When applying for disability insurance benefits it is extremely important that the application for benefits is properly completed and that there are no ambiguities that can be misrepresented or misinterpreted by the insurance carrier. The application is the insured’s opportunity to tell his or her story and provide detailed information about their medical condition, limitations, and inability to perform the duties of their occupation.
In many cases, a client contacts our firm after their application for disability benefits has been submitted and during what seems to be an unending evaluation process by the insurance company. The application responses very often did not provide sufficient detail or were unclear – providing the insurance company with the excuse to continuously ask for additional information and documentation. This, of course, prolongs the company’s need to make a decision and increases the chance that the insured will either give up or provide conflicting information that can be used to deny the claim or pay a reduced benefit (partial disability) when the insured is entitled to the full disability benefit.
Claims analysts rely heavily on the information and documents submitted with the application in conjunction with the insured’s responses to their many written and verbal 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 your occupation, if not described with sufficient detail and explanation allows the claims representative to “fill-in-the-blanks” with assumptions as to the minimal effort required to perform the job. The application process also provides the insured with the opportunity to explain what led up to their inability to work if they suffer from an illness or injury that progressed over time and how their symptoms and limitations prevent them from performing the duties of their occupation, or where appropriate, of any occupation. Additional documentation showing proof of earnings and the status of your business or position 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 be asked to undergo an independent medical examination and/or their physician may be contacted by the insurance company’s consulting physician. Making sure your physician is aware that you are seeking disability benefits, supports that decision, and understands the definition of disability is imperative. It is also not unusual for the insurance company to require the insured to appear at an in-person interview and answer even more questions. Finally, it should be noted that the Insured is not necessarily required to provide the carrier with every piece of requested information; but knowing what should and should not be included requires a solid understanding of the claims process.
No matter what stage of the disability process you are in – whether you need to apply for benefits, have already applied but are waiting for a determination, have been denied benefits, have been approved but are frustrated with the ongoing requests for information and proof of claim, wish to seek a lump sum buyout of your policy, or believe litigation is necessary, DI Law Group has extensive experience in each area and has handled thousands of disability claims with almost every disability carrier on the market. Please feel to contact our law firm for a free consultation regarding your claim for disability benefits. We will be happy to go over the details of your particular policy and insurance carrier.