If you’re suffering from a condition that makes it difficult for you to work, you may wonder, “Do I qualify for disability insurance benefits?” Many American workers are covered under either a group or individual policy, and these policies can pay out tens or even hundreds of thousands of dollars in benefits to those who are too injured or ill to work. But qualifying for disability insurance benefits can be a tricky process. Learn more about some of the key factors that go into a disability determination.
The Starting Point of a Disability Claim
Most disability claims stem from an illness or injury that prevents the claimant from effectively and adequately performing their job. But to be approved for disability benefits, the claimant will need to do more than show a doctor’s note – they’ll need to be able to provide medical records showing that these functional limits make full-time work impossible. The disability insurance claimant may also need to fight back against allegations that the complained-of injury or illness is a pre-existing condition.
Getting Your Disability Insurance Policy
If you have a group disability insurance policy through your employer, by law, your employer’s human resources (HR) department is required to provide you with a copy of your policy upon request. If you’re concerned about the potential of retaliation, you can always inform your HR personnel that your financial advisor, estate planner, or insurance agent asked you to gather copies of all your insurance policies to have on hand.
The disability insurance policy holds the key to your disability insurance claim. Each long term disability policy is a little different, so without having the policy itself on hand, it’s very hard to make any sweeping generalizations about whether a claimant will qualify or how much they can receive in benefits.
Pre-Existing Conditions and Disability Coverage
Each policy defines “pre-existing conditions” in its own way. Generally speaking, a pre-existing condition is anything that appears within a year or so into the new disability policy. For example, someone who seeks a disability determination for back pain just six months into a new job (and new disability policy) is far less likely to be approved than someone who seeks a disability determination after being covered for 10 years. The disability insurance carrier may go over the disability claimant’s medical records with a fine-toothed comb to see whether the claimant has previously visited a doctor for anything close to the complained-of condition.
Why Medical Support is So Important
Many disability claims are decided on a “dry record” – documents and legal briefs instead of witness testimony or closing statements. As a result, having thorough and consistent medical records is crucial to any long term disability claim. Claimants who haven’t secured the support of their doctor before filing a disability claim are unlikely to succeed, while those whose medical records lack detail may not be able to meet their burden of proof when it comes to establishing disability.
When to File for Disability Insurance Benefits
So many disabling conditions tend to be chronic, growing just a little worse each day. If you’re in this state of limbo, you may wonder about the best time to file for disability insurance benefits. Should you file now, or wait until you’re unable to hold down any job? The answer, as always, depends on your specific circumstances. But generally, the thicker your medical file and the more physician documentation you have, the better positioned you’ll be to receive long term disability benefits. If your file currently looks a little thin, a disability attorney can work with you to see what sort of documentation you’ll need to improve your odds of success.
A Successful Disability Claim Must Be Good on Paper
Most disability claims and appeals never see the inside of a courtroom – which means a judge will never be able to hear testimony about your claim or see firsthand the effects of your disability. Because your claim will be decided on a dry administrative record, having a claim that’s “good on paper” can minimize the risk of your claim being denied. If your claim has already been denied, consider it an opportunity to further build up your record by undergoing functional capacity tests or a vocational assessment.
If you’re wondering whether you qualify for disability insurance income benefits, or need some help with your disability insurance claim, our network of disability insurance attorneys can help. Contact Dell & Schaefer today for a free, no-obligation consultation about your case.