Long Term Disability insurance pays monthly benefits to insured employees who become unable to perform the duties of their job for medical reasons. How you file a disability claim depends on the type of plan you have, as follows:
- If your policy is part of a group plan, you should contact your human resources manager to obtain a copy of your summary plan description and a disability claim application.
- If you purchased an individual disability policy, you should contact your broker or insurance agent for an application.
Under either scenario, you can always obtain the necessary paperwork directly from the insurance company.
Obtain and Read A Copy Of The Insurance Policy
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.
You May Need Help to Complete the Application
You will find that the application is very long and has numerous forms that must be filled out. The instructions can often be confusing to someone who is going through this process for the first time. Keep in mind that one wrong answer could mean that your claim will be denied. You should seriously consider seeking assistance from an experienced long term disability attorney in applying for your disability benefits.
Who Decides if I am Disabled?
This is an interesting question because most people assume that there’s someone like a doctor or an independent reviewer who’s going to decide their case, but that is not the case in almost every long term disability insurance case. The insurance adjuster is the one who decides whether they have to pay out on your case. Many individuals consider that to be a conflict of interest, because they may be biased against wanting their insurance company to pay out on your individual claim.
What Evidence is Used to Evaluate Your Claim?
There are several key pieces of evidence in a long term disability claim that will be reviewed by the insurance adjuster handling your case.
If you’d like some assistance in gathering together this evidence to support your case, then I encourage you to give us a call at (866) 853-4512 to discuss your case. If you’d like additional information about the long term disability process, then I encourage you to download a free copy of a book that I wrote called the Top Ten Mistakes That Will Destroy A Long Term Disability Claim. You can download a free copy here.