Disability Insurance Claims – Fundamentals of Making a Claim

Find the original disability policy before making a claim. If you cannot find it, ask the HR department if it is a copy that you received as an employee. This document explains your legal rights with the insurance company. It’s the roadmap for a claim. Do not accept an updated or modified version.

Be prepared for an avalanche of paperwork. Get a copy of everything the insurance company receives: exams, records, reports, doctor’s certificates, etc. Check and make a copy of everything that is sent to the insurance company. If you have questions, ask them. If you don’t get clear answers, keep asking or ask a friend or professional to join on your behalf.

Tell your primary care provider that you are about to file a claim. A doctor who has no experience with disability claims can screw up your claim. Make sure the doctor understands that the success or failure of your disability claim depends on their cooperation.

Medical records must show more than symptoms and a diagnosis. Limitations and restrictions on occupational duties that are a direct result of the disability must be documented. For example, a report cannot simply state that a dentist can no longer perform dental work due to fibromyalgia. The report should explain the tasks required to perform the job: standing for long periods of time, leaning over patients, working with the hands while holding the head and neck in a certain position, maintaining focus and energy levels for extended periods of time. It is not the diagnosis, but the limitations and limitations that the condition causes that cause disability.

Doctors are not insurance professionals, and unless they have experience with the disability insurance claim process, they are not likely to know how to properly document the diagnosis in a way that supports a claim.

The file an insurance company uses to review claims are the files used to deny claims and fight claims in administrative hearings – so think of every piece of paper as something that can be used against you. Every medical report, form and individual document must be treated as evidence in court.

But remember that every form is an opportunity to prove a legitimate claim. Be honest and truthful. If you have certain times of the day when you just can’t function, say so. Be specific about how many days a week you can do daily activities and how many you can’t. If the forms aren’t long enough, or if there isn’t enough space, note on the page that you’re adding pages with more information.

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Keep a record of all contact with the insurance company. Document call dates, rep names, and call details. Send follow-up letters to confirm the conversations and keep a copy of everything you send to the insurance company. Send all letters and any documents by certified mail or express mail that requires a signature. If you receive a follow-up letter from the insurance company to document conversations, read them and if they are incorrect, write back to correct them.

Get all the help you need. If you can’t manage correspondence and phone calls, ask a trusted friend or hire a professional to help you. Tell the insurance company representative if another person will be calling and make sure any follow-up letters include this information.