The individual disability insurance (IDI) claims process allows you to seek financial support if you cannot work due to a long term disability or chronic illness. If you have an IDI policy, your coverage isn’t tied to your job or provided by your employer.
When filing for disability benefits, you must follow all required steps to avoid delays or claim denials. Our Texas long term disability lawyer can help you through all stages of the process. You can learn more during a free consultation.
Steps in the Individual Disability Insurance Claims Process
Because your policy does not fall under group disability insurance, your state’s insurance laws and regulations govern the process, not the federal laws that apply to ERISA claims. This means you have more flexibility in terms of coverage and more rights under state laws.
Follow these steps when filing an individual disability insurance claim:
- Review your policy: Carefully read through your individual disability insurance policy to understand the coverage details, including the definition of disability, the waiting period, and the benefits available.
- Gather essential documents: Collect all required documentation, such as your medical records, a statement from your doctor, proof of income, and any other information your insurer requests.
- Notify your insurer: Contact your insurance company to inform them of your disability and your intent to file a claim. This can often be done online, by phone, or by mail.
- Complete the claim form: Fill out the claim form provided by your insurance company. Make sure to provide accurate and thorough information. If you would like professional help with your claim form, our firm offers long term disability application assistance.
- Submit supporting documentation: Along with your claim form, submit the necessary supporting documents. This typically includes medical records, employment information, and a physician’s statement confirming your disability.
- Cooperate with the insurer: Be ready to give more information if the insurer asks for it. This might include undergoing an independent medical examination (IME) or providing further proof of your income and job duties.
- Follow up: Stay in touch with your insurer to check the status of your claim. Be sure to meet all deadlines and provide additional information promptly.
For a free legal consultation, call 800-562-9830
What Happens After You Apply for Individual Disability Insurance?
When you submit your initial application, the insurance company has 45 days to decide whether to approve your claim. In some cases, this period can extend up to 105 days if more information is needed.
Once the insurer reviews your claim and documentation, it will issue a decision.
- If it approves your claim, you will start receiving disability benefits according to your policy’s terms.
- If it denies your claim, you can appeal the decision.
Filing an Administrative Appeal if Your Disability Claim Is Denied
Claim denials commonly occur, so you are not alone. If your insurer denies your claim, its denial letter should state the reasons why it did not approve your claim. If you file an administrative appeal, the deadline to submit it usually ranges up to 180 days from the date of the denial.
Once your appeal is submitted, the insurance company has between 45 to 105 days to decide on your claim. Most policies allow you to appeal twice if your claim is not approved on the first attempt.
To prepare for the appeal, you can:
- Collect new or additional evidence that supports your claim.
- Write a detailed appeal letter stating why you believe the denial was incorrect. You can provide a thorough explanation of your condition and how it meets the policy’s definition of disability.
- Send your appeal letter and all supporting documents to the insurance company within the time frame specified in the denial letter. Follow all submission instructions provided by the insurer.
If your appeal is still denied, you might be able to file a lawsuit. Our disability insurance claims lawyers can handle an appeal for you and represent you in talks with the insurance company.
Click to contact our disability lawyers today
Filing a Lawsuit After an Unsuccessful Appeal
Some people who have completed the process for an individual disability insurance claim and did not get their claims approved after an appeal can take legal action. If this is your situation, you must file your lawsuit in Federal District Court.
This must be done within three years from the date your proof of loss is due. Missing this deadline can result in losing your right to sue, so we encourage you to act promptly.
Our attorney can gather evidence to support your case and develop legal arguments to show how the insurance company wrongfully denied your claim. This may involve interpreting policy language, presenting medical evidence, and highlighting procedural errors the insurer made.
What Happens After Filing a Lawsuit in an IDI Claim Denial Case?
Your case may involve several court hearings before reaching a resolution. We can represent you in court and present your case to the judge. In many cases, the insurance company may seek to settle the lawsuit before it goes to trial.
If we reach a settlement with the insurer, your lawsuit will be resolved. If settlement negotiations fail, your case will proceed to trial. During the trial, both sides will present their evidence and arguments, and the judge will then make decisions based on the merits of the case.
If the judge rules in your favor, you will receive the disability benefits according to your policy’s terms. If the decision is not in your favor, we can review further legal options you may have.
Complete a Free Case Evaluation form now
We Can Help With the Individual Disability Insurance Claims Process
Navigating the individual disability insurance claims process can be challenging when you have a condition that makes it difficult. The legal twists and turns of the process can also be overwhelming to manage, but you don’t have to take them on alone.
Marc Whitehead & Associates can manage your claim at all stages until we resolve your case. We represent clients in all 50 states and have the resources and 30-plus years of experience helping people get the disability benefits they paid for. Call us today for a free consultation.
Call or text 800-562-9830 or complete a Free Case Evaluation form