Submitting a Disability Insurance Claim

Starting the claims process for long term insurance income is fairly simple. Individual and group policies (in the Summary Plan Description, or SPD for short) both lay out who to notify: with an individual policy, contact your insurer; if a group plan, run to the HR department or employer. If you have misplaced your policy, call your insurance company for a copy. Read it carefully and educate yourself.

Start your long term disability insurance claim early, as time is not on your side. Most insurance policies have time limits within which you must notify the company. The longer you wait—perhaps to collect more information to support your claim—the more you risk a delay in review and payment in your mail box. (However, if you miss this time limit, many states require the insurer to prove prejudice caused by the late submission.)

You will then be provided with a number of forms to be completed and signed regarding the claim.

Completion of the Required Claim Forms

It is critically important that you complete or have completed all the claim forms provided, in as detailed a fashion as possible. Providing the insurance company with as much claim documentation as you can up front means the less they have to ask for later. Failure to do so will most likely result in the claim being denied for failure to provide proof of disability. Typically, these forms include the following:

  • A Disability Claim Form to be completed by you stating the reasons you are disabled and requiring identification of your treating physician(s).
  • An Attending Physician’s Statement to be completed by your treating physician stating the restrictions and limitations which prevent you from performing the material duties of your occupation, and the expected duration of your disability.
  • An Employer’s Statement to be completed by your employer stating your rate of pay and your job duties as of the time you ceased active employment.
  • An Authorization for Release of Medical Information allowing the insurer/claims administrator to obtain your medical records.

You will be expected to complete or arrange for the completion of these forms and to return them or have them returned to the insurer or claims administrator.

Additional Information To Build Your Case

The paperwork may not stop there, as often additional documentation is required to back up your claim, such as

  • Medical records from your physician that corroborate your diagnosis and disability.
  • Evidence that you have been approved for Social Security disability benefits including a Notice of Favorable Decision from the Social Security Administration or the decision of a Social Security Administrative Law Judge.
  • A detailed job description which describes the duties of your work, including the physical and mental demands of the position and the working hours required by your employer. Written statements from your boss are especially significant because they are direct proof of your inability to perform the job duties. If your boss has not provided a written job description, you may draft your own.
  • A letter from you which details the symptoms of the condition(s) upon which you are claiming disability and the impact of these symptoms on your ability to perform the duties of your job.
  • Letters from your family, co-workers, or friends describing their personal observations of your disabling symptoms and its affects on your life.

Because you have a limited time to submit your claim, it is not advisable to delay submission while you are preparing and collecting this additional information. If it is not readily available, you should submit the initial claim forms and then supplement the claim as the additional evidence is obtained. But, the sooner you can submit this information, the more advantageous it is for you as the insurer/claims administrator reviews your claim. In other words, the earlier the claims reviewer decides your claim is payable, the better for you.

Communication with the Claims Reviewer: Document, Document, Document!

Basically any time you communicate with the claims reviewer, keep notes of each time, date, the name and position of the reviewer. Follow up any phone conversation in writing. If you talk by telephone, you should confirm the important points of the call in writing. Also, if you receive a written confirmation from the claims reviewer that misstates the substance of the telephone call, immediately send a written correction of that misstatement. Send all written communications by certified mail, return receipt requested. In your correspondence you should specifically list, by name and date, all documents included. Your correspondence should be dated and reference the claim number assigned to the claim.