When you got your disability insurance policy, you were preparing yourself for the unexpected. You likely never expect to need to make a claim, but if you do, understanding the process can make the experience less stressful.
This process of filing a disability insurance claim is similar across all types of disability insurance: long-term, short-term, group, and business overhead insurance. In this post, we’ll break down the process of filing a disability claim, important considerations to keep in mind, and what to expect during this challenging time.
Eligibility: Your disability insurance policy’s definition of disability will help you understand your eligibility. “True own-occupation” is the recommended definition for physicians, meaning you would be considered disabled if you cannot work in your specialty, even if you’re making money at another job. Reviewing the terms of your policy will help you move on to the next steps in making a claim.
Initial Steps: The next step is notifying your insurance company. This can be done by phone, email or online, depending on your insurance provider. You will need to complete and submit an initial claim form, which will typically include your statement, details about your disability, and your medical history.
Evidence: A disability insurance claim requires medical evidence to substantiate your claim. Your claim will need to be backed up by medical records and a doctor’s statement of your condition. Substantial documentation of your condition and treatment will help the disability insurance process move forward more quickly.
Your employer will also need to make a statement, detailing how your condition is affecting you at work and the wages you have lost. If you’ve stopped working, they will also need to provide your last date at work.
Waiting Period: All disability insurance policies have what is called a waiting (or elimination) period, which is a specific period of time before benefits begin to be paid out. You are able, and encouraged, to start the claim process before your elimination period has ended in order to receive your benefits in a timely manner. If your claim is accepted before the elimination period has ended, you may need to wait a few more weeks to begin collecting your benefits.
Claim Review: Your insurance company will review your claim after it has been submitted to determine if it is covered under your policy. This review will include an assessment of your statements and records. This process can take between a few weeks to a month or more. They may ask for follow up documentation, and any forms should be filled out promptly to reduce delay.
Decision: If your disability claim is approved, then benefit payments will begin once the waiting period has ended. These payments will continue for as long as you are disabled, or as stated in your policy.
If your claim is denied, the insurance company will send you a letter detailing why. Some common reasons claims are denied include:
- Not meeting the definition of disability defined in your policy
- Insufficient documentation from your physician
- Your condition being excluded in your coverage (pre-existing conditions defined during the application process)
You have the right to appeal a denied claim. Your denial letter will include instructions on how, and the insurance company will likely request additional documentation to reconsider your claim.
Disability Insurance Awareness Month
May is Disability Insurance Awareness Month, and there is no better time to review your disability insurance coverage so you can be prepared in the event you need to file a claim. Physicians should have true own-occupation coverage that protects your specialty, high monthly benefits, and portable coverage that goes with you if you change jobs.
Contact me today for a no-cost quote or review of your coverage from a reputable, physician-dedicated insurance agent.