Disability happens.  If you thought about it, you may have purchased a short term or long-term disability policy, to help protect your income and your family’s lifestyle in the unfortunate and sometimes unlikely event that you become disabled during your work years.  Now the unthinkable has happened.  You have had an accident, or your doctor has told you that you should stop working, or you realize you cannot keep working due to a multitude of disabling medical conditions.  Now is the time to file your Disability Application, but what are you entitled to?

If you have purchased a long-term disability policy, either through your employer’s benefits or a private insurance policy, then you may have different types of protection and you need to know the difference because one thing you should know is that insurance companies usually will deny these claims, fight your claims, or stop your payments at some point because that is what insurance companies do.

WHAT KIND OF DISABILITY POLICY DO I HAVE AND WHY DOES IT MATTER?

You may have purchased your disability policy through your employer.  These policies are generally covered under Employee Benefits Laws, particularly the law known as Employee Retirement Security Income Act (ERSI), and there are significant limitations and issues related to these types of insurance policies.  However, you may also have purchased a private disability insurance policy known as an individual or private (ID) disability policy.  Either way, you have made a smart choice to have some type of income protection if you become disabled, but there are significant differences between these types of policies and you must understand what those differences are before you file a claim.

WHAT DO YOU NEED TO DO BEFORE YOU STOP WORKING?

Unless you have had a traumatic injury, you will oftentimes have time to consider that you may have to stop working and file for disability under your insurance policy.  Unfortunately, there is no uniform or standard disability policy.  Prior to stopping working or even applying for benefits, the first thing you should do is get a copy of your disability policy and read it cover to cover.  While some of the words seem familiar and seem to make sense, there are many traps that you need to understand before you stop working.  If you stop working on the wrong day, if you do not understand the limitations in your policy of the coverage, or how the other money you collect (i.e., Social Security, Workers’ Compensation or personal injury) could reduce your benefits, you could be in for a rude awakening.

WHAT MEDICAL CONDITIONS LET ME GET DISABILITY INSURANCE?

Your medical conditions, even if they are “disabling,” may not actually be covered by the policy that you have.  Some policies limit the period of time that you can get coverage, (as short as two years), for mental nervous conditions.  Some people have made applications where there are preexisting medical conditions that might be excluded, as a cause of disability.  Conditions like migraines, diagnoses like fibromyalgia, and other uncommon types of conditions may also be excluded.  It is essential that you understand any limitations on your coverage before you apply so that you can do so in the right way.

WHEN SHOULD I APPLY?

While this seems to be a simple question, it is not.  If you are unable to continue working or your physician has told you to stop working, then it is time to apply for benefits.  However, you could actually pick the wrong date to stop working, which can completely sink your claim for benefits.

WHAT INFORMATION DO I NEED TO FILE A CLAIM?

The disability claims process is all about paperwork, paperwork, paperwork.  Even in this day of electronic records, it is all about the paper.  This is supposedly designed to allow the disability insurance company to make the proper decision but is actually created to delay or even deny your claim.  Making sure that you gather the correct information, that your doctors provide the right type of medical reports, and that you provide the right type of supporting documentation, such as the proper financial or economic data, will make the difference between what you get, and when you get it, and even if you get long-term disability benefits.

But I paid premiums, I do not understand why the insurance company would like to deny my case.  This is a common statement I hear from applicants or people who have been denied.  The bottom line is that disability insurance companies are a business and they are in the business of denying claims and making money based on the premiums that they collected from you for so many years.  There are many loopholes and many dangers in these policies, and if you do not file in the proper way and follow the rules, you can make seemingly innocent but fatal mistakes in the application, which will completely undermine your ability to ever win your case.

HOW DOES A DISABILITY CARRIER DECIDE MY CASE AND HOW LONG WILL IT TAKE?

The disability insurance companies have sophisticated systems to evaluate and decide a disability claim, and they use a playbook that tells their examiners decisions to make, and how to make them, which definitely lean toward denying your claim.  The disability carriers will often play the ‘we need more information game’, which will delay your payments, and payments delayed are the equivalent of payments denied for many people who are suffering from wage loss as a result of disabilities.

WHY SHOULD YOU HAVE AN ATTORNEY HELP PREPARE YOUR INITIAL APPLICATION AFTER ALL THIS IS SUPPOSED TO BE A SIMPLE SYSTEM

Many people who have long-term disability insurance policies or personal individual disability policies believe that the form, usually a few pages, is fairly simple and should be easily filled out, and therefore benefits awarded.  However, as we have mentioned this is not as simple as it seems.  In fact, we deal with many professionals such as doctors, lawyers, accountants, and others with advanced degrees who purchase private disability policies to protect their income and lifestyle, yet the disability insurance companies regularly dispute the policyholder’s application, occupation, pre-disability income, limitations on the ability to perform the material, and substantial duties of your occupation, residual disability, and many other factors.  We often have discussions with potential clients who have filled out applications thinking it is simple and anyone can tell that they are disabled, yet they have done irreparable harm to their cases.  That is why it is important from the start to make sure your application is filled out properly, supported, and literally undeniable.