Presenting/Filing a Disability Insurance Claim
The Claim Form
Fill out the claim form carefully and accurately. Do not provide answers that can be interpreted incorrectly. For example, if the form asks you to list your job duties, make sure you list all of the important ones, not just some of them.
You will be asked to provide physician statements. Before having any doctor submit such a statements make sure he or she understands the definition of disability in your policy. Some doctors assume that Total Disability means that a patient is incapable of doing any kind of productive work. Under an own-occupation policy it does not mean that. Be certain that your doctors know what your work duties are and why you cannot perform them.
Also, make sure your doctors are prepared to identify what the objective evidence of your disability is. Even though the subject of “objective evidence” is seldom mentioned in a disability policy, most insurance companies consider it to be important to their claims investigation process.
Objective evidence of a disability might include such things as X-rays, MRIs, blood tests, biopsy’s, measurements indicating atrophy, visual confirmation and other means that can be physically seen. Pain for which there is no objective evidence, may be considered a “subjective” complaint. And even though the latter are equally disabling and equally qualifying for benefits, most insurers will require something more than subjective complaints before being willing to pay. Find out all the facts that provide verification of your complaints.
The Insurance Adjuster
Once you file a disability insurance claim, an adjuster will be assigned to gather facts on your case – your medical records, information about your employment situation or business and so on.
The adjuster you will be dealing with is unlikely to have substantial authority to make final decisions on your claim. Instead he/she will probably be reporting to a claims supervisor or manager. That person will be making the important decisions.
You should obtain the adjuster’s name, address, phone numbers, and email address and those of his or her immediate supervisor(s) or manager(s). Save these for your records.
You should, of course, cooperate fully with the claims adjuster. Since your goal is to move things long quickly, you should do whatever you can to accomplish this. Try to obtain all the information the company asks for and to provide it promptly. Otherwise unnecessary delays can occur. If you are asked for things you think may be unnecessarily intrusive, such as copies of income tax forms, you should seek advice as to whether or not the company is entitled to such things under the insurance regulations of your state and the facts of your particular claim.
Next: The Claim Process