Delays and denials – Insurance Company’s mantra

Posted on February 4, 2009 by cjblog

Does it seem like the insurance company is taking too long to decide your claim?  Are they asking you for extension, after extension after extension to decide your claim?  Do they ask you to send them more evidence of your disability only send you back a big fat denial?  Delays and denials by the insurance company are just some of the frustrations expressed by our clients in ERISA disability clients.  While the regulations set the standard on the time limits of when the insurance company must decide an initial application or an appeal of a denied claim, as well as how many extensions they can request and the length of the extensions, there are things you can do to help expedite the process.
 
First, before you even leave your job to go out on disability, get a copy of your disability policy.  You need to know not only what the insurance company’s obligations are, but also what you must prove to establish disability and be entitled to receive benefits.
 
Second, get a copy of your job description.  You have the burden of proving that you cannot do your job.  In order to do that, you must first establish what the material or essential duties of your occupation are.
 
Third, gather all of your medical records that establish your disability.  Simply filling out the insurance company’s claim form is not enough to prove disability.  Nor is a letter from your doctor saying “no work” or total disabled enough to prove that you meet the insurance company’s definition of disability.  You will need medical records and any objective evidence to support your disability, such as x-rays, MRI, blood work, or other diagnostic testing, if applicable, and maybe even a print-out of your medications from your pharmacy.  Make sure that your complaints are documented in your medical records.  Also, if your doctor suggested that you stop working, make sure it is documented in his records.  If it is not there, address this with him before you stop working.  You want to make sure your doctor is supporting your disability before you quit your job.
 
Finally, submit all your documents, along with the completed claim form and attending physician statement, to the insurance company by certified mail, return receipt requested.  This will ensure receipt, accountability and a timely response.  While the insurance company is entitled to an extension, taking the steps that I have outlined will go a long way to help expedite the processing of your claim.

This entry was posted in Blog, Insurance Claims, Tips by cjblog.