What is a Disability Insurance Claim?
A disability insurance claim is a request by a person to an insurance company for payment of disability benefits due to the person's inability to work because of a physical or mental impairment. These claims are submitted to insurance companies or employers.
Common types of disability claims include:
- Long-Term Disability Insurance: Offered by employers, this insurance provides income replacement when an individual is unable to work for an extended period due to a disability. The terms and coverage vary widely depending on the insurance policy.
- Short-Term Disability Insurance: Offered by employers, it replaces a portion of an employee's income when an employee has to take a leave of absence due to a medical condition. It can be used for a temporary period of time or can be the first step toward going out on disability long-term.
- Individual Disability Insurance: Purchased by a person from the insurance company, this type of insurance coverage is issued directly to the person. It often provides its own occupation coverage that protects people who are disabled from their occupation and provides a higher benefits amount than group disability insurance.
The process of filing a disability claim often involves providing detailed medical information and medical records, undergoing evaluations by healthcare professionals, and proving the extent of impairment and its impact on daily activities or work capacity.
Reasons for Disability Claim Denials
Each type of claim has specific eligibility criteria and procedures that applicants must follow to qualify for benefits.
Disability claims can be denied for several reasons, such as:
- Insufficient Medical Evidence: Lack of detailed or updated medical records, incomplete documentation of impairments, or failure to follow prescribed treatment can lead to denials. Clear evidence linking the disability to an inability to work is crucial.
- Failure to Meet Disability Insurance Policy Definition: Claims might be denied if the impairment doesn’t meet the definition of disability in the disability insurance policy. The definition typically requires you to be unable to work in your own job for at least the first 24 months of paid disability insurance benefits. After that, you have to be disabled from any occupation.
- Incomplete Application or Forms: Mistakes in filling out forms, missing deadlines, or not providing necessary information can result in denials. It's essential to complete all required paperwork accurately, thoroughly, and timely.
- Lack of Cooperation: Failing to attend medical evaluations or cooperate during the claim review process can result in a denial. Cooperation with your insurance company and providing the requested information is crucial.
- Limitations and Exclusions in Disability Insurance Policies: Disability insurance policies may contain limitations and exclusions that prevent an individual from qualifying for disability benefits, leading to a denial of the claim. Examples of this include pre-existing conditions and a limit of 24 months of payments for certain conditions, such as mental health disabilities.
Understanding these common reasons can help applicants better prepare their claims with the help of a trained disability claim attorney from Dabdoub Law Firm.
Insurance Company Tactics for Disability Claims
It is important to know what documents you are required to provide when filing for disability insurance coverage, as well as those that the disability insurance company is not entitled to. It is also important to properly complete and timely submit the forms insurance companies are allowed to receive.
Significant medical conditions and supporting Attending Physician Statements (APS) from doctors may not be enough to prove disability when submitting a claim. The disability insurance company’s hired doctors may contact your physicians directly, often in an attempt to convince them that you are not disabled or are able to return to work.
Sometimes, the insurance company will conduct surveillance video or online surveillance, such as social media and YouTube searches, in an attempt to find inconsistencies in your reported abilities.
Disability insurance companies will also use tactics to delay approving a claim, such as denying receiving requested medical records or other information. Another tactic to delay the claim review process is to take an extension of time, often without a valid reason.
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“They fought for me like I was family and never left my side even during the hard days.”- Tee
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“Excellent professional services from a law firm specializing in disability.”- Alberto
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“Eddie and the team are very responsive and take the time to explain the process well and guide clients through it all.”- Jimmy
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“What stood out the most for me was how caring he was during this difficult time in my life.”- Jesus
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“This is a law firm that cares about their clients’ interests and how they treat their clients.”- Tahara
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“Dabdoub Law Firm did everything they could to get me back on claim, and when that didn’t succeed, to get me the best outcome possible.”- Cindy
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“Eddie and his team at Dabdoub Law are knowledgeable, efficient, and empathetic.”- Brad
Do I Need an Attorney to Handle My Submission of a Disability Insurance Claim?
It is helpful and highly recommended to hire an attorney who can handle submitting your disability insurance claim because they have extensive experience dealing with insurance companies and understand what the disability insurance company needs.
A disability claim attorney can help by:
- Knowing how to complete disability claim forms.
- Reviewing Attending Physician Statements (APS) completed by the client’s doctors.
- Knowing what documents and information the insurance company is entitled to get.
- Knowing what not to send to an insurance company.
- Responding to requests for a so-called independent medical examination by an insurance company doctor.
An attorney specializing in disability insurance can manage the entire claim process with the insurance company and knows how to argue in support of disability to get the claim approved. You’ll find such attorneys at Dabdoub Law Firm, the law firm trusted by clients nationwide.
Are There Deadlines for a Disability Claim Decision?
Insurance companies have to approve or deny a disability claim by a certain deadline, but the deadline can vary based on the case and insurance type. Our long-term disability attorneys can explain which deadlines apply to your case and can use them to put maximum pressure on the insurance company to approve benefits without delay.
Common insurance claim deadlines that might apply to your case include:
- ERISA Short-Term and Long-Term Disability Claim Deadlines: In ERISA disability insurance claims, the insurers have 45 days after the short or long-term disability claim was submitted to make a decision. They can take up to 2 extensions of 30 days each for a total of 105 days to make a claim determination, either approving or denying the claim. These 30-day extensions are only allowed for “special circumstances.” This must be a situation that is out of the insurance company’s control.
- Individual Disability Deadlines: Unlike ERISA, there is no deadline set by a statute to decide individual disability insurance claims. However, insurance companies have a duty to pay a claim once sufficient proof of disability has been provided. Even if the insurance company wants more or different information, the claim must still be approved as soon as sufficient proof of disability is given.
Our Winning Strategy at Dabdoub Law Firm
An aggressive disability insurance attorney from Dabdoub Law Firm can closely watch the deadlines that apply to your case and take legal action should a timely decision not be made. As the first 45 days approach or as soon as proof of disability is sent, our disability attorneys pressure the insurance company to approve the claim and pay benefits. Should a decision not be timely made, we start preparing a lawsuit. We do not let insurers get away with unreasonable delays or try to use time to find a way to deny the claim. We know each insurance company’s review processes and tactics. Because of our expertise in long-term disability claims, we know how to use the law to our clients’ advantage and the strategies that work to get benefits approved.
We can assist you by providing many different legal services and benefits, such as:
- Expert Guidance: We provide expert advice and guidance throughout the entire disability claim process. Our team understands the complexities of disability law and stays updated on any changes or nuances in regulations.
- Application Preparation: We assist in preparing disability benefit applications, ensuring all necessary documentation is collected and completed accurately. This minimizes the chances of errors or omissions that could lead to claim denials.
- Medical Evidence Collection: We work with clients to gather comprehensive medical evidence to support their disability claims. This includes obtaining relevant medical records, opinions from healthcare professionals, and other pertinent documentation.
- Navigating Legal Complexities: Disability law can be intricate, and we use our expertise to navigate through these complexities. We interpret laws, regulations, and precedents to build strong cases for our clients.
- Communication and Follow-Ups: We handle all communication with the insurance company on behalf of our clients. This ensures that all inquiries, requests, and updates are appropriately addressed and responded to in a timely manner.
- Maximizing Benefits: Our goal is to maximize the benefits our clients receive. We strive to ensure they receive the full extent of benefits they are entitled to under disability law.
Call (800) 969-0488 today for a free initial case evaluation with a disability lawyer.
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