Disability Insurance Claims Act – How to deal with the details

If you’re filing a long-term disability claim when you’ve been injured or taken ill and can’t work, it’s helpful to know that disability insurance is more complicated than most insurance plans. There are very strict rules that must be followed.

Be careful of time constraints and deadlines. The policy states when a claim must be made. Most policies have a retention period of 60 days. Make sure to submit the paperwork before the deadlines and send all documents and details overnight by registered post.

Keep your disability claim information private. Do not post details or comments or complaints on Facebook, LinkedIn or other forums, message boards, chat rooms, social networking sites or other online places related to disability. It doesn’t matter if you just filed a claim or if the insurance company has been paying your benefits for ten years – if you post this information on the internet, you could lose your benefit.

Insurance companies keep a close eye on social media for their plaintiffs, and more than one person has lost their benefits or had a judge rule differently based on their online comments. If you file a disability claim and post vacation photos of you hiking in the mountains, the insurance companies will consider the photos as evidence against your claim.

Once a claim is received by the disability insurance company, they will send you forms needed to process the claim. They include a statement from the plaintiff, a statement from an attending physician, and authorization forms that allow access to third-party health, financial, and occupational materials.

Financial data is used to evaluate income, assets and earnings. This feels intrusive and nosy, but providing the information correctly is important. For salaried employees, tax returns and W2 payroll statements will be easy enough to provide. If you own a business or are a partner in a professional practice or have another complex earnings situation, requesting financial records can be overwhelming. It’s important to check the specific language of the policy to find out what the disability insurance company is entitled to — and what is none of their business. The policy is the contract that governs the whole process. If you are asked to provide something that is not included in the policy, please contact the insurance company to clarify and explain the request. Document questions carefully to minimize non-compliance issues.

Most disability policies require you to undergo an IME – independent medical examination. Keep in mind that the doctor who performs the examination is paid by the insurance company. AOV doctors are not independent. Be careful! Disabled people who think they are talking to a sympathetic doctor are always shocked when the doctor who seemed so nice reports that they are perfectly capable of going to work. Many recent court decisions, including some in our own practice, have made it very clear that the medical exams paid for by the insurance companies are not independent. This inherent conflict of interest is something that the courts are watching closely.

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The insurance company may NOT request that a disability applicant undergo an invasive test or require applicants to travel far to have an examination performed. The insurance company is required to schedule an IME within a reasonable distance of your home.

If you are instructed to take a Functional Capacity Evaluation (FCE), be careful. Please read your policy carefully to determine whether or not you specifically need to take this test. If the FCE is not in the policy, the law does not require you to take it. The FCE is used to test maximal effort. If you go for an FCE and are asked to do something you know you can’t do without pain or discomfort, say no and don’t take the action. There is controversy surrounding this test and it can be dangerous. Document how you feel after the test and, if possible, go to the doctor to document any injuries you may have sustained while taking the test.