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    Filing an Initial Claim for Long-Term Disability Benefits

    Filing an Initial Claim for Long-Term Disability Benefits

    Many workers in the United States have long-term disability (LTD) insurance, either a personal policy purchased directly from an insurer or a group policy provided via an employer.

    When a person is unable to work due to a medical condition or injury, these benefits can protect a portion of their pre-disability earnings—typically, between 60 and 80 percent of a person’s pre-disability earnings. However, to receive these benefits, the worker must file a successful claim with their LTD insurer.

    Preparing an initial claim involves gathering documentation and evidence of the disability preventing the individual from working. This evidence can include medical records and employment information, among other things. It also requires the submission of claim forms to the insurance company by all deadlines specified in the policy.

    A well-prepared claim increases the likelihood of a smooth approval process or a successful appeal, if necessary—insurance companies frequently deny even the strongest of initial claims. Therefore, understanding details like your policy’s definition of disability, specific evidence requirements, and all deadlines is highly advised when pursuing LTD benefits.

    In this article, Chisholm Chisholm & Kilpatrick (CCK Law) will explain:

    • The initial claim phase of the LTD process
    • Documentation and evidence claimants should gather when submitting a claim
    • The claim review process
    • And more
    Who We Are: Chisholm Chisholm & Kilpatrick is a leading public interest law firm based in Providence, Rhode Island. Since 1999, we have been helping long-term disability claimants across the United States get the benefits they need.

    Understanding the Initial Claim Phase of the LTD Process

    Those wishing to file for long-term disability benefits must thoroughly read their insurance policies. These policies will outline how an individual can obtain benefits for their disability. It will also explain the filing deadlines claimants must adhere to, the documentation they must submit, and more.

    3 Stages of the Long-Term Disability Claim Process

    When a person suffers from a disabling medical condition that prevents them from working, they may decide to file a claim for long-term disability. Understanding this initial claim phase of the process is important.

    Note: Some individuals may also have access to short-term disability benefits, which cover a person’s income for a shorter period than LTD benefits. For more information about the differences between these policies and when you may decide to file for one or the other (or both), read our article on the subject here.

    Learn more about some of the important information contained in a long-term disability insurance policy:

    Gathering the Necessary Documentation for an LTD Claim

    To meet an LTD insurance policy’s applicable definition of disability—and thereby become eligible for disability benefits—a claimant must procure the proper evidence. Gathering this evidence before filing a claim can help later when filling out the insurance company’s claim forms. (However, remember to be careful not to miss any claim deadlines in your policy.)

    Why Supplemental Evidence Matters for Long-Term Disability Claims

    Some examples of evidence that individuals should gather for an LTD claim include:

    • Detailed medical records showing the presence of their medical condition and symptoms
    • Test results, such as X-rays, blood work, or MRIs
    • Supplemental evidence, such as functional capacity tests, vocational evaluations, and witness statements
    • Employment information
    Tip: Insurance companies often look for objective evidence (e.g., X-rays) when reviewing a claim, but subjective evidence (e.g., self-reported symptoms) can still be useful when proving a disability. Therefore, it is beneficial for claimants to submit any supportive evidence relevant to their disabilities.

    Submitting the Notice of Claim to an LTD Insurer

    The initial claim stage officially begins when the claimant notifies their insurance company of their intention to file a claim. This is called the “notice of claim.”

    The deadlines for submitting notice of claim are listed within your LTD insurance policy. Your policy will also outline deadlines for submitting proof of your claim. These deadlines vary from policy to policy. But if a claimant misses a deadline, then they could receive a denial of their claim.

    Not sure if your condition is serious enough to warrant an LTD claim yet? Be careful that you do not miss critical deadlines. Some individuals hope to rebound from their condition or injury and return to work, and therefore, they delay submitting their claim. However, it is crucial not to fall into this mindset without being aware of your policy’s deadlines.

    Completing the LTD Claim Forms

    Once the insurance company receives the notice of claim, it will send the claimant claim forms that must be completed. These claim forms are a vital part of the initial claim stage. All claimants seeking benefits must submit these completed forms along with evidence that proves their disability.

    These forms are typically composed of three primary sections:

    • The Claimant Statement: A firsthand account by the person seeking benefits that details how their medical condition prevents them from working and impacts their daily activities.
    • The Attending Physician Statement: A medical professional’s assessment of the claimant’s diagnosis, treatment, and functional limitations. This statement helps provide evidence to support the claim. Thus, it is vital to have open communication during every appointment so that your doctor knows the true extent of your condition.
    • The Employer Statement: A report from the claimant’s employer, confirming their employment history, job duties, and any accommodations attempted before the disability claim.
    Attending Physician Statements in LTD Claims

    Tips that claimants can use to ensure they properly complete these forms include:

    • Be accurate and precise
    • Attach additional sheets of paper if there is not enough space to properly explain the disability
    • Make an appointment with the treating physician to have them fill out their respective form
    Note: Even after a claim has been approved, insurance companies may require additional forms throughout the life of the claim. These are known as “update forms.” These are intended to determine if the claimant’s condition has changed. Insurance companies typically request these update forms when re-evaluating a claimant’s entitlement to benefits.

    The Claim Review Process

    Once a claimant submits their claim forms and evidence, the insurance company examines it. They will analyze the claimant’s medical records, the physician’s statement, the employer’s statement, and the personal statement to understand the condition and how it impacts the claimant’s ability to work.

    The insurance company may also consult with medical professionals, such as nurses or physicians, who specialize in evaluating disabilities. These professionals help assess the severity of a claimant’s condition and its impact on their ability to work. However, since these professionals work for the insurance company, their findings can sometimes be biased.

    In some cases, the insurance company may require a claimant to undergo an Independent Medical Examination (IME). This involves an evaluation by a physician chosen by the insurance company. The purpose of an IME is to obtain an unbiased medical opinion about your condition and limitations—yet these “independent” medical exams are often biased in favor of denial.

    Once a claimant submits their claim to their insurer, they must wait for a decision. This period can be lengthy, especially for ERISA-governed claims:

    “Typically, an insurance company must render a decision on your claim within 45 days after you submit it,” says Leah Small, managing attorney at CCK Law. “However, they are allowed to take up to two 30-day extensions. In order to do so…the extension must be due to circumstances outside the insurance company’s control, and they must notify the claimant, prior to the deadline, that they’re going to be taking an extension.”

    Note: While reviewing a long-term disability claim, insurers may employ surveillance tactics to try to discover a reason to deny your claim. They may do this in person or through online surveillance. This underscores the importance of being honest and accurate in your claim forms.

    What Happens When an LTD Claim Is Denied?

    If an insurance company denies an initial claim for long-term disability benefits, then the claimant needs to remember that this is not the end of the road. Claimants have the right to appeal a denial of their claim. Under ERISA, the period to file this appeal is usually 180 days.

    How Long-Term Disability Administrative Appeals Work

    An LTD claimant can strengthen their claim during the appeals stage by submitting additional evidence. It is often the best time to contact legal counsel, too. Read our article on the administrative appeal stage for more information.

    Other Considerations for Long-Term Disability Claimants Filing an Initial Claim

    The initial claim stage has a lot of aspects that can be confusing when someone is unfamiliar with them. For example, someone filing for long-term disability benefits may wonder if these benefits are taxable. Others may wonder what happens to their LTD benefits if they were to lose their job.

    CCK Law has been helping LTD claimants since 1999 get the benefits they need. Our team has gone up against all the big-name insurers and knows how they operate. As such, we also know about many of the aspects affecting LTD benefits, including:

    Call Chisholm Chisholm & Kilpatrick Today

    The initial claim stage is the first phase of the LTD process and can be challenging. Luckily, it is not something you must handle on your own. Chisholm Chisholm & Kilpatrick has been helping long-term disability claimants for over 25 years and may be able to help you, too.

    If you need help with your initial claim, appeal, or lawsuit, then CCK Law is prepared to analyze your case to see if we can help. Call us today at (800) 544-9144 for a case evaluation with a member of our team.