The procedures for claims submission procedures are explained in the summary plan description, the insurance policy, and other insurance plan documents. When looking for the specific claim submission procedure adopted by the employer, the claimant should consult these documents first. The employer may have the duplicates in case the documents were lost or if the insured was never supplied with the plan documents. Depending on the insurance carrier, the submission procedures will slightly vary, but in most cases, the first step is taken by an employee who contacts the insurance company or the employer to inform them that he or she has to submit a disability claim. At that time, there is a number of forms related to the claim that will be provided to the claimant to complete and sign.
Completion of Required Long Term Disability Claims Forms
In order to initiate the disability claim, it is critical for the claimant to complete all the forms required by the claims administrator. It is very likely that if the forms are incomplete, the claim will be denied because of the failure of proof required by the policy. These forms usually include the disability claim form, release of information and medical authorization, and requiring a list of all doctors and/or facilities you have treated at regarding your disability. The form is used for the claimant to identify the reasons he or she is disabled, and all of the claimant’s treating physicians must be listed in it. The claimant’s treating physician is often required to complete an attending physician statement which can be helpful in support of the claim. The statement will describe the limitations and restrictions that stop the claimant from being able to perform duties of his or her job and how long the condition is expected to last. The claimant’s employer is to complete an employer’s statement, which will specify the employee’s job duties and pay rate at the time the employee stopped working. Another form is an authorization for the release of medical information. It lets the claims administrator get access to the claimant’s medical records. The claimant is responsible for these forms to be completed and returned to the claims administrator. The employer’s statement and the attending physician’s statement are often sent directly to the employer and treating physician for completion by the claims administrator.
Additional Information That May be Submitted in the Long-Term Disability Claim
It is best to submit any additional documentation that may support the claim, together with the required forms included in the initial package or as soon as possible after the forms were sent. An example of such documentation is medical records from the examining or treating physician, which describe the claimed disability and diagnosis, or approval for social security benefits and a notice of favorable decision from the Social Security Administration. Another example is a detailed description of the claimant’s work duties. It should include the working hours required by the employer as well as the physical and mental demands of the position. The claimant may compile his or her own job description if the employer has not provided a written job description to the claimant. It is a good idea to include a personal letter from the claimant detailing the symptoms of the condition upon which long term disability is being claimed, and possibly any statements from colleagues or supervisors. The letter from the claimant may also describe how these symptoms affect the claimant’s capacity to perform the job duties and how they impact the claimant’s daily life. Also, the additional supporting documentation may include letters from the claimant’s co-workers, friends, and family. These letters could describe how the claimant’s symptoms have adversely affected the claimant’s work and life at home, as well as their personal observations of the symptoms experienced by the claimant. However, it is better not to delay submission while collecting and preparing supporting documents. Submit the initial claim forms right away and then supplement the claim as additional evidence is gathered.
Communications with the Claim Administrator About the Long-Term Disability Claim
As much as possible, the claimant and the claims administrator should communicate in writing. After every phone call, it is best to confirm the points of the phone conversation in written form. And if the written communication contradicts the phone conversation, it should also be clarified and corrected in writing. Certified mail and the return receipt request should be used for all correspondence from the claimant to the claims administrator. A clear record is created when the claimant lists by name and date all the documents being sent in the correspondence to the claims administrator. The final step is to make sure that all correspondence has a date and references the correct claim number.
Time Requirements to Submit the Long-Term Disability Claim
After the onset of disability, there is a specified period of time that most insurance policies allocate to the claimant to submit the proof of disability. It is best to make every effort to comply with the time deadlines specified in the particular policy.
At Bonnici Law Group, we’ll assist with any questions you may have about long term disability to make sure you have all the information you need to make the best decision for you and your family. Give us a call at (619) 259-5199 or click here for a FREE consultation!