Disability Insurance Claims

Should you be required to have objective evidence in order to win your long term disability insurance claim and get the benefits you need?

At first glance, the answer to this question seems fairly obvious: yes. If your insurer is going to send you a disability check, there should be an objective way to prove that you are suffering from an issue that keeps you from working.

But how does this requirement for objective proof work for conditions where there are no known objective tests that can provide proof? Should these people be automatically denied because the testing just does not exist? Again, the answer seems obvious: no.

Recently we discussed the impact a disability insurance paper review can have on ERISA disability claims. A “paper review” is where the insurance company doesn’t even bother having their own medical professional perform a personal examination, but instead rejects someone’s case based on the documentation they provide.

Though these paper reviews aren’t as accepted in mental health cases, they are a fairly common practice for insurers when the claimant is complaining of a physical impairment.

Claimants’ attorneys have tried to fight back against this practice in physical disability cases, but for the most part, they have had little luck.

If you are suffering from a mental health disability and your insurer tries to deny your claim without having a medical professional personally examine you, it is vital that you have a representative on your side who knows how to fight back.

In order to get the long term disability benefits that you need to live a relatively normal life, chances are good that you are going to need to provide substantial medical evidence and undergo numerous tests in order to prove you truly are suffering.

How will new ERISA rules affect your disability claim or appeal?

Beginning January 1, 2018, the regulations that control ERISA claims and appeals will change.
This is good news, because the new ERISA disability regulations will give short and long term disability claimants a much needed layer of protection.

It is well-known that group disability claims are fraught with deceptive practices. This is largely because existing ERISA regulations make it easy for insurers to deny valid disability claims without penalties. Under ERISA, legal remedies and due process for claimants are very limited.

Disability insurance riders are additional coverage you buy to add to your privately-purchased base policy. Riders can affect your ability to collect full benefits if you become disabled.

Even so, insurance companies may still deny a valid claim no matter what coverage you have paid for under the policy. There’s no guarantee that, because you have added a rider to your LTD policy, your claim will result in the award of benefits associated with that rider.

Disability policies are inherently complicated. In fact, sometimes by adding further benefits and exclusions through riders, the policy becomes even more baffling.

Our video shares what we consider to be ten important features to consider when choosing long term disability (LTD) insurance. There are two basic types of coverage: an individual disability insurance policy or a group disability insurance plan.

What are the differences? Do they offer the same protection?

The most prevalent type of LTD insurance is group disability coverage through an employer. Even so, most employees are not aware of the limitations and hidden costs of group disability coverage, or the amount of coverage they will actually get.

If you are filing a claim for LTD benefits, you need to know there may be some hidden costs with group disability claims. Specifically, (1) if your income includes a base salary plus bonus income, the bonus income may not be covered, and (2) you may have to pay taxes on your benefits.

As explained in the video above, most group disability policies pay a percentage of the salary you were earning before you became disabled. If you are awarded disability benefits, this “salary percentage” provision can work to your advantage.

When filing a long term disability claim under an employer-sponsored plan, it is important to describe the job duties that you really do. Not realizing the importance of this, many applicants write in their job title and the brief, standardized job description provided by their HR department.

Often these descriptions are too general or not representative of the work you truly do each and every day.

When you are fighting to receive disability benefits, you may hear reference to the Dictionary of Occupational Titles, or DOT. The above video mentions this as a source of vocational definitions.

The DOT is a database that identifies and defines the skills and knowledge a person needs to normally perform an occupation in the U.S. economy.

DOT is actually no longer updated – in fact, the last update was in 1999. Information now is often sourced from the Occupational Information Network (O*Net) – which technically replaces the Dictionary of Occupational Titles (DOT). As you can see, each database links to the other as a shared source.