Disability insurance replaces most of your salary when you become disabled and can't work. You should file a claim as soon as you become disabled, since there may be a deadline for the initial claim.
Filing a disability claim has the same general process across different types of disability insurance and requires submitting proof to the insurance company that you meet its definition of disability (which usually means being unable to work). You do this by filling out forms and providing documents from a medical physician and your employer.
Disability insurance claims are usually resolved within a few weeks or months, although you won't start receiving benefit payments until the elimination period ends. If your disability claim is denied, you have the option to appeal.
Where to file a claim for disability insurance benefits
You can file a claim online with your disability insurance company. You may also be able to make a disability claim by phone, fax, or mail. Some providers may have a preferred method; the details should be available in your policy.
If you're applying for Social Security Disability insurance (SSDI), you can apply on their website by making an account.
What you need to make a disability claim
You'll be required to submit a few forms when you claim disability benefits. These documents detail your condition, and its severity, to prove to the insurer that you're disabled and eligible to receive benefits. Sometimes these forms are called a claim packet, and they’re required whether you’re filing a claim for long-term, short-term, work-sponsored, or Social Security disability benefits.
This section contains biographical information about you (the insured claimant), like your address, places of work, the extent of your disability, and other sources of income, including pension benefits, veterans benefits, and other disability benefits you might already receive. The form may also ask you the names of your doctors and details about your medical insurance.
Your doctor's statement (attending physician's statement)
Your doctor has to show the disability insurance company that you're actually disabled. The attending physician's statement (APS) is a deep dive into your medical condition, and it must be filled out by the physician treating you for that particular disability. They will state your diagnosis, your history with the condition, and any treatment you've been receiving for it. This form also 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.
Your employer's statement
In this section, your employer has to describe your role within the company, including your income 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. If you've had to leave your job because of your disability, the employer will list the date you stopped working.
Your employer may also have to state whether you've filed for workers' compensation, social welfare benefits, and other long- or short-term disability insurance coverage.
If you have a group disability insurance policy, your employer will share how much of the insurance premiums are paid by you and how much they cover.
Your direct deposit info
The insurance company may also include a form so you can enroll in direct deposit to receive your benefits (a similar process to signing up for direct deposit with your employer). You may be asked to provide bank information and a voided check along with the other claim forms.
How long does a disability claim take?
It can take about anywhere from a few weeks to a little over a month to process your disability claim. There's not much you can do to expedite the process beyond filing your documents by the deadline. Social Security disability claims can take longer than five months, and you may be able to speed up the process in certain circumstances, like if you have a terminal illness.
While you wait for your claim to be processed, you should gather any medical documentation, such as your health records, in case the insurance company requests more information. If the insurer sends you more forms and questionnaires to fill out, be sure to reply as promptly as possible.
If your disability policy has a social benefits offset rider, your insurer will require you to apply for Social Security disability benefits while your claim is being processed. This rider reduces your disability payment amount by the benefit amount you receive from SSDI. (SSDI benefits are considerably smaller than those offered by long-term disability, but it doesn't cost anything to receive them so it can provide an added measure of income protection.) If you're denied SSDI benefits, your insurance company will pay you the full benefit amount.
After your disability claim is accepted
Your disability insurance has an elimination period, a period of time you have to wait before you benefit payments begin. (Most long-term disability insurance policies have a 90-day elimination period.) The elimination period begins on the day you become disabled, not the day you file your claim. That means even after your claim is approved, you may still have to wait until the elimination period ends before you get your first benefit payment.
Payments can last until you resume work or your benefit period ends. With long-term disability insurance, the benefit period can last for years, even up to retirement. Short-term disability benefits, on the other hand, may only last a few months. (You can get free quotes for disability insurance with Policygenius.)
After you file your claim, you may recover from your injury or illness and be able 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.
Why was my disability claim rejected?
Here are common reasons your disability claim could be rejected:
You didn't meet your policy's definition of disability.
You misrepresented something about your health or hobbies on your disability insurance application.
You are claiming disability for certain injuries and illnesses that are excluded from your coverage (such as a pre-existing condition).
If you file a claim for disability insurance benefits based on a medical issue caused by an exclusion, your claim will get denied. Along with pre-existing conditions, other exclusions include drug abuse, acts of war, or any disability incurred while you were committing a crime.
Appealing a denied disability claim
If your disability claim was denied, you’ll receive a letter from the provider explaining why and how you can file an appeal. The reason may be as simple as not providing enough documentation or not first seeking treatment for your condition before filing.
You should file the appeal as soon as possible, which will involve submitting documentation specifically requested in the denial letter. You should also request a copy of the information the disability insurance company has on file about your claim. That will help you dispute any errors.
If your appeal is denied, you may be able to file a lawsuit. For individual plans, states may have local laws that protect your coverage. A lawyer specializing in disability insurance can help you understand your rights as well as the legal obligations of the insurer.
However, a disability insurance plan administered by your employer could fall under the purview of the Employee Retirement Income Security Act of 1974 (ERISA), which could make it difficult or impossible to claim damages.
Long-term disability insurance can help protect your income in case of illness of injury. Talk with a licensed agent at Policygenius learn more.