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How to file a disability insurance claim

To get benefits, you have to prove to the insurance company that you meet its definition of disability, which usually means being unable to do your job in your current capacity.

Disability insurance replaces most of your salary when you become disabled and can’t work. It’s the kind of financial product that you never hope to use, but when you do use it, it’s because you really need it. Disability insurance benefits are paid out by the insurance company sort of like paychecks in that you get a predetermined amount every month.

To start receiving disability insurance benefits, you must be up to date on your premium payments at the time you incur your disability. Then, you need to file a claim with the disability insurance company.

Filing a claim correctly can ensure that you can start receiving disability insurance benefits without delay, provided your claim gets approved. You should file your claim as soon as possible, especially because there may be a deadline for the initial claim as well as at several junctures during the process.

But filing the claim can be tricky. It’s not immediately obvious what documents you need to have on hand. Your task is proving to the insurance company that you meet its definition of disability, which usually means being unable to do your job in your current capacity, by showing them statements from your physician and employer. You’ll also need to fill out a benefit claim form (called a “claim packet”).

Then, it’s time to wait. The claims process could take weeks or even months, and after you’re approved you may still have to wait out an elimination period before the disability insurance company starts paying out. You could also get denied, but you have the option to appeal, and there are many reasons why the carrier’s decision could get reversed.

Read on to learn more about:

Filing a disability insurance claim

If you’re become so disabled that you can’t work, it’s time for you to file a claim and begin the process to receiving disability insurance benefits. The first thing you should do is locate your policy; hopefully, you have a copy safely stored among your records.

The policy should have all the information you need to file a claim and will also spell out how to qualify for benefits. Although you probably knew this before purchasing the policy, double-check whether the policy is an any-occupation or own-occupation policy. If it’s the former, you’ll have a harder time claiming benefits if you’re able to do less physically challenging work, even if that work pays a significantly lower salary. Own-occupation policies qualify you for benefits if you can’t work at your current job but could potentially do other work, meaning that you can still earn an income while claiming disability insurance benefits.

Policy on hand, you should now know where to file the claim. The initial claim can usually be filed online at the website of your disability insurance company. You could also call the company. Once you get in touch with the insurance company, they’ll direct you to their claim packet, which is where you fill in the fine details about yourself and your disability. Your employer and physician will also need to fill out information in the claim packet.

What information is needed in the claim packet

The claim packet is a collection of forms that you need to fill out as well as legal documentation that describes your rights and responsibilities as an applicant for disability insurance benefits. You’ll most likely recognize a lot of the information from when you originally took out the policy, but the disability insurance carrier will use the claim form to confirm that the information remains correct. The claim packet also details your disability and its severity.

The claim packet should also include information about where to mail the completed forms, including a snail-mail address or a location online.

A typical claims packet will ask for the following information:

Claimant statement

This section is to be completed by you, the person claiming disability benefits. You’ll give them a lot of biographical information, such as your address, places of work, the extent of your disability, and other sources of income, including but not limited to other types of disability insurance benefits you already receive. The form may also ask you about which physicians you see.

Employer statement

One of the main criteria for determining your eligibility for disability benefits is that you can no longer work. On the claim packet, your employer, or whoever holds your policy, also has to describe your employment with the company and how your disability affects your capacity to do your job.

This could be a checklist of tasks you can no longer complete as well as the amount of wages and salary you’ve had to forgo because of your disability. Other information, such as how you get paid and how you contribute to your disability insurance policy may also be included.

The claim packet could also ask for your employer to attach tax documents like your W-2 or 1099 that demonstrate proof of income.

Attending physician statement

Your doctor has to demonstrate to the disability insurance company that you’re really as disabled as you claim to be. This part of the claim packet takes a deep dive into the type of medical condition you incurred, including how it was treated and what your prognosis looks like.

The physician who fills out the attending physician statement should be the one you first saw after becoming disabled.

As with the other sections, the attending physician statement documents the level of your impairment, both physically and mentally, as well as whether the physician believes you’ll be able to return to work and when.

Direct-deposit enrollment

Your disability insurance company’s claim packet may also include a form to enroll in direct deposit of your benefits. Like signing up for direct deposit with your employer, it’ll ask you for bank information.

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Takeaway

Disability insurance is meant to replace your income when you become disabled.

I filed my claim. What’s next?

Once you submit the claim packet, your next step is to wait. The claims process could take a while, especially if the disability insurance company needs to confirm any of the information you submitted is correct.

You should also use the time to gather any medical documentation, such as your health records, in case more information is requested by the disability insurance company. The disability insurance carrier may send you more forms and questionnaires to fill out, so be sure to reply as promptly as possible.

If you’re approved, there will likely be an additional wait before you start receiving benefits. This is called the elimination period, and the average policy has a 90-day waiting period. This is to show the carrier that your disability is at least semi-permanent before they start giving paying you disability insurance benefits, and if you opt for a shorter elimination period when you first take out the policy you’ll pay higher premiums while your policy is in force.

The elimination period begins on the day you become disabled and stop going to work. The claims process runs during the elimination period, although it could last as long as 60 days. Make sure you file your claim right away, so you only have the remainder of the elimination period to wait out once your claim is approved.

Once approved, you should receive your first disability insurance benefits payment on the first of the month after your elimination period ends, and you’ll keep receiving a payment monthly until you can work again or your benefits period ends. If your policy is long-term disability insurance, the benefits period will last for years, even up to retirement. If it’s a short-term disability insurance policy, the benefits period usually lasts for just a matter of months.

After you file your claim, you may recover from your injury or illness enough to go back to work. When that happens, you’re no longer eligible to receive benefits, and you should contact the disability insurance company to cancel your claim. (If your policy is own-occupation, you can still work another job and be eligible for benefits.)

I got rejected. What’s next?

It’s possible to get rejected for disability insurance benefits even if you’ve been otherwise good about paying your premiums. That happens when you’re not deemed disabled enough to miss work, or if you misrepresented something about your health on your disability insurance application.

Certain injuries and illnesses are also excluded from disability insurance coverage, such as anything that was a pre-existing condition. If you file a claim for disability insurance benefits based on a medical issue caused by a pre-existing condition, your claim will almost certain get denied. Other exclusions include drug abuse, acts of war, or any disability incurred while you were committing a crime.

Following a claims denial, you’ll receive a letter from the carrier explaining why your claim was denied and how you can file an appeal. The reason may be as simple as not having enough documentation on file or not first seeking treatment for your condition before filing. Make sure your claim packet submission is clear about your capacity to work.

You’ll have at least 60 days to file an appeal, but you should do it as soon as possible. During that time, you should get copies of all medical records related to your disability, taking care to gather any document specifically requested in the denial letter.

You should also request a copy of the information the disability insurance carrier has on file about your claim. That will help you dispute any factual errors that caused your claim to be denied.

Hiring an attorney specialized in insurance law can help you decipher why you were denied in the first place and make sure your appeal doesn’t hit any snags. This will be most important if your disability insurance plan is administered by your employer, as it could fall under the purview of the Employee Retirement Income Security Act of 1974, or ERISA. This law makes it harder for claimants to win their appeal and could cause the process to be dragged out for at least an additional year, even requiring the claimant to file a lawsuit in federal court.

What you can do in the meantime

Qualifying for disability insurance benefits can be a lengthy process, and there’s not much you can do it expedite it beyond filing your documents by each deadline. But one thing you can do, if you need extra assurance, is to apply for Social Security disability insurance (SSDI).

Social Security disability insurance is very difficult to qualify for, because the Social Security Administration has a much stricter definition of disability than commercial disability insurance companies. However, although SSDI benefits are considerably smaller than those offered by private policies, it’s possible to receive both SSDI benefits and disability insurance benefits without either affecting the amount of the other.

With a social benefits offset rider on your long-term disability policy, you can even pay less in premiums as long as you apply for SSDI coverage when you become disabled. This rider works by reducing the amount the disability insurance company pays in the expectation that SSDI benefits will offset part of the amount. But, under this rider, if you’re denied for SSDI benefits, the disability insurance carrier will still pay you the part that was meant to be offset, meaning you’ll receive your full benefit amount.

Disclaimer: Policygenius’ editorial content is not written by an insurance agent. It’s intended for informational purposes and should not be considered legal or financial advice. Consult a professional to learn what financial products are right for you.

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