Importance of getting the policy
The first that you need to do before you start the process of filing a claim is to get a copy of your long term disability (LTD) policy. How you get a copy of your policy will depend on the type of policy that you have: Individual or Group. If you have an individual policy, you will need to contact the long term disability company directly and ask for a copy. Be aware that some companies may charge you a fee. If you have a group policy through your employer, you will need to contact the administrator of the policy, usually the human resources department. They are required to provide you with a copy within 30 days of receiving the request. If possible, be sure to request a copy of your long term disability policy in writing as documentation for you to have in case your employer or LTD company gives you the runaround.
Reviewing the policy
The next step is to review your policy. LTD policies can be difficult to understand sometimes because they are filled with legal jargon but here are some things to look for. How does your LTD policy define “disability”? This will have a major impact on whether or not your claim will be approved. There are two broad categories: “Own occupation” and “any occupation”. Own-occupation is when you cannot work your regular job but might be able to work another job. Any-occupation is when you cannot work at all in any job. Any-occupation is typically harder to prove. What is the amount of benefits you can receive? Usually, this number is somewhere between 50-80% of your salary. If there an elimination period? LTD policies can carry a wait time between 30-365 days. How long will benefits last? This can be a very wide range; 2 years through retirement age.
Determining what you have to prove as part of your "Proof of Loss"
Proof of loss is evidence that you will have to submit to the insurance company to support your claim for long term disability insurance benefits. The requirements for the proof of loss statement will vary from policy to policy. You can find it in your policy under “Policy Definitions” or “How to Submit a Claim.” Some insurance companies will use terms like “Easy or quick” to give the insurer to the impression that the proof of loss policy form is something that can be quickly completed. This cannot be further from the truth. The proof of loss form is your official statement and evidence you provide to your insurance company. The information included must be complete and accurate.
Gathering evidence to support the claim
This is probably the most tedious process of filing a LTD claim. Gathering all the documents that will support your claim will take time.
- Copy of your LTD policy.
- Copies of all letters from your insurance company and you to the insurance company.
- Why you can not perform your job duties (this will require medical documentation).
- A list of all medical providers that you have seen for this condition and a letter from each provider stating that your condition prevents you from working.
- Letters that summarize all conversations (by phone or in person) between you and the insurance company representatives, nurses, doctors, and your employer. Send copies to all parties involved in the communication via certified mail as proof it was received.
- Keep everything chronological so that if your claim is denied you have a complete record of how your claim was handled.
- Proof of your monthly earnings.
- Proof that you are under the care of a physician for your condition.
- All medical documents from your physician regarding your condition including but not limited to your official medical file, lab reports, X-ray and MRI reports, physician notes, list of surgeries including surgical reports.
Harmful Elements on Your Application
Denied claims are usually because your claim did not provide sufficient evidence for approval. This is why it is so important to double check everything before you submit it. Did you provide the correct doctor’s names and addresses? Did you provide the correct dates of service? The majority of claims are denied due to simple mistakes that can lead to months of frustration for you. Some insurance companies will try to point out “bad facts” that are on your medical record. This could be drug abuse, alcoholism, working after you say your disability started, or a doctor notating that you are exaggerating your claim. If you feel that these bad facts are hurting you, contact the Ortiz Law Firm and let them help you.
Although based in Florida, the Ortiz Law Firm represents claimants across the United States. If you’d like to speak to one of our Pensacola Long-Term Disability Insurance Attorneys contact us at (888) 321-8131 to schedule a consultation. We can help you evaluate your claim to determine if you will be able to access Long-Term Disability Benefits and how to move forward with the process.