Episode 1: Long-Term Disability Insurance Claims 101

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Insurance companies often dispute the claims made by their policyholders, making it difficult for the insured to get their payout. In the inaugural episode of The Insurance Lawyer, host Evan Schwartz discusses some of the basics of Long-Term Disability (LTD) claims and what you need to know when filing. Feel free to visit us at www.schlawpc.com for more information.

Podcast Show Notes

This episode covers the basics of long-term disability insurance for people who have it individually or through their employer, and what they should consider prior to filing a claim or while they are in the midst of a claim.

In order to understand how to prepare to file a claim, it is important to understand what the insurance companies are looking at when they are notified that someone intends to make a claim. First, the insurance company tries to get basic information from the insured to figure out why they are filing the claim. Then they enter the information into their system, assign a claim number and send out claim forms that must be filled out by the insured and by a doctor. This must be done in order for the insurance company to evaluate the merits of the claim and determining whether or not they will pay the long-term disability claim.

The first step the insurance company will do upon receiving the claim is look over the application that was filled out when you received your insurance policy. Then, they will try to determine if any of the information is untrue or misrepresented. Afterward, they will gather your medical records and financial information to decide if your claim is payable. They will also look for medical support for your claim, specifically the restrictions of your disabling condition. Finally, during the course of your claim, they will continue verification. Meaning, they will be surveilling the alleged disabled person to see if they are engaging in any activities that are inconsistent with the restrictions of their disability.

The early claims preparation is what you should be doing prior to submitting a claim, for example, knowing your insurance coverage and your disability insurance policy. Then you must recognize and understand the symptoms of your disability or diagnosis. This will help you understand what your limitations are in terms of your ability to work and will allow you to communicate it effectively to the insurance company. Or if you’re having difficulty finding a diagnosis, the least you can do is document your symptoms and how they affect you. This information can be useful in proving your long-term disability claim.

After recording your symptoms, you must have proper medical support, proper medical support is documentation from a doctor that supports that you’re limited and restricted from working in your occupation. Not any doctor, but the right doctor in the right discipline of medicine. This is crucial because insurance companies can push back your claim if they do not think the doctor is qualified in your condition’s area. Make sure your healthcare providers are on your team, not just with your treatment but with supporting your claim.

Once you have your healthcare providers on your side, the next step to filing a claim is Documented Deterioration. That means that when you go to see your healthcare provider and you tell them about your symptoms and your restrictions, they’re entering it into their records. This is important because when the insurance company receives your medical records, they will see your consistent reports of difficulties with your symptoms and how they are increasing, and your limitations are becoming greater. Your increasing amount of pain and restrictions is the reason why you stopped working, and the doctor documenting it will help you build a case for your long-term disability claim.

Takeaway

In order to properly file your long-term disability claim, it is critical that you prepare first. You prepare by knowing your insurance coverage and disability insurance policy, then you must be attentive to your symptoms and record them. Once your symptoms are recorded, report them to a doctor that focuses on that discipline of medicine and they will note them in their records. If this is done over time while your symptoms are becoming greater and your abilities are decreasing, this is documented deterioration which can be crucial in forming a case when filing for long-term disability insurance.

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