The initial application is the most important step in your long term disability claim. When vital benefits hang in the balance, it’s essential your application is handled correctly from the start.
The information you send to the insurance company at the beginning of your claim lays the foundation for everything that happens in the days and months to come. Unfortunately, you are applying to a company that would rather deny your application. Any claim the insurer can avoid paying implies significant profit for them.
The claims process is filled with traps for unsuspecting claimants. To apply for disability insurance benefits requires a great amount of preparation, with coordination of input between you, your attending physician(s) and often your employer. One misstatement can open the door to claim denial. Even the application forms are designed to cause errors and omissions.
Most people are unaware of problems when they apply for disability insurance benefits and don’t realize when an attorney’s help is needed. To self-insured professionals who own individual disability policies and to employees covered by group disability plans, we urge that you discuss your situation with us first at no cost.
Don’t Guess Your Way through the Disability Application.
Each disability company has its own corporate culture that determines its claims handling strategy. Wrongful claim denials have gone on for decades, and our law firm has taken on every major disability insurance company in the country.
Our experience enables us enable us to strengthen the effectiveness of your initial application and protect your rights during the life of your claim. We represent people with all manner of disabling conditions and in every type of occupation in their fight for benefits, and we would be honored to help you.
We have prepared the following videos explaining the best ways to apply for disability insurance benefits and what to expect throughout this process. Get the facts you need about
- why so many applications are initially denied,
- what the insurance companies are up to when they review applications, and
- how we can help you take control and prevail during this essential first step.
Disability Application Forms
The insurer is going to inspect every word of your application. They will look for omissions, mistakes, and a lack of evidence of disability. If there are any weak spots in your original claim, you can bet the insurer will find them and use them as the basis for denial.
The disability application forms the insurer sends you will seem fairly simple. The insurer hopes you’ll see it that way and do it yourself. Now we take a closer look at what it takes to prepare a disability application that an insurance company cannot easily contest.
The initial application for group disability benefits generally has three parts with two or three different contributors:
- The claimant seeking benefits fills out a statement. In a group disability claim, this is called the Employee Statement. For an Individual Disability Insurance (IDI) policy, the wording on this form would say Individual Statement.
- Your treating doctor completes the Attending Physician Statement.
- With group plans, your employer completes the Employer Statement; if you’re filing an application for individual disability insurance benefits, you will not have the Employers Statement form.
While some requirements on the application are clear and straightforward, other portions offer intentionally vague instructions, inappropriate choices, and various other means intended to trip you up.
The Attending Physician Statement
The Attending Physician Statement is one of the most influential factors in your disability application. This is the form your doctor fills out on your behalf. Its purpose is to inform the insurance company of your diagnosis and whether your condition is disabling.
What your doctor says and the wording he or she uses is key to establishing the clinical nature of your impairment, and the severity, extent and expected duration of your disability.
Your medical records and medical evidence are a vital part of the Attending Physician Statement. This includes diagnostic testing, laboratory data, special tests (X-rays, MRI, CAT scan, EKG, etc.), physician’s written statements and opinion, treatment notes, a record of hospital visits, and supporting medical literature.
One wrong statement on the form or one behind-the-scenes phone call between the insurance company and the doctor can sink a claim. The following video describes how we stay involved in this process, managing the flow and the content of this important medical input.
Do You Have an Individual or Group Disability Policy?
Whether you are a surgeon, a receptionist, an IT specialist, or a company CEO – it is a mistake to assume you can file a winning disability claim on your own.
Most people do not fully know the scope of their coverage, and what the claim process involves. No claimant is prepared for the lengths that some disability insurance companies will go to defeat their policyholders’ ability to collect benefits.
Our role in your initial application is to submit a claim that puts you in the best possible position to receive maximum benefits.
To begin the application process, we review the type of policy you have and the provisions that you must follow. The kind of coverage you have will shape your entire application.
Coverage purchased on your own behalf is referred to as individual disability insurance (IDI), or privately purchase disability insurance.
If your disability insurance is provided to you by your workplace as part of an employee benefit plan, you likely have a group disability insurance policy. By far, the highest volume of disability claims in the United States are group disability claims.
The difference between the two types is important because the laws governing each are different. There are major disparities in how they work — especially if your initial claim for benefits is denied and you need to appeal.
Own Occupation and Any Occupation – Your Policy’s Definition of “Disability”
One difference in how you apply for disability insurance benefits under a group policy versus an individual disability policy involves the policy’s definition of disability.
The following video describes how occupational standards will influence your handling of the application, what you need to watch out for, and how important it is to provide a thorough description of your occupation in the application.
Independent Medical Exam (IME) & Functional Capacity Evaluation (FCE)
Be prepared for your insurance carrier to require that you submit to an Independent Medical Exam, or IME, as well as a Functional Capacity Exam, or FCE. These exams are scheduled by the insurer with a “neutral” doctor or other health care professional who is employed or contracted by the insurer.
What Is the IME For?
The goal of the Independent Medical Exam is to investigate the degree of your disability and the credibility of your claim.
On one hand, this is an insurance company’s protection against fraudulent claims. On the other hand, it is often a tactic that insurers use to create evidence against legitimate claims so they can deny you initially or terminate existing benefits. There is usually nothing independent, or neutral, about it.
Over many years, our attorneys have observed how certain insurance companies attempt to game the IME process. More often than not, the third party doctor is being paid to reinforce the disability company’s in-process decisions to discredit valid claims.
Yes, You Must Attend the Independent Medical Exam
Most policies will contain a provision that states you are obligated to comply with the IME. This means you must attend the exam or risk claim denial. You can be ordered to undergo an Independent Medical Exam “as often as reasonably required” if that is how the policy is worded.
The IME provision will vary from policy to policy, and instructions can be vague or specific about the extent of the exam or type of assessments to be allowed.
IME doctors are not always qualified to assess complex medical restrictions or combinations of disabling impairments for every claimant they see. Even with the proper training and background, an IME doctor, in one or two visits, can do more harm than good to your disability case.
What Is the FCE For?
Your policy may also allow the insurer to require that you submit to a Functional Capacity Evaluation, or FCE as part of the application process. These assessments usually last from 4 to 6 hours, and occasionally may be conducted over 2 consecutive days.
In the Functional Capacity Evaluation, you are asked to go through a series of tests designed to measure your physical capacities and functional abilities, such as:
- Standing, walking, sitting
- Lifting, carrying, pushing, pulling
Strength in the workplace is measured in five terms:
- Sedentary work
- Light work
- Medium work
- Heavy work
- Very Heavy work
The insurer may also test your capacity for grasping, pinching, fine motor coordination, gross motor coordination, reaching, bending, squatting, kneeling, crawling, climbing, and balancing.
Less defined activities may include assessment of your ability to perform repeated activities, work-simulation activities, and other physical demands.
Prepare for Surveillance (Insurers are Watching You)
Disabled claimants must be aware that insurance carriers consider much more than medical records when reviewing claims.
Disability insurers commonly use surveillance and other probing techniques to deny claims. These companies wait and watch for those moments that can help them “prove” that you are actually capable of working.
Insurers also look for ways to allege you are faking or exaggerating symptoms, also known as “malingering,” as grounds to deny benefits or terminate existing benefits.
Along with video surveillance, social media monitoring is has become a very effective tool for gathering this type of information. Video and digital surveillance can have a devastating impact on a disability claim and is a high priority for many insurers who seek to deny or cut off an insured’s valid benefits.
Unfortunately, video surveillance is not against the law – generally speaking as long as it is done in a public setting (i.e., not in your home or your business office), and when it does not violate your reasonable expectation of privacy. What is not legal is when the person doing the surveilling trespasses on your property, bugs your phone (wiretaps), monitors (hacks) your email or obtains your confidential information without consent.
In Summary: How Our Attorneys Help Apply for Disability Insurance Benefits
Marc Whitehead & Associates will oversee your application and disability case from start to finish. The following summarizes what we do for our clients in the initial application stage, to make sure all policy and legal requirements are met down to the smallest detail:
- Thorough insurance policy review and summary by a Senior Associate, including:
- Type of disability insurance coverage
- Claim Process
- Formulate a plan to address any limitation or exclusions that apply to you
- Review medical, vocational and/or claim information from various sources as needed
- Review your diagnosed disabilities and treatment history
- Coordinate the transition between any short-term and long-term disability claims
- Conduct legal research to determine the viability of any suggested strategies
- Review salary, bonus, and other compensation issues
- Recommend appropriate medical and vocational testing
- Complete all application documents
- Provide one-on-one consultation with you before, during or after the application is complete
- Communicate updates to you as appropriate
While we can never guarantee results, our experienced attorneys will know which pieces of information are critical for an award of benefits. We understand what it takes to effectively prove you can no longer work and will take every responsible measure to help you win your case from the outset.
When we take a case at the initial stage, we prepare the disability application so that it becomes a case file that will stand up in court before a Federal judge in a group (ERISA) disability claim or in state court before a jury in an individual disability claim.
It’s never too soon to have a good lawyer’s help in your disability insurance claim. When you find that you are can no longer work, call us. We’ll explain your initial application options and how we can assist you.