What You Should Know Before You Read:
- Individual Disability Insurance (IDI) policies are private insurance contracts purchased directly from an insurance company (usually through a broker), often by professionals or business owners seeking to protect their income.
- Filing an IDI claim requires careful attention to policy language and medical evidence.
- Mistakes or incomplete claim packets can lead to unnecessary delays, underpayment, or outright denial.
- Dabdoub Law Firm focuses exclusively on disability insurance claims, representing clients nationwide with a proven record of success in federal court.
Understanding Individual Disability Insurance Claims
Individual Disability Insurance (IDI) policies are designed to provide income protection when illness or injury prevents you from working. Because these are private policies, and not provided by an employer, they are governed by state law rather than federal ERISA law. The governing law gives claimants greater flexibility, but it also means insurers often conduct a more intensive review of each claim.
Whether you are a physician, dentist, or self-employed professional, you must properly prepare your disability insurance claim. The following five do’s and don’ts will help you protect your rights and strengthen your case.
1. Do Review Your Policy Thoroughly Before Filing
IDI policies vary widely, and understanding what yours covers is the first step to a successful claim. These policies often contain detailed definitions of “disability” and specific requirements for proof of loss as well as timing for submitting your claim.
Do:
- Review the policy’s definition of total and partial disability. Some policies provide benefits if you cannot perform your “own occupation,” while others require that you be disabled from your own occupation but not working in any occupation.
- Identify the elimination period and ongoing proof-of-loss requirements.
Do Not:
- Assume that all IDI policies operate the same way or that the insurer will explain everything to you. Your claim must meet the exact terms of your disability insurance policy - it is the governing document.
2. Do Provide Complete and Consistent Medical Evidence
Disability insurance claims fall squarely on the strength of the medical evidence. Without supporting medical evidence, your chance of approval is slim to none. .
Do:
- Obtain clear and detailed letters and questionnaires from your treating physicians describing how your condition prevents you from performing your job.
- Include any supporting test results, diagnostic imaging, or specialist evaluations where applicable.
Do Not:
- Submit medical evidence that is not relevant to your disabling condition or lacks details regarding your functionality. . Insurers will scrutinize your file for any signs that your condition does not meet the policy’s definition of disability.
3. Do Accurately Describe Your Occupation and Its Duties
Most IDI policies require you to be unable to work in your own occupation. Thus, it is imperative that the insurance company understand understand the full scope of your professional responsibilities to evaluate how your condition limits your ability to perform them.
Do:
- Provide a detailed description of your daily job functions, physical demands, and cognitive requirements.
- Include documentation such as contracts, job descriptions, billing statements, or CPT codes to support your occupational definition.
Do Not:
- Simplify or generalize your duties. For example, a surgeon and a general practitioner may both be “physicians,” but their functional requirements are very different. Precision helps ensure your claim is evaluated under the correct occupational standard.
4. Do Keep Records of Every Communication with the Insurer
IDI claims often involve extensive communication with claims representatives, nurse consultants, and medical examiners. Keeping a complete record of all correspondence protects you if the insurer later misrepresents what was said or agreed to.
Do:
- Keep copies of all letters, emails, and forms submitted.
- Document every phone call with dates, times, and the names of the individuals you spoke with.
Do Not:
- Rely on the insurance company to maintain accurate records on your behalf. Detailed documentation is one of the most effective ways to protect your rights.
5. Do Contact Dabdoub Law Firm
Individual Disability Insurance claims often involve complex policy interpretation and high-value benefits. Legal representation can help ensure your claim is presented clearly, accurately, and within the policy’s requirements.
Do:
- Consult Dabdoub Law Firm. We focus specifically on disability insurance claims and can help you navigate the complexities of the IDI application.
- Allow our expert team to review your policy, identify any potential issues, and guide you in preparing a complete submission.
Do Not:
- Wait until your claim is denied to seek help. Our attorneys can often prevent denial by ensuring that your initial filing is fully supported and compliant with policy language.
How Dabdoub Law Firm Can Help
Filing an Individual Disability Insurance claim requires careful preparation and a deep understanding of both the medical and contractual aspects of disability law. Dabdoub Law Firm represents professionals, executives, and business owners across the country in complex and high-value IDI claims.
We assist clients with:
- Filing an IDI claim when the insurer delays or disputes benefits.
- Appealing a wrongful denial or underpayment based on improper policy interpretation.
- Negotiating a lump-sum settlement when it serves the client’s financial and professional goals.
- Litigating claims in federal or state court when insurers fail to meet their contractual obligations.
Our firm has taken on every major insurance company and built a record of success in court. With a nationwide practice focused exclusively on disability and life insurance law, we combine legal precision with strategic advocacy to secure the benefits our clients deserve.