Submitting a claim to your long-term disability policy can be a complex process — one loaded with potential minefields. A missing medical record, a misinterpreted statement, even a missed deadline can cause your claim to be delayed or even denied, lengthening the amount of time you have to wait before you get the money you are entitled to as a policyholder.
The process of making a successful claim has many potential pitfalls, so it is often best to consult with an experienced attorney about your case before proceeding. It is crucial to make your doctor a part of your disability claim team, as his or her statements and findings can make a significant difference to the outcome of your claim.
Steps to an Effective Relationship
Failing to supply adequate evidence that you meet your policy’s definition of “disabled” is one of the top reasons insurance carriers deny claims. Your health care provider’s statements can be a major part of the evidence you submit, but you have to have a good working relationship with him or her and do your part to ensure everyone is on the same team.
- Ensure your doctor understands disability as defined by your policy. Every insurance policy is different, and each carrier may have a different definition of what it means to be disabled. For example, some policies define disability as being unable to perform one’s occupation at the time of disability, while others define disability as being unable to perform any occupational function. It is important you and your doctor understand the terms of your policy in order to make an appropriate assessment.
- Build a relationship with your doctor. The only way your doctor is going to be able to assess your well-being and your ability to work is if he or she sees you. Keeping your doctor’s appointments is vital; the longer a physician has been seeing you and the better he or she understands your condition, the more weight his or her statement will have with the insurer.
- Seek treatment before bringing up disability. If you are seeing a new physician, do not mention you are considering or making a disability claim until you have met with him or her a few times. Some doctors are reluctant to support a disability claim for a new patient because they have not yet had an opportunity to provide treatment or because they question the motivation.
- Be honest and detailed. Effectively communicating your symptoms and limitations to your doctor ensures everything will be accurately reflected in your records.
Avoid Common Mistakes
While your health care provider is an important part of your team when you make a disability insurance claim, it is possible to make mistakes that could negatively affect the outcome of your case. To avoid unnecessary delays or wrongful denials, remember a few important points.
Do not go “doctor shopping.” Submitting records from multiple doctors you only saw once or twice, without building any type of relationship is a red flag to some insurers. While you might need to see a different doctor than your usual primary care provider or specialist for evaluation and treatment, visiting multiple different doctors in order to find one that will give you the answers you want is not going to help your case.
Submit appropriate records. The insurance carrier will request copies of your medical records in order to evaluate your claim, but they do not need irrelevant or unrelated records. For example, if you are claiming disability due to a back injury, the insurance company does not need the records from a pregnancy if it is not related. The insurer will not sift through mountains of paperwork to determine what is relevant but will look at the claim as a whole. However, do not fail to submit records that might be relevant, even if you think they could harm your case. The carrier will notice the gap and ask for more documentation, thereby delaying your claim.
By making your physician a part of your team from the start rather than waiting until you request records and support for your claim, you increase the likelihood of a successful disability claim — or a favorable outcome should you need to pursue more substantial legal action down the road.
About the Author: Richard Quadrino is a successful attorney with many years of experience in litigation, class action lawsuits and denied insurance claims.