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The Disability Insurance Claims Process

February 1, 2015 Workers' Compensation

When workers become disabled for one reason or another, they are eligible to claim disability insurance benefits. Although legal provisions enable disabled workers to demand these benefits, actually procuring the benefits can be a long, complicated process. Some factors affecting disability claims procedures are the worker’s insurer, the policy terms, and whether the insurance was provided by an employer or not.

The disability insurance claims process

Disability Insurance

A disability can severely affect the earning capabilities of the victim or any human being for that matter.

Typically, when filing a claim, the policy holders are required to fill out the following information in a form:

  • Details of the injuries or disabilities preventing work
  • Previous work responsibilities
  • Last salary and benefits
  • Other personal financial information
  • Statement from policy holder’s doctor detailing injury with treatment plan

When the claim is submitted, a policy holder has to wait and watch whether the insurance company approves or denies the claim.

When the claim is denied

Disability insurers deny claims for many reasons, which may be:

  1. Specific types of illnesses are excluded from most insurance plans.
  2. Some policies have time limits for filing claims.
  3. The doctor’s statements are not conclusive.
  4. The supportive documents are not sufficient.

When a claim is denied, and the insurance policy comes from an employer, then federal law requires adherence to a strict administrative process for “appealing” before filing a lawsuit. In case of private insurance policies, the policy holders have the option to file a lawsuit or go through an administrative appeals process.

How to file an appeal

The appeals process involves following strict guidelines and deadlines. Failing to follow either can lead to a rejection of the appeal, and even the loss of opportunity for a lawsuit. The claims and appeals process can be tedious, but that may be the only option left to a policy holder to counter a denial of claims by the insurer. Deadlines are held sacred during an appeal, and any non-conformance to the deadlines can lead to a rejected appeal and a denied lawsuit.

How to file a lawsuit

The right to file a lawsuit will depend on how well the policy holder handled the appeals. The type and nature of the lawsuit will depend on:

  • Whether the policy is from an employer or personal
  • Whether the policy holder has selected a trial court
  • Whether the policy is governed by federal Law
  • How well the policy holder’s file is presented

The truth behind long-term disability claims    

Even when a policy holder wins an appeal or a lawsuit, he or she has to recheck the terms of long-term disability. In most cases, all insurance benefits stop after two years of continuous disability. Insurers do not provide long-term disability beyond two years. In many cases, policy holders can get a rude shock to learn that the disability terms in their policies have been changed or updated.