The application process is generally quite simple. First, you must notify your insurance company or your Human Resources department of your claim. You will then be asked to complete a claim form and to sign a medical authorization form so that the insurance carrier may request copies of your medical records directly from any doctors who have treated you for your conditions. Your doctor will also need to fill out a form certifying that you are unable to return to work because of your medical conditions. Lastly, your employer must complete a form providing the insurance company with your position and salary information so that they may properly calculate your monthly benefit payment.
As part of their investigation, the insurance company may also send you to one of their doctors to examine you in order to determine if you are able to return to work or send you to a functional capacity evaluation to assess your physical capabilities.
If your claim is approved, your long term disability policy typically will pay you 60% of your wages while you are disabled, depending on the specific terms of your policy. Your insurance company will require periodic updates on your condition, from both you and your physicians, to verify that your disabling condition is ongoing. In some instances, the insurance company may hire an investigator to conduct surveillance of your activities while you are away from your job and possibly conduct an internet search to uncover your volunteer or social activities.
If your claim for benefits is denied, there are options available to you if you do not agree with the insurance company’s decision. This will depend on your policy, but typically you will have the opportunity to file an appeal, usually within 180 days of the denial. During the appeal process, you will be able to submit further medical evidence of your disability. This is one reason why it is important to continue treating with your doctor while you are off of work.
In a perfect world, your long term disability insurance carrier will pay your claim until you are well enough to return to work or until your maximum coverage age of 65 if you are deemed totally disabled and cannot return to work. However, if your claim is denied, please contact the O’Ryan Law Firm to see if we can assist you in convincing the insurance company to properly pay your disability benefits.