Talking About Financial Matters That Affect You and Your Organization
LTD (Long Term Disability) Claims Process
Mar 29th, 2018
Dealing with an injury or illness that is preventing you from earning your income is tough enough, but navigating the Long-Term Disability process can become frustrating and exhausting. Here are some steps you should take when making your initial submission,
1. Understand your existing program. This means having an up-to-date copy of your employee benefits booklet, benefits statement, and confirmation from the plan administrator about the amount of coverage resisted with the insurer.
2. As you navigate your health condition, ensure you keep track of all of your treating physicians and ensure you clearly understand the diagnosis and prognosis. Any documentation or reports provided to you about your condition and treatment plan should be kept for future reference. You are your own best advocate when managing your condition.
3. Make sure you complete all the required documentation (along with the employer's submission and physician's submission). Ensure you submit all required information in a timely fashion with clear identification (your plan member number and group policy number that relates to your Long-Term Disability benefits).
If your claim is declined, here are some steps you should take,
1. Ensure you denial is provided in writing including absolute clarity on the reasons for decline relating to your claim. These reasons for the decline will be the focus or your appeal, including a copy of the decline letter (including the claim number and adjudicator identification information).
2. Re-visit the medical evidence provided by the physicians who made submissions on your behalf. A majority of claims are declined based on missing medical information, which is the responsibility of the claimant.
3. Participate in the appeal request. Providing the insurer complete information about your claim, including rebutting the reason for decline with addition information along with supporting medical information from your treating physician is key.
4. Consider participating in or requesting an independent medical examination in cases where the insurer does not deem your physician's submission to be adequate. While this may not always be an option for you or the insurer, it shows signs that you are prepared to take steps to authenticate your condition. Many insurers will pay for the costs associated.
Throughout the process, it is important to play the long game. Amassing all the information related to your claim will empower you to advocate for yourself. Don't be discouraged by multiple declines, each decision letter from the insurer may provide new or increased insight as to what is missing to help approve the claim. While it may feel contrary, disability claim adjudicators are people too, they are prepared to help you if you ask and advocate for yourself.
Don't get pulled into confrontation too quickly. Handing the process to a lawyer too early can be the worst decision you make. Once the process goes legal, it slows and there is no wiggle room. Since many lawyers specializing on disability claim appeals work on a contingency fee basis, they will take a percentage of the payments you receive. When your disability plan replaces 85% or less of your net pre-disability income, losing a portion could be catastrophic to your financial independence.
If your benefit plan has an adviser, recruit them to help, advocacy is part of their job.