One of the most important things you absolutely must do during the claim process is obtain and read your insurance policy. This is so important that you really should obtain and read the policy before you even file your claim for benefits. I know this step may seem obvious, but many claimants immediately start complaining that the insurance company is breaching the insurance contract agreement when the claimant has no idea what the contract even says.
Your first thought may be that you have no idea how to obtain the insurance policy.
If you purchased a private individual disability insurance policy, then your insurance agent should have provided you with a copy of the policy when you bought the policy. If, however, you have misplaced the policy, you should call your agent and request a replacement copy of the policy. You may have to pay an administrative fee to obtain the replacement. Don’t be cheap and quibble about paying the fee. Just pay the fee and obtain the policy. It spells out all your rights.
If you obtained the insurance policy through an employer as a group plan benefit, then you should request a copy of the policy from your employer. With bigger companies, you typically do this through your human resources department. Here’s an extra tip: request a copy of both the Summary Plan Description and the full insurance policy agreement. The federal regulations that apply to employer-sponsored benefits, the Employee Retirement Income Security Act (ERISA) requires that these documents must be provided to you upon your written request. In fact, the failure to produce such documents may result in penalties by the insurer.
Once you obtain a copy of your insurance policy (and Summary Plan Description, where applicable), you must read them from beginning to end. Disability insurance contracts are constantly changing language. You must be familiar with the policy language in your policy. Remember to include the policy amendments and endorsements in your review. These can have an important impact on your claim as well.
You must read the policy in order to determine what you must prove to receive ongoing benefits. For example, it is critical to know the definition of the term “disability” as it is used in your policy. Under many policies, the definition of “disability” changes after 24 months. You must know whether such a change takes place in your policy. If it does, you must understand the definition to understand what you must prove after two years to continue receiving benefits under the policy.
Because reading the policy and understanding it may be confusing to someone who does not read insurance contracts on a regular basis, you should consider hiring an attorney experienced in reading such contracts to assist you in your claim.