The long term disability claim process can be long and frustrating. Having to speak to doctors, lawyers, and insurance representatives can be tiresome, especially if you are dealing with the daily frustrations of your disability.
Developing and building a complete administrative file will help you build your long term disability case. We have some tips for you to help you avoid some common pitfalls that can derail your case as well as help you build a strong administrative file. Get approved by not falling into these ten traps:
Trap #1: Failing to Review Your Application for Disability Insurance Coverage Before Applying for Benefits
For some of you who have Long Term Disability benefits or Short Term Disability benefits as a fringe benefit with an employer, this article may not apply to you as you may not have filled out an application to purchase the insurance. However, for those of you that purchased an individual policy directly with an insurance agent/broker or insurance company, then this article directly applies to you.
Start with a call to your agent, broker, or insurance company. Request a copy of your application for insurance. Once you have your application in hand, review every answer you wrote in the application. Make sure every response is complete and accurate.
If one of your responses is inaccurate, the insurance company may try to cancel the policy by claiming the policy was based on a fraudulent misstatement. If the policy is canceled out, then the insurance company doesn’t have to pay a dime under the policy.
Trap #2: Trusting That All Your Paperwork Has Been Received
Although the insurance company is not out to harm you intentionally, sometimes things are misplaced. Always send documents through certified mail with return receipt and save copies. Don’t believe that if you send it in the mail, they will receive it. Be sure to call and follow up that your documents were received. Record who you speak to, what date and what time. If you miss a deadline, you could be in danger of losing your case, so it is essential always to verify that your documents arrived on time.
Trap #3: Believing That Your Claim is Different Compared to Others
Eight out of ten disability cases are denied on the first attempt. To the insurance company, you are just one of the many claims they are working on at any given time. Not to say that they don’t care about what you are going through, but they are also trained to look for ways to deny your claim and save the insurance company money. They are not emotionally invested in your case the way that you are. By building a strong administrative file, you increase your chances of approval.
Trap #4: The Belief That All You Need is a Medical Opinion From Your Doctor
There is a misconception that if your doctor writes a note and takes you out of work, then you must be disabled and that should be enough for the insurance company to approve your claim. Unfortunately, the system does not work like that. Proving that you are disabled enough to receive long term disability benefits involves providing complete medical information, prognosis, and functional limitations. A note from the doctor will not be enough. Read your policy to understand how your insurance company defines “disability.”
How Does Your LTD Policy Define the Term “Disability”?
Every long term disability policy has a definition of what “disability” means to the insurance company. They are usually “totally disabled” which means you can no longer work at all and “partially disabled” which means you can no longer work full time in your current job. It is also essential to know that your policy will outline precisely what they consider to be a disability, and your injury or illness must meet those minimum criteria to be eligible for benefits.
Trap #5: Believing Your Policy Includes Coverage for Any Medical Condition
Your long term disability policy may specifically exclude coverage for certain medical conditions. For example, medical impairments related to alcohol or substance abuse are typically excluded from coverage. Moreover, medical conditions that are based on subjective complaints rather than objective testing (such as depression, fibromyalgia, or chronic fatigue syndrome) may be limited to 24 months of benefits.
Trap #6: Believing That The Insurance Investigator is On Your Side
During a long term disability case, it is common for the insurance investigator to request a “field interview”. First, they will call you and ask you casual questions about your health and your daily life. Do not be fooled! They are not calling to check on you because they care. They are looking for inconsistencies in your story to prove to a judge that you are lying about your disability. Second, they will say that they need to have a face to face meeting to discuss how to are doing. This is called a field interview. Field Interviews are used to discredit claimants filing for disability.
Trap #7: Not Knowing You Could Be Under Surveillance
When filing for LTD benefits, you may be under surveillance. It’s not uncommon for insurance companies to have claimants put under scrutiny by a private investigator when applying for benefits. Always follow your doctor’s orders, you never know who is watching. This also goes for social media. More insurance companies are monitoring the social media activities of claimants. If you are not supposed to be lifting significant weight or bending, but the insurance company adjuster sees a picture of you rock climbing in the mountains or lifting your grandchild for a picture, the adjuster may assume you are not truthful about your pain level.
Trap #8: Believing You Do Not Have to Apply for Social Security Disability Benefits (SSDI and/or SSI)
Most LTD policies require the claimant to apply for Social Security Disability Insurance (SSDI) benefits. That’s because insurance companies are allowed to reduce your LTD payments by applying an “offset” of SSDI payments against the LTD benefits. In other words, the monthly LTD benefits will be reduced by the amount of monthly SSDI benefits. Because of this “offset” provision, the insurance company has an express interest in your Social Security disability claim being approved. Thus, if you fail to file a claim with the Social Security Administration, your LTD benefits could be terminated.
Trap #9: Failure to Continue Medical Treatment
LTD policies require you to submit continuously updated proof of your disability. You may satisfy this proof as easily as providing updated medical records. Or you may provide evidence of an annual or semi-annual re-certification by your doctor that you continue to be disabled. Or you may be required to attend regular “independent medical examinations”.
As you may surmise, one of the most common reasons LTD benefits are terminated is that the claimant failed to receive regular, ongoing medical treatment. That’s why you should continue to obtain medical treatment even if your doctor has told you there’s “nothing else” the doctor can do for you to improve your medical condition. Even if there is “nothing more” that can be done for you, you should continue to go to the doctor to produce the evidence that your condition continues to be so serious that you are disabled. If you completely stop going to see the doctor, your insurance company may interpret your lack of treatment as proof that your condition has improved.
Trap #10: Believing That You Cannot Afford an Attorney to Represent You With Your LTD Claim
The vast majority of LTD attorneys work on a contingency basis. Working on contingency means they do not get paid until you do. If you do not win your case, then they don’t get paid. They have a vested interest in seeing you win and are trained to help you build a strong case.
Some attorneys ask you to pay the fees for things like obtaining your medical records from your doctors, but they handle the legal case. An experienced attorney will know how to help you win if you have a case.
Do You Need an Attorney?
Contact the Ortiz Law Firm at (866) 853-4512 for a free consultation. You can ask any question that you would like, and our licensed attorney will help walk you through the process. There is no obligation to use our firm, but we would love to help you with your case.
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