Disability Insurance Claims
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If you have had your claim denied, or if your claim was granted and then later terminated, you may be eligible for substantial additional benefits.
What is It?
Disability insurance is insurance that will insure you from physical injury preventing you from working. There are two important components to this type of insurance. First, is the type of injury which they are insuring. Secondly, is the employability of the injury. Let’s discuss each.
These policies generally insure a person from either accidental injury or injury due to a sickness. So generally any type of physical injury is covered as long as it was not the result of your personally hurting yourself.
The next important component is how this injury affects your ability to work. Most policies insure a person from injury or sickness for the first 12 or 24 months if the injury or sickness keeps them from doing their own job. So if you are a brick layer and hurt your back, you can’t do your job, so the insurance company will have to pay you your monthly benefit for the maximum benefit period – 12 to 24 months while you cannot work.
After this 12 or 24 months of not being able to do your job, most policies then state that after this period you must be disabled from doing ANY job. So if you can’t do your own job, then you get benefits for 12 to 24 months. When that time runs, you have to prove that your injury keeps you from doing any job. This is called the “any occupation” clause.
Disability insurance can be a very good thing to have. Although, you have to understand if your policy has an “any occupation” clause, this seriously limits your benefits and makes your burden of proof in trying to get the benefits much harder. One important point worth mentioning is that if you are injured in a work related accident most disability policies will not cover you. So if you have a work related injury that is preventing you from doing your job, then you must file this under your employer’s workers compensation policy. Your disability policy will most likely not cover this event.
Where to Look?
If you purchased this policy on your own and can’t find it contact your agent or the insurance company. By law, if you request your policy, they must give you another copy. If you got this insurance through your employer and can’t find your policy, then ask management to give you a copy. Again, by law they have to provide you with a copy. If your employer supplied your disability policy then the law requires that your employer help you get the benefits offered. Another important point is that many disability policies have serious limitations on conditions that are considered forms of mental illness. Often these are depression and general psychological problems. Read and be aware of all these limitations before you make your claim.
What do I do if I have a claim?
First, your claim must be the type of claim covered. You must read your disability coverage language very carefully. Many policies define what will be a disabling injury or sickness under the policy. Once you fully understand what coverage your policy provides, you are then ready to make your claim. Remember, if you make a claim and have not read your policy, you will probably do or say something that will hurt your claim.
Make sure that you have the type of disabling injury or sickness that you are required to have under your policy terms. Your policy will tell you the conditions not covered. Next, you will have to make a formal claim. Many companies require you to use special forms to make a claim. Call the claims number provided in your policy documents and ask that they send you any of the forms required. Once you receive these forms, take great care in completing them. Many times the insurance company will use these forms against you. Make sure you tell the truth. Also make sure your disability is what is covered in light of what the insurance company defines as a disabling injury or sickness. Make sure you use the correct forms and that you complete them, providing accurate information. Also, note that many companies require that these forms be submitted within a certain time frame. Look for these deadlines and do not let them expire. (Snooze you lose). Another thing you should do during the claims process is keep a journal. If you don’t write everything down you will never remember. This process will drag on for months, if not years. Do you think you will remember? You won’t! Write it down. Write down every rude comment made. Write down every time you call and leave a message for someone to call you back. This journal will be your best friend if you have to sue them, which you probably will.
All disability insurers will require that you get your doctor to complete forms answering questions about your conditions and your ability to do your job and others. This is very important to discuss with your doctor. You must make him understand that you apologize for any inconvenience but that without his help you and your family will not receive these much needed benefits. Be nice and appreciative – this will go a long way. These forms must be completed and the insurance company will ask for them on more than one occasion.