Filing a claim for long term disability benefits can be challenging. As if dealing with debilitating symptoms were not difficult enough, disability insureds are forced to fill out detailed application forms, obtain statements from their doctors, and gather their medical records. They must also have the wherewithal to avoid insurance company traps and errors that could jeopardize approval of their disability claims.
Because the long term disability claim form or a “proof of claim” form comprises the first impression given to an insurance company, long-term disability claimants must submit comprehensive information in support of their claim. Below are some common mistakes to avoid when filing long-term disability applications:
Limiting Responses to the Space Provided on the Long Term Disability Proof of Claim Forms.
When applying for long term disability benefits, insureds will be required to complete an application or claim form. When doing so, insureds should provide accurate, comprehensive answers to explain the medical and/or psychiatric basis for the disability claim. Yet, insurance companies notoriously provide only two or three lines within which to complete answers to complex health and work-history questions that could easily consume multiple paragraphs or pages.
For example, a response to the question “Please explain why you are unable to perform your job duties?” is often quite lengthy – especially if the disability claimant suffers from multiple disparate symptoms, restrictions, and limitations. Don’t fall into the insurer’s trap. Instead of trying to shoehorn an answer into the limited space provided by the insurance company, insureds should consider attaching a separate sheet of paper so that a proper, more detailed response to this, and any other questions posed by the insurance company can be provided.
Letting Treating Doctors Submit Forms Directly to the Insurance Company.
Proof of claim forms almost always include a form – typically called an Attending Physician’s Statement – for a treating physician to complete. The treating physicians should send the completed form to the insured and not directly to the insurance company so that the insured can: (1) check for any factual errors and (2) submit the Attending Physician’s Statement with the rest of the applicable proof of claim
forms.
Doctors are very busy, and getting them to complete a form in support of a disability can be challenging. And, when they do eventually complete the Attending Physician’s Statement, doctors often provide short, non-detailed, and sometimes inaccurate responses. For example, in response to the question “Please explain your patient’s limitations.” the doctor may simply write “Patient is Totally Disabled.” While a supportive statement, it may be insufficient. Insurance companies want to know the disability claimant’s specific restrictions and limitations. Therefore, before the Attending Physician’s Statement is submitted to the insurance company, it should be carefully reviewed to ensure that it is completely accurate and provides sufficiently detailed responses.
Letting One’s Guard Down When Communicating with the Insurance Company.
When filing for long term disability insurance benefits, a disability claimant will inevitably have to speak with an insurance company representative. More often than not, the representative will be friendly. The claims representative appears to sympathize with the insured’s struggles, and explains that the insurer is looking out for the insured’s best interests. Claims representatives are also prone to assenting that it is the insurer’s goal to obtain approval of the disability claim. However, insurance company representatives don’t have any allegiance to the insurance company’s insured. Quite to the contrary, their allegiance lies with their employers – the insurance companies. Under these circumstances, while insureds should be honest and cordial when speaking with an insurance company representative, they should also be guarded. An insured should answer the representative’s questions in as much detail as is necessary, and stop there. Insureds should avoid going off on tangents and giving anecdotal stories. It may also be helpful to record the telephone calls with the insurance company or have a witness present.
Attending an Interview with the Insurer Alone.
The disability insurance company may request either an in-person or telephonic interview as part of its claim administration process. Attending that interview alone could be a mistake. All too often we hear stories of claims representatives misconstruing or misrepresenting what has been said during an interview. As such, an insured should always have a witness (preferably a representative from an attorney’s office) attend the in-person interview or listen in on a telephonic interview.
In addition, if the insurer requests an in-person interview, it will likely suggest that the interview take place in the insured’s home. An insured should avoid this, and suggest a neutral, public location, such as a local coffee shop, a library, or a large hotel lobby. Inviting an insurance company representative into the home is a recipe for disaster. It gives the interviewer the opportunity to observe the disability claimant in their “natural habitat,” where they are most comfortable and relaxed. It also gives the interviewer the opportunity to observe the state of the insured’s home in general – to suggest or imply, for example, that an insured is not disabled because they keep their house clean. It is Hiller PC’s standard practice to insist that an in-person interview take place in our conference room, and that the interview be witnessed or recorded. If the interview is telephonic, we will set up a conference call with the insurance company to ensure Hiller PC’s participation. In either case, the client should be fully prepared for the interview.
Missing a Deadline Imposed By the Insurance Company.
When processing an application for long term disability benefits, an insurance company will give certain deadlines within which to submit proof of claim forms and supporting documentation. If an insured misses one of the deadlines, the insurer could deny their disability claim without even considering its merits. Don’t give the insurance company an easy way out; insureds should make sure they comply with any and all deadlines. If an extension of time is required – because, for example, an insured’s doctor is taking a long time to complete an Attending Physician’s Statement – an extension must be requested before the deadline expires.
Contact an Experienced New York Disability Insurance Attorney at Hiller, PC
Filing a claim for long term disability benefits can be a frustrating endeavor. Worse, a simple, seemingly innocuous mistake can lead to the denial of your disability insurance application. Hiring a disability lawyer can help you navigate the application process; avoid common mistakes; and side-step your insurance company’s tricks. Contact us today at (212) 319-4000, and let us help you get your disability claim approved right from the start.
