If you’re filing a long-term disability claim when you’ve been injured or become ill and can’t work, it’s helpful to know that disability insurance is more complicated than most insurance. There are very strict rules that must be followed.
Beware of time constraints and deadlines. It will say in the policy when a claim must be filed. Most policies have a 60-day filing window. Be sure to submit your paperwork before the deadlines and send all documents and records by certified mail the next day.
Keep your disability claim information private. Do not post details, comments or complaints on Facebook, LinkedIn or any disability-related forums, bulletin boards, chat rooms, social networking sites or other places online. It doesn’t matter if you just filed a claim or the insurance company has been paying your benefits for ten years, putting this information on the web could cause you to lose benefits.
Insurance companies monitor social media for their claimants very carefully and more than one person has lost their benefits or a judge has made a different decision based on their comments online. If you file a disability claim and post vacation photos that show you hiking in the mountains, insurance companies will consider the photos as evidence against your claim.
Once the disability insurance company receives a claim, they will send you the necessary forms to process the claim. These will include a statement from the claimant, statement from the treating physician, and authorization forms allowing access to third-party health, financial, and occupational materials.
Financial records are used to evaluate income, assets, and profits. This feels intrusive and praying, but providing the information correctly is important. For salaried employees, tax returns and W2 earnings statements will be fairly simple to provide. If you own a business or are a partner in a professional practice or other complex earnings situation, the request for financial records can be overwhelming. It is important to check the specific language of the policy so you know what the disability insurance company is entitled to and what is none of their business. The policy is the contract that governs the entire process. If you are asked to provide something that is not included in the policy, contact the insurance company to clarify and explain the request. Carefully document questions to minimize noncompliance issues.
Most disability policies require you to undergo an IME – Independent Medical Examination. Keep in mind that the doctor who performs the exam is paid by the insurance company. Disability insurance company doctors are not independent. Be careful! Disability claimants who think they are talking to a sympathetic doctor are always surprised when the doctor who seemed so friendly reports that they are perfectly fit to go to work. Many recent court decisions, including several in our own practice, have made it abundantly clear that medical exams paid for by insurance companies are not independent. This inherent conflict of interest is something that the courts are watching carefully.
The insurance company may NOT require a disability claimant to undergo an invasive test or require claimants to travel a long distance for an exam. The insurance company is required to schedule an IME within a reasonable distance from your home.
If you are ordered to take a Functional Capacity Evaluation (FCE), be careful. Read your policy carefully to determine whether or not it specifically requires you to take this test. If the FCE is not in the policy, the law does not require you to take it. The FCE is used to test maximum effort. If you choose an FCE and are asked to do something you know you can’t do without pain or discomfort, say no and don’t do the action. There is controversy surrounding this test and it can be dangerous. Document how you feel after the test, and if you can, see your doctor to make sure you document any injuries you may have sustained while taking the test.