Disability Insurance Claims: The Basics of Filing a Claim

Disability Insurance Claims: The Basics of Filing a Claim

Before filing a claim, look for the original disability insurance policy. If you can’t find it, ask your human resources department if it’s a copy you received as an employee. This document explains your legal rights with the insurance company. It is the roadmap for a claim. Do not accept an updated or altered version.

Be prepared for an avalanche of paperwork. Get a copy of everything the insurance company gets: tests, records, reports, doctor’s notes, etc. Review and make a copy of everything sent to the insurance company. If you have any questions, please ask. If you don’t get straight answers, keep asking or get a friend or professional involved on your behalf.

Tell your primary treating physician that you are about to file a claim. A doctor who is inexperienced with disability claims can screw up your claim. Make sure the doctor understands that the success or failure of your disability claim depends on her cooperation.

Medical records must demonstrate more than symptoms and a diagnosis. Restrictions and limitations of occupational duties that are a direct result of the disability must be documented. For example, a report cannot simply say that a dentist can no longer perform dentistry due to fibromyalgia. The report should explain the tasks required to perform the job: standing for long periods of time, bending over patients, working with the hands while holding the head and neck in a particular position, maintaining focus and levels of energy for long periods of time. It is not the diagnosis, but the restrictions and limitations caused by the condition that create a disability.

Physicians are not insurance professionals, and unless they are experienced with the disability insurance claims process, they are unlikely to know how to properly document a diagnosis in a way that supports a claim.

The file an insurance company uses to review claims are the files used to deny claims and to fight claims in administrative hearings, so consider each piece of paper as something that could be used against you. All medical reports, all forms, and all documents must be treated as evidence in the courtroom.

But remember that each form is an opportunity to prove a legitimate claim. Be honest and truthful. If there are particular times during the day when you just can’t function, say so. Be specific about how many days a week you can do daily activities and how many you can’t. If the forms are not long enough, or if there is not enough room, make a note on the page that you are attaching pages that contain more information.

Keep a record of every contact with the insurance company. Document the dates of the conversations, the name of the representatives and the details of the conversations. Send follow-up letters to confirm discussions and keep a copy of everything you send to the insurance company. Send all letters and any records by certified mail or express mail service that requires a signature. If you receive a follow-up letter from the insurance company to document the conversations, read it over and, if they are inaccurate, write them down to correct them.

Get the help you need. If you can’t handle mail and phone calls, consult a trusted friend or hire a professional to help you. Tell the insurance company representative if someone else will be on a phone call and make sure any follow-up letter includes this information.

Leave a Reply

Your email address will not be published. Required fields are marked *