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Disability Insurance Claims: The Basics of Filing a Claim

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Before filing a claim, search for the original disability insurance policy. If you cannot find it, ask the human resources department if it is a copy you received as an employee. This document explains your legal rights with the insurance company. It is the roadmap for a claim. Do not accept an updated or altered version.

Be prepared for an avalanche of paperwork. Get a copy of everything the insurance company gets: tests, records, reports, doctor’s notes, etc. Review and make a copy of everything sent to the insurance company. If you have any questions, ask. If you don’t get direct answers, keep asking or get a friend or professional involved on your behalf.

Tell your GP that you are about to file a claim. A doctor who has no experience with disability claims can ruin your claim. Make sure the doctor understands that the success or failure of your disability claim depends on their cooperation.

Medical records must show more than symptoms and a diagnosis. Occupational task restrictions and limitations that are a direct result of the disability must be documented. For example, a report cannot simply say that a dentist can no longer perform dentistry due to fibromyalgia. The report has to explain the tasks required to get the job done: standing for long periods of time, bending over patients, working with the hands while holding the head and neck in a particular position, maintaining concentration and levels of power for extended periods of time. It is not the diagnosis, but the restrictions and limitations caused by the condition that creates a disability.

Doctors are not insurance professionals, and unless they are experienced with the disability insurance claims process, they are unlikely to know how to properly document the diagnosis in a way that supports a claim.

The file that an insurance company uses to review claims are the files that are used to deny claims and fight claims in administrative hearings; therefore, consider each sheet of paper as something that could be used against you. Every medical report, every form, and every document must be treated as evidence in the courtroom.

But remember that each form is an opportunity to prove a legitimate claim. Be honest and truthful. If there are specific times during the day when you just can’t function, say so. Be specific about how many days a week you can go about your daily activities and how many days you can’t. If the forms are not long enough or if there is not enough space, make a note on the page that you are attaching pages that contain more information.

Keep a record of every contact with the insurance company. Document the dates of the conversations, the names of the representatives, and the details of the conversations. Send follow-up letters to confirm conversations and keep a copy of everything you send to the insurance company. Send all letters and any records by certified mail or express mail service that requires a signature. If you receive a follow-up letter from the insurance company to document the conversations, read it and, if they are not accurate, write to correct them.

Get all the help you need. If you can’t handle correspondence and phone calls, ask a trusted friend or hire a professional to help you. Tell the insurance company representative if someone else will be on a phone call and make sure the follow-up letters include this information.

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