact a qualified attorney with experience dealing with insurance companies. 

How do I fill out the application?

Be as thorough as possible with your answers to the questions. This is especially important with questions that deal with the duties of your job. If your job description lists administrative work, but it is only 5% of your actual job, make sure to include this in the application. For any questions where you are not sure, list undetermined. It is always a good idea to hire an experienced attorney to help you with the thorough completion of the application. 

Will I be investigated?

The short answer here is yes. Most insurance companies are sensitive to disability cases and will try to get a video of you doing an activity that you claim you are unable to do because of your disability. Don’t be the individual caught playing golf while out on disability for a back injury. Focus on your rehabilitation while collecting disability benefits. 

Know your Rights

Remember to ask for help with anything that you don’t understand regarding your disability insurance claim. The only dumb question is the one you forgot to ask. Get a qualified law firm on your side to help you through the process. 

Contact us today for your free disability insurance claim evaluation.

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