Cost & Coverage
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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. Benefits are paid out by the insurance company sort of like paychecks in that you get a predetermined amount every month.
When you become disabled, 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.
You need to prove the insurance company that you meet its definition of disability, which usually means being unable to do your job, by filling out a “claim packet” containing statements from your physician and employer.
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 claim is denied, you have the option to appeal.
To file a claim for disability insurance benefits, the first thing you should do is locate your policy. The policy should have all the information you need to file a claim.
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.
If you have an any-occupation policy, you may not be able to claim benefits if you’re able to do other types of work, even if that work pays significantly less than your current job.
A licensed representative at Policygenius can help you choose a disability insurance plan that offers the most protection for your income when you become disabled.
The claim can usually be filed online at the website of your disability insurance company. You could also call the company, send them a fax, or submit your claim through the mail. The details should be available in your policy.
You’ll be required to submit a claim packet when you file your claim. 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.
The claim packet also details your disability and its severity to prove to the insurer that you’re disabled and eligible for benefits. A typical claim packet will ask for the following information:
This section contains biographical information about you, 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.
In this section, your employer has to describe your employment with 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.
If you have a group disability insurance policy, your employer will describe how much of the insurance premiums are paid by you and how much they cover. Disability insurance benefits are tax-free as long as you paid for them with your after-tax earnings.
Your employer may also have to explain whether you’ve filed for workers’ compensation, social welfare benefits, and other long- or short-term disability insurance coverage.
Your doctor has to demonstrate to the disability insurance company that you’re really as disabled as you claim to be. The attending physician’s statement (APS) is a deep dive into the type of medical condition you incurred.
The APS must be filled out by the physician treating you for the disability. He or she will state your diagnosis as well as 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 claim packet may also include a form to enroll in direct deposit of your benefits, like signing up for direct deposit with your employer. You may be asked for bank information, and you may have to submit a voided check with the claim form.
While you wait for your claim to be processed, 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.
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. You may still have to wait out part of the elimination period even after 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 benefit period ends. If your policy is long-term disability insurance, the benefit 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 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.
Your claim may denied for several reasons:
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 an exclusion, your claim will get denied.
Other exclusions include drug abuse, acts of war, or any disability incurred while you were committing a crime.
Disability insurance is meant to replace your income when you become disabled.
Following a claim 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 providing enough documentation or not first seeking treatment for your condition before filing. Make sure your claim packet submission is clear about your ability to work.
You should file the appeal as soon as possible. You may need to submit copies of all medical records related to your disability, including 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 errors.
If your appeal is denied, you may be able to file a lawsuit. However, a disability insurance plan administered by your employer, could fall under the purview of the Employee Retirement Income Security Act of 1974, or ERISA, which could make it difficult or impossible to claim damages.
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.
There’s not much you can do it expedite the claim process beyond filing your documents by the 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, and SSDI benefits are considerably smaller than those offered by private policies. However, because it doesn’t cost anything, SSDI can pay you benefits if you hit any snags with your private disability insurance.
If your policy has a social benefits offset rider, your insurer will require you to apply for SSDI while your claim is being processed. This rider reduces your benefit amount by the benefit amount you receive from SSDI. But 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.
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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