Disability Insurance Claims – Basics on Filing a Claim
Before filing a claim, find the original disability insurance policy. If you can’t find it, ask the HR department if it is a copy you received as an employee. This document explains your legal rights with the insurance company. It is the roadmap for a claim. Don’t accept an updated or altered version.
Be prepared for an avalanche of paperwork. Get a copy of everything that 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 questions, ask. If you don’t get straight answers, keep asking or have a friend or professional get involved on your behalf.
Tell your primary treating physician that you are about to file a claim. A doctor who does not have experience with disability claims can ruin your claim. Make sure the doctor understands that the success or failure of your disability claim depends on their 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 can’t simply say that a dentist can no longer perform dentistry because of fibromyalgia. The report has to explain the tasks required to perform the job: standing for long periods of time, leaning over patients, working with hands while holding head and neck at a particular position, and maintaining focus and energy levels over extended periods of time. It is not the diagnosis -but the restrictions and limitations that the condition causes that create a disability.
Doctors are not insurance professionals, and unless they have experience with the disability insurance claims process, it is not likely that they will know how to properly document the diagnosis in a way that will support a claim.
The file that an insurance company uses to review claims is the files used to deny claims and to fight claims in administrative hearings – so consider every piece of paper something that could be used against you. Every medical report, every form, and every single document must be treated as courtroom evidence.
But, remember that every form is an opportunity to prove a legitimate claim. Be honest and truthful. If there are particular times during the day when you simply cannot function, say so. Be specific about how many days a week you can conduct daily activities and how many you cannot. 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 containing more information.
Keep track of every contact with the insurance company. Document dates of conversations, name of representatives, and details of the conversations. Send follow-up letters to confirm the conversations and keep a copy of everything you send to the insurance company. Send all letters and any records by registered mail or express mail service that requires a signature. If you get a follow-up letter from the insurance company to document conversations, read it, and if they are not accurate, write back to correct them.
Get whatever help you need. If you can’t manage correspondence and phone calls, ask a trusted friend or hire a professional to help. Tell the insurance company representative if another person will be on a phone call, and make sure any follow-up letters include this information.
