If you file a disability claim, you will need to provide your insurer with sufficient proof of loss before any benefits are payable. Therefore, it is critical to understand what exactly proof of loss in a disability insurance claim to be sure that you get the disability benefits to which you are entitled.
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Proof of Loss in a Disability Insurance Claim
Proof of loss refers to the information you must initially submit to your insurer in order to be approved for disability benefits. The disability claims procedure begins when a claimant submits their proof of loss to the insurer. Often, proof of loss will be specifically defined in your disability policy. But in general, it includes any combination of the following pieces of information:
- your initial disability benefit application forms,
- the date you first missed work due to your disability,
- a statement from your employer documenting your material job duties and earnings,
- a signed authorization permitting your insurer to obtain your medical records,
- a list of your treatment providers,
- a statement from your doctor(s) detailing why you are unable to work, and
- any medical records related to your disabling condition(s).
You will also likely need to submit proof that you are under the regular care of a physician, as well as a personal statement detailing in your own words why you are prevented from performing the duties of your regular occupation.
Ongoing Proof of Loss
Let’s assume you are approved for monthly disability benefit payments after submitting your initial application and sufficient proof of loss. Now what?
That is not the end of the road. Your entitlement to disability benefits is not automatically guaranteed through your policy’s maximum benefit period. Rather, your entitlement is established on a continuing basis. This means that you will need to provide ongoing proof of loss to your insurer periodically.
The frequency with which an insurer requests ongoing proof of loss can vary. Your insurer may request ongoing proof of loss every couple of months or so. Your insurer will request in writing what specific information it is looking for – this commonly includes updated medical records, claim forms, and updated statements from your doctor detailing why you remain unable to work due to your disabling conditions and resulting limitations.
Because most of the information needed to establish ongoing proof of loss will come from your doctor, it is crucial that you continue to regularly meet with your doctor and discuss your disability. You and your doctor should also be on the same page regarding your ongoing medical restrictions and the updated forms that your doctor is submitting to your insurer on your behalf.
Ultimately, you need to be sure that you provide any information that your insurer requests of you. A failure to do so may justify your insurer’s decision to terminate your otherwise meritorious claim.
Common Problems Involving Proof of Loss
There are a number of issues to look out for given the significance of providing your insurer with proof of loss. Perhaps the most obvious of these issues is the failure to submit proof of loss. Failure to provide proof of loss will likely result in the denial or termination of your disability claim.
Group and individual disability insurance policies often contain strict deadlines governing when a claim must be filed. Insurers typically require submission of proof of loss within 30 to 90 days after you cease working. Indeed, the State of Illinois adheres to strict notice requirements. Therefore, you must be mindful of your deadline.
Even if you submit your proof of loss within the proper timeframe, your insurer may still deem the proof insufficient. In this scenario, your insurer will likely document the specific information that it is looking for in order for you to perfect your proof of loss. You should provide that information to your insurer as promptly as possible.
If you have questions about proof of loss or are unsure whether you have provided sufficient proof of your disability to your insurer, you should contact our experienced benefits attorneys to help walk you through this process.