Disability Insurance Claims Law – How to Handle the Details

If you are filing a long term disability claim when you have been injured or become ill and cannot work, it is helpful to know that disability insurance is more complicated than most insurance. There are very strict rules that must be followed.

Be careful about time limitations and deadlines. In the policy it will say when a claim must be filed. Most policies have a 60 day filing window. Be sure to file paperwork ahead of deadlines, and sending all documents and records by overnight registered mail.

Keep your disability claim information private. Do not post details or comments or complaints on Facebook, LinkedIn, or any disability-related forums, bulletin boards, chat rooms, social networking sites, or other online places. It does not matter if you have just filed a claim or the insurance company has been paying your benefits for ten years – putting this information on the web could lead to your losing the benefits.

Insurance companies monitor social media for their claimants very carefully and more than one person has lost their benefits or had a judge render a different decision based on their online comments. If you are filing for a disability claim and post vacation photos that show you hiking in the mountains, the insurance companies will consider the photos evidence against your claim.

Once a claim is received by the disability insurance company, they will send you forms that are required to process the claim. Among them will be a claimant statement, attending physician statement, and authorization forms permitting access to health, financial and occupational materials from third parties.

Financial records are used to evaluate income, assets and earnings. This feels intrusive and prying but providing the information correctly is important. For salaried employees, tax returns and W2 earnings statements will be simple enough to provide. If you own a business or are a partner in a professional practice or another complex earnings situation, the request for financial records can be overwhelming. It is important to check the specific language of the policy to learn what the disability insurance company is entitled to – and what is none of their business. The policy is the contract that governs the entire process. If you are asked to provide something that is not included in the policy, 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 IME – Independent Medical Exam. Keep in mind that the doctor performing the examination is being paid by the insurance company. Disability insurance company doctors are not independent. Be careful! Disability claimants who believe they are speaking with a sympathetic doctor are always shocked when the doctor who seemed so nice reports that they are perfectly able to go to work. Many recent court decisions, including several in our own practice, have found it very clear that the medical exams paid for by the insurance companies are not independent. This inherent conflict of interest is something the courts are watching carefully.

The insurance company may NOT ask that a disability claimant undergo an invasive test or require claimants to travel a far distance to have an examination performed. The insurance company is obligated to schedule an IME within a reasonable distance from your home.

If you are ordered to take a Functional Capacity Evaluation (FCE), be careful. Read your policy closely 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 that you take it. The FCE is used to test maximum effort. If you do go for an FCE and are asked to do anything that you know you cannot do without pain or discomfort, say no and do not perform 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 to document what injuries you might have suffered from taking the test.