5 Disability Insurance Issues Worth Talking About

Glenn Kantor, founding partner of Kantor & Kantor in Northridge, CA, oversees one of the largest ERISA law firms in the country.  The firm focuses primarily on helping employees obtain wrongfully denied insurance benefits for disability, health, long-term care and life insurance policies under the Employees Retirement Income Security Act, but also works with people denied benefits under individual policies.

Knowing about these issues can help you advocate for your long term disability benefits.

Living with a chronic and progressive illness can mean steady doctor appointments, changes in body control, sleepless nights, financial difficulties, and even insurance complications. Insurance problems come up frequently for people who have a long term disability (LTD) policy.  Insurance companies often make it very difficult to satisfy their requirements for getting a LTD claim paid. Becoming familiar with these five common LTD insurance issues can help prepare you to (1) become your own best advocate and (2) fight for the disability benefits to which you are entitled.

  1. The burden of proof. Keep in mind that you have the burden of proving not just that you suffer from Parkinson’s disease (PD), but that the condition prevents you from working.  You must provide evidence that your illness is debilitating enough to entitle you to LTD benefits per the terms of your policy.  The first step is to become familiar with the definition of disability in your policy. This is usually a very specialized and restrictive definition. You know that your PD has unquestionably altered your ability to function at work. Your family knows this. Your physicians know this. Insurance companies, however, often remain doubtful and require “objective evidence” as proof of your disability. Anyone who has experienced PD understands the frustration of this situation. Those living with PD often experience “invisible symptoms” far before “visible symptoms” emerge. These “invisible” or less obvious symptoms can be powerful, debilitating, and incredibly bothersome. Far less obvious than a tremor or slowness, “invisible” or nonmotor symptoms can include: sleep issues, fatigue, and gastrointestinal issues. All of these symptoms can greatly interfere with the ability to function properly in the workplace. 

    Furthermore, imperfections with diagnosis, treatment, and understanding of the disease can make it even easier for your long-term disability insurer to find a way to deny your claim. Because there is no standard diagnostic test for diagnosing PD, diagnosis relies mostly on individual clinical information provided by the patient, and the findings of the neurological exam by the physician. Essentially, the physician must rule out and exclude other diseases that might mimic PD. This can create an added challenge for those suffering with PD, especially when communicating the severity and impact of their illness to physicians, family and friends, employers and even insurance companies. Unfortunately, the burden of proving your disability is yours. So, what can you do about it?
  2. Keep a journal and take copious notes. Many people, including your insurer, cannot begin to imagine what it is like to live with a neurodegenerative brain disorder. Document and explain this. As an expert on your progressive symptoms, only you can explain the far reaching impact that your illness has created. It is worth it to take time out to record this information. This way, you will be prepared in the event that you need to prove and objectify your condition. It is essential that you communicate this information to your physician.  You might even want to bring the journal to your doctor visits - to make sure your doctor notes everything relevant about your condition.
  3. Follow the advice of your treating physician. Once you have found a neurologist qualified to treat your PD, be sure to communicate honestly and effectively. Always tell your doctor the whole truth, including any reactions or side effects from medication. Try not to miss appointments, and follow the advice and recommendations from your physician. If you do not feel the advice your physician is providing is appropriate for you, document why that is the case. Following your doctor’s orders, and communicating honestly, will lend credibility and consistency to the serious nature of your illness.
  4. Prepare yourself for effective communication with your insurance company. Be prepared! Before you even pick up the phone to call your insurance company, make sure you write down exactly what you would like to say. When you are on the call, ask for the name, title, phone number, and email address of the person you are speaking with. Write down everything that has been said in the conversation. When you are through, confirm the conversation in writing – and send it in to the insurance company through certified mail or email. Remember, if you can’t prove it, it doesn’t exist!  For this reason, it is important to try to keep all of your communication with your insurer in writing.
  5. Making your long-term disability claim. Begin by requesting a copy of your Policy from your employer or insurance company.  Once you have a copy of your policy, you can refer to the policy for the specific claims submission procedure implemented by your employer. The steps for submitting a claim can vary depending on your employer, however, the process usually begins when you contact your employer or insurer to tell them that you need to submit a disability claim. You can expect to be provided with a number of forms to complete and sign for your claim. Make sure that you complete ALL required forms…failure to do so could result in a denial for “failure of proof.”

Dealing with PD, in addition to long term disability insurance issues, can be emotionally overwhelming and financially devastating.  If you have questions about your long-term disability policy or insurance denial, do not hesitate to contact us for guidance and support.

We understand, and we can help.  www.kantorlaw.net (800) 446-7529

Posted: 2/14/2014 12:16:03 PM by Cathy Whitlock

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