Techniques for Successfully Managing Your Claim and Receiving Benefits

You may feel relief once your claim for long-term disability (“LTD”) benefits are approved. It is a grueling process, and you finally see some light at the end of the tunnel. However, you are not done with providing information to your Disability Insurer. Most LTD policies state “disability benefits will be paid for as long as the claimant continues to meet the definition of disability under the policy.” What does that mean in a practical sense? It means the Disability Insurer can continue to review your claim “as often as reasonably necessary” to determine your continued entitlement to benefits. In this article, we discuss strategies to ease the Burden of Disability Insurance claim paperwork and limiting paperwork requests from your insurer.

What Information Can My Disability Insurer Request?

The information your insurer requests for a periodic review will be like what you provided during the application process. Most disability insurers requests include:

  • Updated medical records;
  • Attending Physician Statements from your treating physicians;
  • Request for signed authorizations to release information from your employer or treating physicians;
  • Tax information or documents;
  • Any information related to part-time work or income you are receiving from other sources (including pensions, 401k distributions, or Social Security disability benefits); and/or,
  • Work history or continued education obtained.

It is important that you comply with any requests for information and provide all medical records that support your ongoing claim for LTD benefits to your Disability Insurer. Unfortunately, this may include obtaining, which must be completed by your treating physician. It is common for treating physicians to get frustrated with the repetitive nature of these requests. Therefore, it may be helpful to bring a copy of the Attending Physician statement with you to your appointment and ask the physician to complete the form during your appointment. That way you can get the information you need, instead of continually trying to follow up with your physician from home.

Exactly How Often Is a “Reasonably Necessary” Review?

Well, that depends. In most claims, disability insurers will request updated documents for review on a monthly basis during the first twelve to twenty-four months of disability. The type of illness or injury that caused your disability can inform how often you receive requests for information. 

When a claimant is in the early stages of an illness or injury, generally they receive frequent care from a multitude of doctors to treat or stabilize their condition. Therefore, the disability insurer will probably send monthly requests for information in order to keep up with the multitude of records, new physicians, and any new surgery or treatment the claimant may receive. 

In addition, many policies change the definition of disability from being unable to perform the material and substantial duties of “your own” occupation to “any” occupation after twenty-four months of benefits have been paid. (Please note, this can vary widely from policy to policy, so check your LTD benefits plan for the specifics to your individual claim.) Therefore, monthly reviews are common until your disability insurer has determined that you will be unable to return to work in any capacity. 

After a time and depending on the illness or injury that caused your disability, the disability insurer may put your claim on a quarterly, semi-yearly, or yearly review basis. Generally, this occurs once your illness or injury has stabilized (with little to no improvement), and you are receiving treatment on a less frequent basis.

My Condition Is stable, but My Disability Insurer Continues to Request Monthly Reports.

Unfortunately, disability insurers are given quite a bit of latitude when reviewing a claim for ongoing benefits. However, after several months of providing the same documentation with little to no change in your condition, it is reasonable to ask your claim manager for more time between information requests. It may also be helpful to ask your treating physician to write a letter, providing an update on your condition, and offering an opinion as to your chance of improvement.

You Can Ease the Burden of Paperwork Requests From Your Insurer by Being Proactive and Organized

In conclusion, it is important to be proactive in managing the paperwork requirements of your disability insurance benefits claim. Keep track of deadlines and make sure to provide complete and accurate information when requested. If you feel that the frequency or scope of the insurer’s requests is excessive or unreasonable, consider seeking legal assistance to help negotiate a fair resolution. Remember, your goal is to receive the benefits you are entitled to under your policy, so it is worth the effort to ensure that your claim is properly documented and supported.

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