Most insureds don’t really have a clue about how to go about filing a disability claim, or, at least filing one with the best chance of success. Not surprisingly, there are quite a few precursors to filing a claim that should be well thought out and prepared for.
First, except for a “catastrophic injury or sickness” disability doesn’t happen overnight.There is a usual pattern of what I call “disease progression documentation” meaning that individuals develop a pattern over time of treatment by one or more physicians for a disease that over time becomes chronic.
Most diseases do not immediately cause an individual to stop working. Employees generally try to remain at their jobs until it is impossible to perform them for financial reasons, so despite what the insurance industry says, there is no incentive for people to “hurry up” and declare themselves disabled.
Therefore, there should always be a history of medical treatment, which has worsened over time, to the point that the disease now precludes working. Due to better medical information we have these days, we now know that disease doesn’t happen in a day. Therefore, when a person decides to file for disability, there should at a minimum be at least 6 months to a year’s worth of patient notes showing a progression of, and treatment of, one or more diseases.
Applicants for disability MUST HAVE THE SUPPORT OF THEIR TREATING PHYSICIANS. I have often said, “no medical, no claim”. Physicians should agree to documenting a DATE OF DISABILITY and providing continuous support for filling out disability claims.
Those who have private policies (non-ERISA) often “just take themselves out of work”, go to a doctor, and file for disability. This is so wrong. Even when you have a private policy and are self-employed, you still need to show a history of medical treatment, and only file for disability when your treating physicians have documented “that you should stop working.” In addition, most private polices require proof that there is also a reduction of at least 20% in earnings in order to qualify for disability. Unfortunately, some of these finer points are overlooked.
Second, claimants and insureds need to have, or obtain, copies of their Plans and policies, have read them, and understood what the provisions mean. If you don’t do this, how can you defend, or prove your claim? You punt. Nope, that’s not good enough. You really need to know and understand what you are entitled to, what your obligations are under the contract, and what accountabilities the insurance company has towards you.
You should also have a general understanding of what ERISA, discretionary authority, own occupation vs. any occupation etc. means before you make out the application. In particular, all those with Employer ERISA Plans need to look carefully at the “offset provisions for SSDI, Workers’ Comp, and the 24 month limitation to benefits for mental and nervous illness. EVERYTHING WITH AN INSURANCE COMPANY IS HOW YOU POSITION YOUR DISABILITY TO YOUR OWN BENEFIT. You can be sure your insurer is doing everything they can to deny your claim, and you should be prepared with information to defend your Plan or policy.
Insurance companies DO NOT work on your timeline. Have an understanding what reasonable timelines are, and don’t force your expectations on the insurance company. They aren’t going to listen to you, but will instead, work at their own pace through their system of review.
Some companies require applicants to provide copies of their tax returns. In my opinion, in most circumstances those who are totally disabled, and not working, do NOT have an obligation to provide tax returns, although insurers insist they won’t move the claim forward until you provide them. This is probably a “fight you won’t win”, and most decide to send the returns anyway.
If you take anything from this post, I hope you understand that you cannot just take yourself out on disability – only a physician can do that. “Disability” usually occurs after a period of consultation, diagnosis, and treatment. (With the exception of heart attacks, accidents, and injuries.) You need to know what you’re doing and understand your Plan or policy perfectly.
Get help if you need it, and not necessarily from attorneys who aren’t skilled with the actual claims process. This may be a little hard to understand, but insurance companies react differently to the threat of litigation than they do to claims management, and it isn’t good. Attorneys aren’t the “know alls” of insurance; people actually in the business of insurance are the ones you want to get information from.
I hope this post will help you with your preparations to filing a disability claim.
If you are considering retaining help with your claim and would like more information, please feel free to give me a call to discuss at 1-207-793-4593, or contact me by email: lindanee.dcs@gmail.com.
You may also visit my website at:
http://www.disabilityclaimssolutions.com
I look forward to hearing from you.
