If you file a long-term disability claim when you have been injured or become ill and cannot work, it helps to know that disability insurance is more complicated than most insurance. There are very strict rules that must be followed.
Beware of time constraints and deadlines. It will say in the policy when to file a claim. Most policies have a 60-day filing window. Be sure to submit documentation before the deadlines and send all documents and records by certified mail the next day.
Keep your disability claim information private. Please do not post details, comments, or complaints on Facebook, LinkedIn, or forums, bulletin boards, chat rooms, social networking sites, or other disability-related online venues. It doesn’t matter if you just filed a claim or if the insurance company has been paying your benefits for ten years; putting this information on the web could cause you to lose the benefits.
Insurance companies monitor social media for their claimants very carefully and more than one person lost their benefits or a judge made a different decision based on their comments online. If you are filing a disability claim and you post vacation photos showing you hiking in the mountains, insurance companies will consider the photos as evidence against your claim.
Once the disability insurance company receives a claim, they will send you the necessary forms to process the claim. These will include a statement from the claimant, a statement from the treating physician, and authorization forms that allow access to third-party health, financial, and occupational materials.
Financial records are used to evaluate income, assets, and earnings. This feels intrusive and intrusive, but it is important to provide the information correctly. For salaried employees, tax returns and W2 earnings statements will be simple enough to provide. If you are a business owner or partner in a professional practice or other complex income situation, the request for financial records can be overwhelming. It is important to check the specific language of the policy to know what the disability insurance company is entitled to and what is not your concern. The policy is the contract that governs the entire 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. Carefully document questions to minimize non-compliance issues.
Most disability policies require you to undergo an independent medical examination (IME). Note that the insurance company pays the doctor who performs the exam. Doctors in disability insurance companies are not independent. Be careful! Disability applicants who think they are talking to an understanding doctor are always surprised when the doctor, who seemed so friendly, reports that they are perfectly qualified to go to work. Many recent court decisions, including several in our own practice, have made it very clear that medical exams paid for by insurance companies are not independent. This inherent conflict of interest is something the courts are watching closely.
The insurance company may NOT require a disability claimant to undergo an invasive test or require claimants to travel a long distance for an examination. The insurance company is required to schedule an IME at a reasonable distance from your home.
If you are ordered to perform a Functional Capacity Assessment (FCE), be careful. Please read your policy carefully to determine whether or not it specifically requires you 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 maximum effort. If you are going to have an FCE and you are asked to do something that you know you cannot do without pain or discomfort, say no and do not take the action. There is controversy surrounding this test and it can be dangerous. Document how you feel after the test and, if you can, go to the doctor to make sure you document any injuries you may have sustained during the test.