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May 2012 Archives

It is Critical to Have the Documents Governing a Benefits Claim Before Filing a Claim.

Whether you are insured under an individual insurance policy that you obtained on your own, or a participant under a group benefit plan that was provided to you as a benefit of your employment, it is critical to have a copy of the documents governing your benefits claim before contacting the insurance company or other administrator regarding your claim for benefits. The documents, whether individual insurance policy or group plan benefit documents, are legally significant and contain the terms by which your benefits claim should be reviewed and determined.

Important Information about Psychological, Mental/Nervous Disability Claims

Most employer sponsored group disability plans, and a very few individual disability insurance policies, limit the payment of disability benefits to 24 months if the disability is caused by a mental/nervous condition such as Fibromyalgia or Generalized Anxiety Disorder.

The Importance of Designating Someone to Receive Secondary Notice Under Your Long-Term Care Insurance Policy

Designating someone to receive secondary notice under your (or your loved one's) long-term care insurance policy could mean the difference between losing a valuable insurance benefit or keeping it in force. Some long-term care insurance policies and even some state statutes allow an insured the right to designate a third party to receive a copy of certain notices also sent to the insured. The importance of having such a proper designation on file with the insurance company cannot be understated.

The Pre-Existing Condition Provision in a Disability Insurance Policy

Most employer provided Long Term Disability policies and some individual disability insurance policies include an exclusion for disabilities caused by a pre-existing condition. Generally, a disability insurance pre-existing condition is defined as a mental or physical condition for which you become disabled within the first 12 months of coverage and that existed and for which you received treatment within the 3 to 12 month time period just prior to the date of coverage under the policy. The time periods, however, vary from policy to policy. The purpose of the pre-existing condition exclusion is to prevent individuals who have been insured for one year or less (in most cases) from receiving disability benefits for injuries they had prior to the start of the policy. As such, the disability insurance pre-existing condition may result in a denial of benefits. Most pre-existing condition provisions include two time periods: a "Look Back" period and a Pre-Existing Condition Waiting Period:

You could be severely damaging your disability insurance claim by phasing out your job duties or agreeing to a transition period before you officially stop working.

Often, after it becomes clear that an individual can no longer perform the duties of their occupation and must apply for disability benefits, they will attempt to work reduced hours and/or phase out their job prior to stopping work altogether. Usually, a claimant will not want to leave their company and co-workers short-handed or employers will request that the employee stay for a "transition" period. However, you could be severely damaging your disability insurance claim by phasing out your job duties or agreeing to a transition period before you officially stop working.

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