Disability Claims Solutions

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Big MistakeOne of the most common mistakes among IDI insureds is that they take themselves out of work on their own volition without having a documented treating physician’s buy-in. If this were possible most insureds with IDI policies could stop working whenever they wanted to, and for any reason. Insurers won’t allow that to happen.

I can almost understand why IDI insureds seem to think they have control when in fact they really don’t. Since these policies are underwritten separately and are bought and paid for by insureds themselves, it might seem reasonable that insureds believe they are in charge of the process. Think again.

All disability leave, both public (SSDI), and private, must be recommended by a treating physician who is qualified to treat the claimed impairement. This is an area in which quite a few doctors, dentists, and highly paid executives seem to get wrong. They leave work on their own say-so, and then a year, or many years later, want to claim disability going back to when they first left their jobs or businesses.

Or, self-employed insureds leave work with no medical certification, stay out for several years, and then decide to file for disability going all the way to when they first took themselves out of work. I can’t tell you how many times I’ve been contacted by IDI insureds with these same scenarios thinking they are owed several years of benefits when in reality they just “walked off the job”, or stopped doing it.

Let me say this again……disability claims require documentation from qualified physicians who are recommending patients not work and should seek disability. The DATE of the recommended “stop work” is documented in the patient notes and becomes the DATE OF DISABILITY.

A good definition of the date of disability for insureds might be, “the day after the last day worked coincidental with the first date of medical treatment by a physician who recommends and documents the patient should stop working.”

IDI insureds open themselves up to “late filing” and “prejudice” investigations when they have unauthorized non-working periods because there are no certifications, no patient notes from qualified physicians recommending total disability, reduction of hours or cesssation of certain job duties.

To make matters worse, IDI insureds engage in periods of “now I’m working, now I’m not, now I’m working, now I’m not…”, so much so that for each non-working period insurers will require treating physician medical impairment certification. Most IDI insureds can’t produce physician recommendations for each period of disability and therefore have to opt for more recent dates of disability.

The lesson here is that all periods of disability must be documented by qualified physicians BEFORE insureds stop working. No insured or claimant can “take themselves out of work” without a physician’s buy-in.

These mistakes can be costly to IDI insureds with significant benefits. Disability must be applied for promptly and with the official recommendation of a qualified physician. Medical recommendations to cease working should always be documented in patient notes.

IDI insureds cannot just stop working on their volition and expect to be paid benefits. There are process rules to filing for private disability and this is one of them. Only a treating physician can say you can’t work for disability purposes.

See also my post on November 20th on this same subject.