How to Apply for Long Term Disability Benefits
Read your policy., Complete your application., Get appropriate documentation., Work with your claims administrator., Consider consulting an attorney.
Step-by-Step Guide
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Step 1: Read your policy.
If you have a private long-term disability policy and you've become disabled, your policy documents will explain the process for applying for benefits.
Your policy specifies the disabilities that are covered by your policy as well as how to file a claim.
Make sure you are already seeing a doctor before you apply for benefits, since the insurance company will want proof of your disability and will need to review your medical records and discuss your impairment with your doctor.Look for the plan's definition of disability.
This definition essentially outlines what you have to prove to be eligible for benefits under your policy.Certain conditions, such as those related to pre-existing conditions, or to drug or alcohol abuse, typically are excluded from coverage.
Similarly, your benefits may be limited if your disability is based more on subjective complaints than on an objectively quantifiable impairment.
Examples of such conditions include depression and fibromyalgia.Keep in mind that if your policy was provided by your employer, it is governed by federal law.
The Employee Retirement Income Security Act (ERISA) regulates applications for long-term disability benefits under these policies.Under ERISA, you have the right to receive a copy of your plan description and policy documents upon written request. -
Step 2: Complete your application.
Private insurers typically will have an initial application you must fill out to provide the company with information about your disability.
Use the information you learned from reading your policy to determine the type of information you must include in your application or claim form to prove to the insurance company that you are disabled and entitled to receive benefits.Make a note of all deadlines and make sure you've submitted your application and any related documentation by the dates provided.
If you miss a deadline, your insurer may use it as an excuse to deny your claim., To qualify for long-term disability benefits, you must prove to your ensurer that you are no longer able to work due to a disability expected to last more than a year.
Your insurer most likely will request all medical records related to your disability, including any laboratory or test results, clinical notes, and exam reports.You might want to consider getting copies of your medical records yourself before submitting them to your insurer, so you know what they include and can analyze how this information might be used either to approve or deny your claim.Make sure you submit all documents requested, particularly medical evidence, as soon as possible after it has been requested.
This ensures you won't miss any deadlines and decreases the changes that the insurance company will deny your claim.You might consider getting your doctor to write a letter supporting your application for benefits.
Your doctor can explain your disability and how it limits your ability to work.Keep in mind that your doctor may charge a fee to write a detailed report of your disability and medical history for you, but generally this fee will be worth it if the letter significantly increases your chances of receiving long-term disability benefits.While your doctor's opinion is important, you also need objective proof of your disability and its effect on your ability to perform your job., Your claim will be assigned to a claims administrator, who typically is someone who works for your insurance company.
Your claims administrator may contact you for additional information or to request documents or contact information for your doctors or other health care providers.
Keep in mind that most private insurers who approve you for long-term disability benefits also will require you to apply for Social Security benefits.
If you are approved for Social Security disability, the insurance company is only responsible for amounts your Social Security benefits don't cover., Because ERISA claims are complicated and frequently denied, you may want advice from an attorney who specializes in ERISA and long-term disability claims.If you apply for disability and are denied, you have the right under ERISA to sue the insurance company in federal court.
However, it is exceedingly difficult to convince a court to overturn an insurance company's denial of benefits.Keep in mind that an attorney can not only help you submit an application but knows how to maximize the chances that you will be approved for benefits. -
Step 3: Get appropriate documentation.
-
Step 4: Work with your claims administrator.
-
Step 5: Consider consulting an attorney.
Detailed Guide
If you have a private long-term disability policy and you've become disabled, your policy documents will explain the process for applying for benefits.
Your policy specifies the disabilities that are covered by your policy as well as how to file a claim.
Make sure you are already seeing a doctor before you apply for benefits, since the insurance company will want proof of your disability and will need to review your medical records and discuss your impairment with your doctor.Look for the plan's definition of disability.
This definition essentially outlines what you have to prove to be eligible for benefits under your policy.Certain conditions, such as those related to pre-existing conditions, or to drug or alcohol abuse, typically are excluded from coverage.
Similarly, your benefits may be limited if your disability is based more on subjective complaints than on an objectively quantifiable impairment.
Examples of such conditions include depression and fibromyalgia.Keep in mind that if your policy was provided by your employer, it is governed by federal law.
The Employee Retirement Income Security Act (ERISA) regulates applications for long-term disability benefits under these policies.Under ERISA, you have the right to receive a copy of your plan description and policy documents upon written request.
Private insurers typically will have an initial application you must fill out to provide the company with information about your disability.
Use the information you learned from reading your policy to determine the type of information you must include in your application or claim form to prove to the insurance company that you are disabled and entitled to receive benefits.Make a note of all deadlines and make sure you've submitted your application and any related documentation by the dates provided.
If you miss a deadline, your insurer may use it as an excuse to deny your claim., To qualify for long-term disability benefits, you must prove to your ensurer that you are no longer able to work due to a disability expected to last more than a year.
Your insurer most likely will request all medical records related to your disability, including any laboratory or test results, clinical notes, and exam reports.You might want to consider getting copies of your medical records yourself before submitting them to your insurer, so you know what they include and can analyze how this information might be used either to approve or deny your claim.Make sure you submit all documents requested, particularly medical evidence, as soon as possible after it has been requested.
This ensures you won't miss any deadlines and decreases the changes that the insurance company will deny your claim.You might consider getting your doctor to write a letter supporting your application for benefits.
Your doctor can explain your disability and how it limits your ability to work.Keep in mind that your doctor may charge a fee to write a detailed report of your disability and medical history for you, but generally this fee will be worth it if the letter significantly increases your chances of receiving long-term disability benefits.While your doctor's opinion is important, you also need objective proof of your disability and its effect on your ability to perform your job., Your claim will be assigned to a claims administrator, who typically is someone who works for your insurance company.
Your claims administrator may contact you for additional information or to request documents or contact information for your doctors or other health care providers.
Keep in mind that most private insurers who approve you for long-term disability benefits also will require you to apply for Social Security benefits.
If you are approved for Social Security disability, the insurance company is only responsible for amounts your Social Security benefits don't cover., Because ERISA claims are complicated and frequently denied, you may want advice from an attorney who specializes in ERISA and long-term disability claims.If you apply for disability and are denied, you have the right under ERISA to sue the insurance company in federal court.
However, it is exceedingly difficult to convince a court to overturn an insurance company's denial of benefits.Keep in mind that an attorney can not only help you submit an application but knows how to maximize the chances that you will be approved for benefits.
About the Author
Teresa King
Committed to making crafts accessible and understandable for everyone.
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