While many insured’s believe that medical evidence of a disability is enough to obtain disability benefits from their disability insurance carrier, this unfortunately, is not the case. A successful disability insurance claim begins with the application process . The information contained within the application for benefits is essential, and if insufficient, can cause extensive delays in the approval of the claim or even a denial of the claim for benefits. The following case is typical of the delays and difficulties experienced by many of our clients who applied for disability benefits on their own.
Dr. Doe had back pain for the last few years, but continued working as a dentist, hoping that the pain would eventually diminish or resolve. Unfortunately, his pain continued to worsen and his daily office routine further aggravated the condition. Despite many months of conservative treatment, including medication, physical therapy and even trigger point injections, he found his ability to perform the duties of a dentist more and more difficult. Realizing his limitations made him a detriment not only to his own health but to that of his patients, he decided to stop working and apply for disability benefits. Dr. Doe had the support of his treating physician and felt quite confident that his disability insurance carrier would review the medical records, understand the duties of his occupation and pay benefits in a timely manner.
According to Dr. Does’ disability insurance policy, disability benefits will be paid if due to Sickness or Injury the Insured is unable to perform the substantial and material duties of his Own Occupation. As such, he contacted his carrier and after answering numerous questions by one of the insurance company representatives, he requested an application for benefits. Like many of our clients, what Dr. Doe did not realize was that the information conveyed during that initial phone call as well as on the application itself is an integral part of the claim and often used to delay payment or, where possible, deny the claim. After 6 months of ongoing requests for more and more information, challenges to his claim and numerous phone calls by the carrier, Dr. Doe contacted contact our law firm . We were able to get him on claim and secure his back benefits. However, had Dr. Doe better understood the application process and/or employed us from the beginning, he would have avoided many headaches and secured his benefits much more quickly.
Completing the application for disability insurance benefits is a confusing and time consuming process. It may, however, be the most important part of the claim for benefits. Claims analysts rely heavily on the information and documents submitted with the application, as well as upon the insured’s verbal responses to their many questions. Thus, in order to reduce the time taken by an insurance company to evaluate the claim and to improve the chances of a favorable determination, it is imperative that the application is properly completed and the claim sufficiently supported.
Conveying what seems like basic information, i.e., the duties of a dentist, if not described with adequate detail can cause problems, as the claims analyst will simplify those duties and rely on his or her own assumptions. It is also vital to provide evidence that those duties were actually performed and confirm that the insured was a hands-on, practicing dentist at the time of disability. Additional documentation showing proof of earnings and the status of your business must also be provided. The information contained within the medical records and the claim forms completed by the insured’s treating physician(s) are closely scrutinized by the carrier in an effort to confirm (or deny) your disability. The insured may also be asked to undergo an independent medical examination. Finally, it should be noted that the Insured is not necessarily required to provide the carrier with every piece of requested information.
With the proper understanding of the claims procedures, the application process can be fairly smooth and uneventful. If you are considering applying for disability benefits, have already submitted an application for benefits, or your claim for disability benefits has been denied, please feel free to contact our law firm for a free consultation regarding your claim for disability benefits.