The long-term disability claim process is often long and frustrating. Having to track down medical records and speak with insurance representatives can be tiresome, especially if you are dealing with the daily frustrations of your disability. You can help minimize your frustration by building a well-supported disability claim. Here, we share some tips to help you build a strong administrative claim file and avoid common pitfalls that can derail your case.
Trap #1: Failing to Review Your Application for Disability Insurance Coverage Before Applying for Benefits
Note: If you have an individual policy purchased directly from an insurance agent or broker, then this applies to you. This may not apply to claims under a group disability insurance policy.
Begin by contacting your agent, broker, or insurance company. Ask them to provide you with a copy of your insurance application. Once you have the application in your possession, carefully go through each response you provided in the application. Ensure that all your answers are accurate and complete.
You must fix any inaccuracies in your responses. Otherwise, an insurance company might attempt to cancel your policy by alleging that it was obtained through fraudulent misrepresentation. If your policy gets canceled on these grounds, the insurance company will not be liable to pay any claims under the policy. You must review your application and correct any errors to avoid such consequences.
Trap #2: Trusting That All Your Paperwork Has Been Received
Your insurer is not out to harm you intentionally, but sometimes things are misplaced. Always send documents through certified mail with return receipt and save copies. Don’t believe they will receive it just because you sent it in the mail – be sure to call and follow up that your documents were received. Record who you speak to, what date, and what time. If you miss a deadline, you could risk losing your case. Always verifying that your documents arrive on time is essential.
Trap #3: Believing That Your Claim is Different Compared to Others
Eight out of ten disability cases are denied on the first attempt. To the insurance company, you are just one of the many claims they work on at any given time. Not to say that they don’t care about what you are going through, but they are also trained to look for ways to deny your claim and save the insurance company money. They are not emotionally invested in your case the way that you are. By building a strong administrative file, you increase your chances of approval.
Trap #4: The Belief That All You Need is a Medical Opinion From Your Doctor
Misconceptions abound when it comes to obtaining long-term disability benefits. One prevalent misunderstanding is that a doctor’s note declaring you unfit for work automatically guarantees approval from the insurance company. Unfortunately, the reality is quite different. You must provide comprehensive medical information and demonstrate functional limitations that meet the definition of disability.
Understanding how your insurance company defines “disability” is crucial to the success of your claim. Every long-term disability policy defines “disability” differently. Generally, this definition consists of two categories: “own occupation,” which means being unable to perform your previous occupation, and “any occupation,” which indicates an inability to perform any occupation (as long as it meets certain requirements – which are also defined by the policy.)
Trap #5: Believing Your Policy Includes Coverage for Any Medical Condition
Your long-term disability policy may specifically exclude coverage for certain medical conditions. For example, medical impairments related to alcohol or substance abuse are typically excluded from coverage. Moreover, benefits for certain medical conditions such as depression, fibromyalgia, or chronic fatigue syndrome may only be payable for 24 months.
Trap #6: Believing That The Insurance Investigator is On Your Side
During a long-term disability case, it is common for the insurance investigator to request a “field interview.” First, they may call you to ask casual questions about your health and your daily life. Second, they will say that they need to have a face-to-face meeting to discuss how they are doing. Do not let the insurer fool you! They do not care about you. Field interviews are used to discredit claimants filing for disability. The insurer is looking for inconsistencies to prove to a judge that you are lying about your disability.
Trap #7: Not Expecting The Insurer to Conduct Surveillance
When applying for LTD benefits, it’s important to be aware that insurance companies may subject claimants to surveillance by private investigators. Following the instructions of your doctor is crucial since you never know who might observe you.
Social media is not exempt from scrutiny either, as insurance companies increasingly monitor claimants’ online activities. For instance, if your doctor advises against lifting heavy weights or bending, but the insurance adjuster finds pictures of you rock climbing or engaging in activities that contradict your claim, they may doubt the veracity of your pain level.
Trap #8: Failing to Apply for Social Security Disability Benefits (SSDI and/or SSI)
Most LTD policies require applicants to apply for Social Security Disability Insurance (SSDI) benefits. This is because insurance companies have the right to “offset” SSDI payments against the LTD benefits, reducing the monthly LTD payments equivalent to the monthly SSDI benefits. Consequently, the insurance company is vested in the approval of your Social Security disability claim. Failing to file a claim with the Social Security Administration could lead the insurer to terminate your claim for LTD benefits.
Trap #9: Not Continuing Medical Treatment
Most LTD policies require the continuous submission of updated proof of your disability. This could be as simple as providing current medical records, an annual or semi-annual re-certification by your doctor, or attending regular “independent medical examinations.”
One of the most common reasons for the termination of LTD benefits is the claimant’s failure to continue receiving regular medical treatment. Therefore, it’s essential to maintain ongoing medical visits, even if your doctor claims there’s nothing more they can do to improve your medical condition. Consistent medical treatment helps provide evidence that your condition remains severe enough to prevent you from working. If you stop seeking medical attention altogether, your insurance company might take this as an indication that your condition has improved.
Trap #10: Believing That You Cannot Afford an Attorney to Represent You With Your LTD Claim
The vast majority of LTD attorneys work on a contingency basis. Working on contingency means they do not get paid until you do. They don’t get paid if you do not win your case. They are vested in seeing you win and are trained to help you build a strong case.
Do You Need an Attorney?
Contact the Ortiz Law Firm at (888) 321-8131 for a free consultation. You can ask any question you would like, and our long-term disability attorney will help walk you through the process. There is no obligation to use our firm, but we would love to help you with your case.