Get Your Disability Application Approved

The application submitted for short or long term disability insurance benefits is the foundation of every claim. There are many traps in an application for disability benefits that can result in a claim denial or delay of benefits. It’s always easier and more affordable to do it right the first time rather than clean up a mistake further in the process. The disability company employees are trained to look for reasons to deny a disability claim.

Since our inception in 1979, our disability insurance lawyers have helped thousands of individuals nationwide to apply for disability benefits against every disability insurance company. We have helped people in every occupation and we encourage you to review the multiple videos below that explain what to expect in the application process. We have also included a few videos from our experience of helping hundreds of medical professionals and business owners to apply for either individual or business overhead disability benefits.

We File Applications For All Types of Disability Insurance Policies

Individual or Group Disability Insurance Policy

Whether you have an individual long-term disability policy that you purchased from an insurance agent or a group disability policy provided by your employer, the application process requires the same attention to detail.

An application for disability income benefits must contain specific information and be supported by the proper documentation. The application process involves a collaboration between the applicant, the treating physicians, possibly an accountant and any co-workers at the time the applicant became disabled. The disability application requires an applicant’s occupational duties to be specifically broken down into categories and the amount of time spent performing each duty must be established. The manner in which this is determined can make the difference between receiving total or only partial disability benefits. In order to verify occupational duties, an insurance company will want to analyze the applicant’s tax returns, pay-stubs, profit and loss statements, appointment books, monthly and annual CPT code production reports (physicians only) and any other documentation that shows the work the applicant has performed during the three years prior to filing a claim and the time period after filing a claim.

Next the insurance company will require the applicant’s treating physicians to submit Attending Physician Statements, which must state whether or not the applicant can perform either the duties of his or her occupation or in some instances, the duties of any other occupation. In addition, the insurance company will either call or meet with the treating physicians in order to discuss the applicant’s claim for disability benefits. We regularly consult with an applicant’s treating physician, so that the treating physician can properly evaluate an applicant’s restrictions and limitations in conjunction with the applicant’s daily occupational duties. In most cases, disability should not be addressed in a generic sense, but in relation to the applicants own occupation. Disability insurance claim examiners are trained to look for specific information in the medical records, and if information is missing they will rely on a lack of information to deny or delay claim approval.

While evaluating the applicant’s claim for benefits, the insurance company will usually send out a company field representative to interview the applicant and review any financial documentation in the applicant’s possession. Field representative interviews should never be conducted without the presence of an attorney. How you phrase a response will follow you throughout the claim’s process. In addition, the applicant may be required to appear for an independent medical examination (IME) and a functional capacity evaluation (FCE). In order to protect the rights of the applicant and ensure legitimate testing, we always recommend that these so-called independent medical exams are videotaped and a copy of the report is provided to the applicant upon completion.

Lastly, without the applicant’s knowledge or consent, the insurance company will usually have a private investigator follow the applicant and conduct video surveillance for several days. The insurance company will then send the video surveillance to the independent medical examiner or the claimant’s own doctors in order to determine if the observations in the video are consistent with the applicant’s stated inability to perform the duties of his or her pre-disability occupation. We always ask the insurance company for a copy of the surveillance video and to give the applicant’s treating physicians an opportunity to review the surveillance video before any claim decision is made.

The insurance companies are not entitled to every piece of information they request, and an applicant must be aware of the legal implications of every communication and document requested by the insurance carrier. Insurance companies have a lot of discretion under the terms of a disability insurance policy. They are required to focus on the limitations and restrictions which prevent an applicant from performing his or her occupational duties at the time the disability started. Determining the date of disability is often difficult, yet it must be selected in coordination with the supporting medical records. The playing field is not equal. Unfortunately, the insurance carrier is the wolf in sheep’s clothing.

If you are considering applying for benefits or are waiting for a decision, contact Attorneys Dell & Schaefer for a free evaluation of your claim for disability benefits.

Doctors, Dentists, and Chiropractors Disability Insurance Policy

Of all the occupations, doctors, dentists, and chiropractors undergo the highest level scrutiny when it comes to filing a claim for long term disability insurance benefits. The reason for the high level of scrutiny is often due to the broad scope of a physician’s occupational duties and the dollar amount of the claimant’s monthly disability benefit. Determining the date of disability and the occupational duties of the claimant at the time of disability is one of the most challenging aspects of a medical professional’s claim for disability benefits. In most disability claims, a doctor has a either a degenerative condition or a medical condition that they have been working with for several months or years. When a doctor finally reaches the point where he or she can no longer work, the disability carrier will often argue that the claimant is partially disabled and not totally disabled (see our video discussing residual disability). Some doctors are owners of their medical practice and can continue to earn income even if they stop practicing. In this situation, a disability carrier will attempt to argue that the claimant is partially or residually disabled as they were an office administrator as well as a doctor at the time of disability. Some doctors stop working or sell their practice and then seek disability benefits without first obtaining treating doctor medical support. Timing, medical documentation, occupational activity documentation and financial documentation are essential when it comes to filing a claim for long term disability benefits.

Our team of disability insurance lawyers has helped hundreds of surgeons, doctors, physicians, chiropractors, dentist, and nurses to collect long term disability insurance benefits. Our disability division was started by representing medical professionals. We have dealt with just about every disability application scenario imaginable and have experience with the disability insurance policies that have been sold by every disability insurance company and medical association. As a medical professional, you need to have a plan in place when it comes to filing a claim for disability insurance benefits. Doctors earn substantial income and in most cases the disability policy is a significant reduction in annual income. We understand that our client’s financial livelihood is dependent on the approval of long term disability benefits. We are committed to doing whatever it takes to make sure that our clients have the best possible chance of collecting benefits to which he or she is eligible for.

We encourage you to obtain a copy of your disability policy and contact us for a free consultation to discuss either your potential or current disability claim. Upon request we can provide you with the ability to speak with past clients in your similar occupation that have retained our law firm. We look forward to helping you.

Business Overhead Policy

We regularly represent individuals that have Business Overhead Expense disability policies, which are usually referred to as “BOE” policies. The challenging issues with collecting on a BOE is when a business is sold or shut down, the policy language may prohibit eligibility for benefits. All too often we receive calls from potential clients that have sold their business and now want to collect under their business overhead expense disability policy.

Throughout the years we have developed some unique and creative strategies that have allowed our clients to maximize the benefits of their BOE policy. Any business owner that is selling their business as a result of a long term disability should always consider how the BOE benefits will factor into the sale price of the business. For example, if the claimant has a building lease obligation of $5,000 a month for the next 12 months, the BOE may pay this lease so long as the claimant and the business remain liable for the lease payments. If the claimant owns the building that has the lease, then this could potentially be an additional $60,000 of disability income for the claimant.

Disability Buy-Out Policy

A disability buy-out policy is a type of long-term disability insurance which is purchased so that one business partner can buy out the disabled partner for his or her share of the company. These buy-out disability policies usually require the claimant to be totally disabled for at least 12 months. Furthermore these buy-out disability policies require the buy-out to take place in accordance with the buy-sell agreement that has been agreed upon between the partners.

We have represented multiple clients with buy-out disability policies and the common issues usually include:

1. The business drafted a buy-sell agreement a long-time ago and the agreement does not accurately reflect the current value of the business;
2. The business does not have a buy-sell agreement and can the business draft a new buy-sell agreement post the date of disability;
3. The disability company is claiming that the buy-sell agreement values the shares of the business at more than the fair market value and the disability company does not want to pay the full value of the buy-out policy; and
4. The amount of buy-out disability coverage is insufficient, but it is unclear whether the disabled partner must sell all of his or her shares in order to recover benefits under the buy-out policy language.

How Do We Help?

Whether you are a doctor, dentist, chiropractor, business owner, accountant, teacher, high level executive, engineer, manager, lawyer, financial planner, or a salesperson, you should not assume that you know how to apply for disability benefits. Our job in the application process is to make sure we submit a claim that puts you in the best possible position to receive a claim approval. Many people wrongfully think that the application for benefits will be as simple as the application that was completed to buy disability coverage. It’s far from simple unless you have suffered a catastrophic injury. The disability benefits application process is complex and most applicants applying for disability benefits do not realize the manner in which disability insurance companies scrutinize and investigate claims for disability insurance benefits.

Filing for disability requires a coordinated effort between your treating physicians, employer, accountant, past co-workers and family members. Once Attorneys Dell & Schaefer are representing you, all communications go through our office and you never need to worry about the disability insurance company contacting you or claiming that you did not send them requested information. Our disability attorneys will handle every aspect of the claim so that you can focus on taking care of yourself.

Doctor Support Is Key

The most important and first step for benefit approval is to have the support of your treating physicians. Please watch our video below about the importance of doctor support in obtaining disability insurance benefits.

Doctors are in business to treat patients and they are neither trained to deal with insurance companies nor do they often want to. Your doctors will be asked to submit an Attending Doctor Statement to your disability company and the manner in which this is completed will be essential in getting your claim approved. We always work with your doctor to get these claim forms completed. Additionally all of your medical records will be required to be submitted.

The manner in which your doctor documents your complaints and findings in your medical records are very important. The insurance companies will conduct a detailed review of your medical records and they will often cherry pick the information that is either not supportive or missing. If we don’t think the records provide enough support then we will work with you and your doctor to obtain the proper documentation needed to support the claim.

If you don’t have doctors that are willing to be involved with insurance company paperwork then we will work with you to find a doctor that can treat you and cooperate with the process to receive benefits.

Application Documents & “Your Occupation”

Every disability company has specific disability claim forms that they require to be completed in order to submit a claim for disability benefits. There are several important sections in these forms that will shape and establish the entire claim. For example, selecting the proper date of disability is critical, as the selection of an improper date could either result on claim denial or prevent a claimant from receiving certain benefits that may have been available.

In many disability policies the definition of “disability” during the first 12-24 months is defined as “the inability to perform the duties of your own occupation”. Disability companies are notorious for relying on their own opinion of how a claimant’s occupation is generally performed in the national economy. They also like to rely on an employer’s job description which we often find barely scratches the surface in describing the real job duties.

In all of our applications we draft personal occupational statements and we make sure that the disability company understands all of the requirements of your job on a daily and weekly basis. We further make them understand why your symptoms and limitations prevent you from doing your job. Disability companies prefer to ignore your job duties and classify your job as either sedentary, light duty or heavy duty. By doing this, they ignore your actual job duties, cognitive responsibilities and the requirement to be an employee that is required to show up to work 5 days a week for at least 8 hours a day.

The disability companies basically make the conclusion that if you can sit in a chair for more than 4 hours a day then you should be able to work as long as you can take some breaks. After handling thousands of disability applications we anticipate all of the disability company arguments and we know how to present your claim so that we can eliminate their typical nonsense reasons for denial. The second video above discusses a disability denial lawsuit in which a disability company’s denial was reversed for failure to evaluate the claim with the appropriate occupational duties.

Your Interview

Your disability policy usually gives the disability company the right to interview you and the right to have you examined by a doctor of their choice. The disability company will usually request this interview after they have completed your background check, reviewed your medical records, social media profile and possibly followed you around with video surveillance. These interviews, also known as field interviews, can be telephonic or in person. We never allow the insurance company to come to your home. We always attend and prepare you for this interview. In many cases we try to eliminate the interview and communicate on your behalf with the disability company. We have prepared a video which discusses what to expect at an insurance company interview.

Request For Medical Exam

Every disability insurance policy contains a clause that gives the insurance company the right to have a doctor of their choice examine you. The disability companies call these exams Independent Medical Exams (“IME”), but they are not independent and are often conducted by hired gun doctors that have previously performed numerous exams for the company.

We maintain portfolios on the hired gun doctors and we don’t allow our clients to see doctors that we know will deny a claim. Once we agree on a doctor that you can see, we will prepare you for the exam and we will often either video tape the exam or have a court reporter present. We always request a copy of the completed IME exam report so that we can review it with your treating doctors and submit a reply if necessary. Our video below discusses what you should expect at an IME exam and some tips about how to handle an IME exam.

Phone Call With Your Doctors

We have seen lots of applications for disability benefits denied because the insurance company attempts to reach out to your doctors and they either cannot speak with them or they do speak and the doctor is not prepared to address your claim. In order to protect our clients we always tell the insurance company that if they want to communicate or need anything from our client’s doctors, then they must contact our office and we will help them obtain what they need.

If the disability company wants to speak with your doctor, then we will prepare your doctor for the phone call and we will attend the phone call. Without preparation, most treating doctors don’t understand the language in a claimant’s disability policy and they are often caught off guard by the insurance company doctor or nurse that calls.

We regularly see insurance companies send summary letters to doctors following a phone call and the doctor’s office will wrongfully sign a letter that is inconsistent with what was said during the conversation. In many situations if an insurance company wants to speak with our client’s doctor, then we will ask for them to submit the questions in writing and we will contact the doctor to get them answered.

Beware of Third Party Administrators

It is a common practice in the disability insurance industry for a disability insurance company to hire a third-party company to administer claims for disability benefits. This means that a company different than the insurance company that sold the long-term disability policy will make the decision as to whether you are entitled to disability benefits.

For example, Disability Management Service, Inc. (“DMS”), states on their website that they are a full service third party administrator and consulting firm specializing in the management of individual and group disability claims. DMS further states:

“Disability benefit eligibility determinations are seldom black-and-white. Moreover, disability is rarely static in nature. People recover and return to work. Or, they remain disabled and adapt. Sometimes their conditions worsen.

DMS focuses on the importance of early and proactive involvement with every disability claim, using a team-oriented approach. DMS claim professionals often interact with treating medical providers, specialized clinical experts, medical consultants, vocational specialists, forensic accountants, investigation professionals and legal advisers to gain a comprehensive understanding of each claim. DMS has access to the expertise of a national network of Independent Medical Examination providers, Peer Review experts, and Functional Capacity Evaluation professionals who help in the assessment of impairment and its impact on the claimant’s capacity to work. Our thorough, objective process ensures that new claims receive a fair assessment of benefit eligibility and active claims are appropriately managed for the duration of the disability.”

Disability insurance companies will hire companies such as DMS, because the insurance company that sold the policy either does not have a claims handling department or they believe that it is cost effective to outsource the handling of the disability claim. We have handled numerous claims against companies such as DMS. It is important that a claimant understands that the goal of every disability claim examiner is to look at an application for disability benefits with a goal of returning the claimant to work and therefore denying benefits at some point. There are several third-party administration companies throughout the country. Recently we have represented clients in which the client had purchased a MetLife long-term disability policy, but Unum was hired to act as the third party administrator. Additionally, disability insurance companies such as Trustmark Insurance Company, are forming subsidiary companies (TrustmarkDisabilityAdvisors.com) in order to administer claims for other disability insurance companies. Attorneys Dell & Schaefer are available to answer any of your questions or concerns about the handling of your long-term disability claim.