The Claims Process

  • The first step in receiving your benefits is making a claim for them.
  • Your insurance carrier in all likelihood requires that you use a specific form for this purpose.
  • It will also require forms, including certifications, to be completed by your doctors.
  • In assessing your eligibility for benefits, your STD/LTD carrier may put you through what may seem to be an overly thorough and invasive process.
  • They may seek what you feel to be way more than needed documentation from your medical team, including not only your medical records but also the completion of various forms from your primary care physician, neurologist or other health care providers.
  • They may send you to other physicians for evaluation, or testing, even including psychometric evaluation. The carrier’s rights to such information are established (and limited) by your insurance contract.
  • The good news about this process is that it can ultimately help you.
  • For one thing, it may help your carrier better understand your case, and make subsequent reevaluations (yes, they usually reevaluate each year or so) more streamlined and likely to result in re-approval of your benefits.
  • The process will also often support, and can sometimes be done in tandem with, an application for Social Security benefits.
  • Income replacement policies may require, as a condition of payment, that you apply for Social Security benefits.
  • Securing those government benefits may or may not be required as a condition for being paid under your LTD policy.
  • However, if you are approved, your policy may allow your insurance carrier to deduct your Social Security payments from what it is responsible to pay to you.
  • Your carrier may assign you an advocate to represent you in your Social Security application process. Your contract may or may not require you to use this advocate as a condition for receiving STD/LTD benefits.

 

Content for this section provided by Mark Rubin, J.D.

 

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