Long term disability insurance is supposed to replace a portion of the insured’s income when he or she is unable to work. For many claimants, particularly those who have a policy as part of their employee benefits package, they may need to first file for short term disability benefits. Once those short term disability benefits are exhausted, a claim may be considered for long term disability insurance benefits.
For individual policy owners (those with coverage privately and not through their employer), there usually is no such requirement for short term disability insurance claims.
The claims process is the first place where inexperienced claimants find themselves tripped up by what many consider to be a deliberately difficult series of pitfalls and/or a process designed to develop evidence to deny or terminate a legitimate claim.
The most important thing to know is this: the primary treating physician and their medical records will be pored over and examined not by the kindly representative who answers the 1-800-phone for the insurance company, but by a claims examiner or a third-party company that is looking for reasons to deny the claim. It is critical to have the doctor be able to articulate how and why someone is disabled, and not just state that one cannot work.
Often, claims are snarled in this early process, when requests come for additional medical or financial information. How long it takes to resolve these requests depends on the nature of the disability, the monthly amount to be paid, and the age of the claimant.
It’s simple math. A high earning individual at age 40 represents a huge financial liability to the insurance company and typically these claims will receive more attention from the examiners than a middle or low income individual in their 60s.
When the claims process is concluded and benefit checks start to arrive, claimants usually breathe a sigh of relief. Unfortunately, there is no guarantee that once benefits are being paid that they will continue to be paid. EACH MONTH IS ITS OWN CLAIM FOR BENEFITS. PROOF OF LOSS MAY BE REQUIRED MONTHLY. Frankel & Newfield has represented many clients who were paid for months or years and suddenly, through no reason that they could understand, the long term disability insurance company terminated their claim.
If the claims process ends in a denial or termination, contacting an experienced disability insurance attorney is recommended. Many claimants try to handle an appeal themselves. Frankel & Newfield is often contacted by claimants who thought they could simply explain in more detail why they were unable to work and that would make the insurance company change its mind. Unfortunately, that’s not how it works.
Appealing a disability claim is a complex process. In addition, there are strict time limits and if deadlines are missed, it is possible that the claimant may permanently lose their legal right to appeal. Going it alone has significant risk to the success of the claim and the ability to pursue litigation, if necessary.
If you have questions about how long term disability insurance claims work, call our office today at 877- LTD-CLAIM (877-583-2524). Also, visit the testimonials page of our website to learn how we have helped so many men and women whose claims were delayed, denied and terminated.