Marc Whitehead & Associates helps disabled persons receive the long-term disability benefits they deserve. While we’re there to fight for you at every stage of the claims process, client participation is an important factor in reaching a successful outcome. After all, no one knows the history of your disability better than you, and you can help your cause immensely by providing timely and accurate information about your injury or illness and the impact it has had on your life.
Initial Steps and Preparation
The initial step is understanding your long-term disability policy and coverage. Most long-term disability policies fall under the federal Employee Retirement Income Security Act (ERISA). You must meet the insurance company’s definition of disabled. Your attorney can help you understand exactly what is covered and what is excluded under your policy.
The next step involves gathering the relevant medical documentation. That may include:
- Test results
- Medical records
- Physician’s treatment notes
- Prescribed medications and therapies
- Treating doctor’s written opinion regarding disability
Filing the Initial Claim
Start the long-term disability claims process by completing the necessary forms and documentation. Employer plans have different requirements when it comes to this paperwork.
Timely claim submission is imperative. Not filing the claim within your policy’s deadline jeopardizes the ability to receive benefits.
Generally, you apply for disability benefits within 30 to 90 days after the date on which your disability prevented you from working. Your attorney will ensure that all claims are filed in a timely manner.
As noted, providing comprehensive medical records is a critical part of the initial claim process. Insufficient or missing medical evidence is a primary reason insurers deny long-term disability claims.
Open and Honest Communication
Open and honest communication is needed during the long-term disability claims process. For instance, you must report any changes in your medical condition, positive or negative, as soon as possible. Always be truthful, and do not exaggerate or minimize symptoms.
You will receive requests from insurers as they determine your level of disability and progress. Respond promptly to these requests and keep insurers informed regarding updates on your rehabilitation process.
Participating in Medical Examinations
Your insurer will ask you to undergo an independent medical exam. That is an examination conducted by a doctor of their choosing. Cooperatively engaging with independent medical examiners is a necessary part of the long-term disability process. The insurance company wants to know if you meet its criteria for disability. While the doctor is technically independent, they are paid by the insurer to conduct the exam.
Communicating your limitations and challenges to the doctor performing the medical examination is crucial. This information becomes part of your medical record.
Understanding Vocational Assessments
Vocational assessments determine whether you are able to perform your own occupation or any other type of work. Cooperation in vocational assessment programs is essential for qualifying for long-term disability.
You do not have to prove that you cannot perform all of your required job functions. You must prove that you cannot perform major job duties.
Part of vocational assessment involves demonstrating your willingness to return to work. The ultimate goal of vocation assessment is to allow people to obtain and maintain employment, even in a field unrelated to the individual’s former occupation.
A vocational assessment provides insight into transferable skills, those skills that are compatible with similar or new occupations for a person with a disability. This may involve determining whether a person can return to work for the same employer at a different job, or if they must seek a different type of work with another employer.
Appeals and Additional Information
Many, if not most, long-term disability claims are initially denied. Many claimants achieve success by filing an appeal and having the denial overturned. The best results are obtained by claimants hiring legal counsel to represent them in the appeal process.
The claimant collaborates with their legal representatives during this complicated procedure. Active participation in the appeals process can help the client receive benefits.
If your claim is denied, under ERISA you have 180 days from the denial letter date to file an appeal. The insurer has up to 45 days to review the appeal.
Denial notices must include the reason for the denial. Because many claims are denied due to insufficient medical evidence, providing new evidence or documentation of your disability may reverse the denial.
Maintaining Accurate Records
Maintaining accurate records during the long-term disability claim process can make the difference between having your claim approved or denied. Document all communications and correspondence. That includes keeping a careful record of medical appointments and treatments. Keep all relevant employment and financial documents organized.
Contact a Long-Term Disability Attorney
Do not try to navigate the complexities of a long-term disability claim on your own. Marc Whitehead & Associates can ensure that your claim and any appeals are submitted properly and promptly. Contact us today to schedule a free, no-obligation consultation.
