Submitting a Disability Claim
Careful Preparation in the Application Process is Key
Your Long Term Disability Application and all supporting evidence will be scrutinized by insurance claims personnel trained to find weaknesses that can be used to delay, deny or limit policy benefits. Careful preparation in the early stages of an STD/LTD claim is essential and can help avoid common mistakes.
We highly recommend obtaining competent legal counsel experienced in Long Term Disability and ERISA claims at the initial application stage. Obtaining experienced legal advice early in the process can help to overcome many of the bases the LTD carrier will employ to attempt to defeat the claim. How your application is prepared can make a tremendous difference in whether or not your claim is paid or how much is paid or how long the claim is paid. Experienced legal counsel will know what policy language to pay attention to and how to prepare the application to give you the best chance of approval early in the process.
Take your time and go through each step of the process slowly, and ask for guidance from experienced practitioners. Unfortunately, too many individual with legitimate disability claims and lawyers new to the litigation of LTD claims wait too long to seek advice from experienced legal counsel and the strengths and weaknesses in the initial application and appeals process can have a major impact on the outcome of a claim. For example, some policies pay more or pay longer for a disability that arises from an injury/accident verse a sickness; which can be tricky if the two converge at the time of disability; and some polices may strictly limit benefits for certain conditions
Examine and Decipher the Details of Your Disability Plan/Policy
Obtain a copy of your complete short-term and long-term disability plan/policy, and any other benefit plans you are covered under (medical & dental, life insurance, pension, etc?) and read the documents thoroughly before applying for benefits. If you purchased individual coverage, we recommend getting a copy of your policy from your agent and the insurance company. We also recommend asking your agent for a complete copy of the agent file before you apply. If your coverage is through an employer welfare benefit plan, the legally designated plan administrator must provide a copy of the plan document and Summary Plan Description (SPD) to you under ERISA within 30 days when it is requested in writing. Note: pamphlets that describe the benefits may not be the actually Plan or the SPD.
Your rights and obligations under your LTD or DI policy are governed by the terms of the agreement. Not all contracts are identical. For instance, there may be important differences in the definition of disability; the term of disability; whether there are limitations on disability caused by mental illness, etc…