Long Term Disability (LTD) coverage provides benefits to an individual when the person is disabled.
However, getting a claim from a long term disability insurance company may not always be straightforward. The reason is that all insurance companies treat each individual as distinctive and each situation as unique.
Therefore, the process of filing a claim must be done with utmost care.
A typical claim process consists of three basic steps:
- Completing the plan member’s statement
• Getting the doctor to complete the Attending Physician’s Statement
• Submitting or sending the LTD claim package
On receipt of the claim package, the long term disability insurance company will assess the information provided by the claimant with regard to:
- The medical information to assess the individual’s ability to carry on with his or her daily activities
• The demands of the occupation and the work environment
• How the illness is likely to affect the individual’s ability to perform the requirements of the occupation
The long term disability insurance company may also, as part of the review, contact the individual via telephone to ask further questions, if any. This also provides an opportunity to the individual to ask his or her queries regarding the claim.
It is in the interest of the claimant to answer all the questions in the forms to avoid either rejection or delay in getting the claims. It is also important that attending doctor’s statement must be complete with diagnosis and prognosis of the claimant’s condition.
The most disheartening situation for you as a claimant is when your claim is denied by the long-term disability company.
To get a fair idea, here is a list of the most common reasons for denial of claims:
- The attending doctor has not properly cooperated with you in filling out the “Attending Physician’s Statement”
• Your definition of disability does not agree with what is stipulated in the insurance company’s policy
• If the records show you have not being getting appropriate treatment either by not visiting your doctor regularly or otherwise
• There is no objective evidence to prove your disability. This could be in the form of absence of reports, such as a MRI, X-ray, or a CAT scan, to prove that your medical condition is restricting your daily activities
Another tricky issue is determining the date of disability. This is true especially for those claiming long-term disability for a chronic condition.
In a car accident or in the event of a stroke or a heart attack, it is easy to define a date from which a victim is disabled. However, for a chronic condition, there is no clear cut easy way to determine a date.
A good solution in such circumstances is to make a concerted effort by you as a claimant and your doctor to ensure that the medical records truly document your ongoing disability with evidence.
If a long term disability insurance company, even if it is private long term disability insurance, is dragging its feet for more than 90 days, you must contact a disability lawyer to represent you properly.
Disability lawyers, with their expertise, know best how to handle such cases in the best interest of claimants.