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.
Every disability insurance company sells their own version of a disability policy and we are familiar with all of them. Understanding the language in your disability policy is extremely important and we always recommend that you contact us for a free review of your disability policy. Below you can view videos, articles, resolved cases and claimant reviews about your specific disability insurance company.
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.
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.
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 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.
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.
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.
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.
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