It’s human nature for people to try and remain at work even when they find it harder and harder to do their jobs. I understand that. It’s very hard to give up a career that’s bought and paid for, or lose the only income that’s supporting your family. So, people wait and wait until they just can’t do it anymore, and then they stop working.
Insurance companies often wonder why insureds could work sick and disabled, with medical restrictions and limitations a month ago, but not now. It’s called the “what changed defense.” “You worked with those migraines for two years, but you can’t now? What changed?”
The best laid out disability claim is one where patient notes provide evidence of long-term treatment followed by recommendations to STOP WORKING when medical restrictions and limitations preclude work performance. The worst thing insureds can do is JUST STOP WORKING.These are people generally with wealthy IDI claims who think they have the right to take themselves out of work. Wrong. Only a physician can take someone out of work.
Another mistake is not filing a disability claim shortly after leaving work. It should be remembered that disability Plans and policies are “Income Replacement” policies and sooner or later “Income Lost” must be proved. It really doesn’t do any good at all to stop working, and then wait a long period of time before filing the claim. Connected to this thought is the idea that you have to wait until the Elimination Period is over before filing. NOT CORRECT. Usually, the EP of 90 or 180 days is more than enough time to put together a good application and benefits are due, say on the 91st day. Why wait?
There are responsibilities that insureds must pay attention to before filing a claim, though. Over the years insureds with IDI claims have come to me to file claims when the last five years of Federal Tax Returns have not yet been filed. These include tax returns for businesses. It is absolutely imperative that tax returns be up to date before filing disability claims. Of course, insurance companies will request them for many reasons, one of which is to prove “income lost”. I’m afraid insurers will not approve your claim without some kind of tax verification of occupation and income lost as a result of disability. So, keep those tax returns up to date.
One final mistake is to try and file a disability claim when there is no official diagnosis.A chiropractor once came to me with this dilemma. All of her objective tests came back normal, but due to chronic pain she was unable to work. I can assure you that if your doctors can’t identify your disease, or render a diagnosis, no insurance company will be able to pay you for it. In order to write medical restrictions and limitations, physician first need to have diagnostic data proving what you say you have. If there is no clear diagnosis, R&Ls are non-existent even though the patient is experiencing pain enough to cause cessation of work.
Bottom line, if you cannot continue working, file for disability, be able to prove a history of impairment, produce tax returns to verify “income lost”, and don’t wait to apply, file right away. These things alone will help you with your claim.”
