We often get questions from people who have called or e-mailed us to take advantage of our free consultations that prompt great discussions of issues common in many disability claims. Some of these wouldn’t justify an entire blog post, so we’ve decided to put together a “mailbag” of some of our recent questions. If you have more questions, you can visit our FAQ page or contact our offices.
I was diagnosed with depression 18 months ago but didn’t file a claim for benefits from my DI policy because I did not even consider my insurance policy or possible deadlines due to my mental state. Now I see that my policy has a 12-month limit on how far back the insurance company will consider. Have I waited too long or can I still get my claim approved? – D.K., Texas
This is a very common question. Many people are unaware of deadlines when they become diagnosed with a disability, especially one that puts you in a “brain fog” like depression. Many disability policies have a 12 month limit for prior benefits, but this limit has become more of a soft deadline, subject to appeal or negotiation. There have been several recent court decisions that have made insurance companies take longer periods of time into account if medical records and other evidence of the occupation and disability are still available, especially in mental health claims. This is another reason why it is important to keep detailed medical records of any and all doctor visits and treatments you’ve received. If you’re self-employed, keep your business records, including calendars or planners. It’s important to remember that benefits can only go as far back as the evidence supports, so always keep the records showing your appropriate care and treatment for any condition that you may eventually realize is disabling. Also, this is not limited to only mental and nervous claims – many other types of disabilities can also result in late notice claims. A reasonable explanation and clear evidence is the best way to ensure your claim will be approved and your prior benefits paid.
Recently, I have been unable to perform my job like I used to. I’m working fewer hours and I’m struggling even doing that. I am in constant back pain and my employer has hired someone to help do the work I was once able to complete. My job duties and performance have declined, and I am afraid of losing my job. Am I eligible for LTD? – A.M., Florida
Emphatically….maybe. It’s important to be diagnosed with your disability as early as possible, although as our last question shows, it’s possible to obtain benefits even if you’ve waited to file for benefits. Some insureds feel guilty for claiming benefits when there is no clear diagnosis, just pain. But there is nothing to be ashamed of when you’re suffering from this kind of condition.
In chronic pain claims, it’s especially important to “dot every I and cross every T” because insurance companies look for every reason to delay or deny these types of claims. First, get a diagnosis from your doctor(s) for the pain and a description of all the ways that it’s affecting you. Make sure the diagnosis is backed up with medical tests, if possible. Next, put together an accurate and complete description of your job duties from before the onset of your potential disability. Here’s where it gets tricky – you should include dates and details when your job duties changed, making sure those dates line up with changes in your medical condition (i.e., pain levels). Many people try to work through disabling pain, but this only hurts your claim in the long run – and even may hurt you and your medical treatment. Also, see if you can get a statement from your employer about your former job duties – what you did before the onset of your disabling condition. Finally, make sure you have a copy of the summary plan document (SPD) and policy, which are usually available from your HR department or insurance agent. By doing the groundwork now to prepare for a possible claim, you’ll be in a much stronger position if you do need to claim LTD benefits.
My insurance company has an entire department to help me file for my benefits and they seem to be very friendly and helpful. Why should I hire an outside disability claim consultant? – J.S., Georgia
Claim departments of insurance companies have one goal: to pay only those claims they absolutely have to pay. And unfortunately, some companies even take that one step further by designing their claims process to elicit information from insureds that is then misconstrued and used to close the claim. Documents have even been known to have been “lost” that don’t support their conclusions. Their friendliness is specifically designed to give you a false sense of security so you will share more information than you might otherwise, and their helpfulness is designed to get you to trust them so you won’t question the documentation they demand, all while studying you and your claim to figure out how best to reduce or close your claim as soon as possible. Claims examiners are on the payroll of the insurance company, meaning their employer’s instructions come first and foremost. All of the information you submit plus the additional information they’re able to obtain is examined and reviewed with their one goal in mind.
Hiring your own claims expert gives you the confidence that your claim is properly prepared and is well supported. Our decades of experience working in disability claim departments allows us to have insights in how certain companies operate as well as giving you access to the same claim resources used by the insurance company. Rather than search for reasons not to pay your claim, we help you demonstrate the reasons that your claim should be paid. Nobody blindly trusts the IRS to handle their taxes – why should you blindly trust the insurance company bureaucracy?
Isn’t it a hassle to work with a consultant who lives so far from me? With all of the paperwork, I feel much more comfortable talking face to face than over the phone. Do you travel to every client’s house? – M.B., Florida
Our firm understands how you feel, so we’ve incorporated modern technology to give a quick and personal experience to all of our clients. Our proprietary Secure Client Portal allows you and us to instantly exchange and share documents. It’s really simple to use – if you have a computer, we can share documents. We also send and receive information via faxes or Federal Express. We also utilize Skype to video conference with our clients – the very face-to-face experience you want. And finally, YES, when the circumstances require it, we will travel to your house to work with you!
These are just a few of the great questions we get every week. If you want more explanation on any of these questions or have any other questions, please sign up for a free consultation or call our offices toll free at (855) 828-4100. Keep the questions coming – we love to help!