In this video, CCK’s Long-Term Disability Insurance Litigation Team discusses:
- Overview of LTD insurance forms
- Initial Claim Forms vs. Update Forms vs. Employer Forms
- Read your Long-Term Disability Insurance Policy – What to look for
- Deadlines and Extensions
- The Claimant Statement
- Tips for filling out Claim Forms
- Attending Physician Statements (APS forms)
- Tips for getting APS forms completed by your doctor
- Summary of LTD Form Tips
Mason: Good afternoon and welcome to our Facebook Live. Today we’re going to be talking about long-term disability claim forms and we’re going to talk about some tips in completing those. With me, I have Leah Small, who is an attorney in our insurance litigation practice and Melanie Boyer, who is a paralegal in our insurance litigation practice. My name is Mason Waring and I’m a partner in the practice. Melanie, could you start us off by giving our viewers an overview of what types of long-term disability claim forms that insurance companies typically require?
Melanie: Sure. So, typically on an initial claim when you first just become disabled and you’re filling out your forms, it’ll come in a packet usually with three types of forms. The first would be a claimant statement or something for you to fill out to explain to the insurance company why are you disabled, what disables you? That typically will come with a medical authorization form as well for you to sign so that the insurance company can request medical records on your behalf. The next form would be what is typically referred to as an attending physician statement or a form that your doctor would complete on your behalf to explain why you’re disabled, what your treatment is, what the symptoms are of your condition, things of that nature. Then the last form would typically be an employer form for your job. Usually your human resource department or your supervisor to complete to explain what your job duties are, what the last day worked was, what your salary was, things of that nature.
Mason: You mentioned initial form. So, there is usually two types or two situations where the insurance company is requesting claim forms relative to a long-term disability claim. You have the initial claim when you’re filing the claim for the first time and then there are also update forms where you’re on claimed but the insurance company is asking you for information to figure out if your condition has changed. They usually do that when you’re reevaluating your claim. Leah, could you tell us about some of the differences between the initial claim form packet that Melanie described and what you might be asked to complete for an update?
Leah: Sure. For a claim update, you still usually get a claimant statement which again is asking for you to describe your condition, your symptoms, what keeps you from working, and what your day to day is like and also the attending physician statement or the form that your doctor fills out to describe what your current condition is but usually that you don’t have to do an employer statement anymore. It’s just like the claimant statement and attending physician statement. As you said it focuses more on how your condition has changed if it has, rather than just getting the general information that they’re looking for on the initial claims.
Mason: Great. We’re using particular names to talk about these different forms. We’ve talked about the claimant statement which is a claim form that you would complete. We’ve talked about the attending physician statement which is a form that your doctor completes, and an employer form which your employer would complete. They can have different names and so don’t get hung up on that but those are the labels that we’re going to use to talk about the general concepts there. These claim forms can be different and they vary from insurance company to insurance company, so each company will have its own forms that they have created for these purposes. Even the insurance companies themselves might use different forms at different times, so there can be some variation when we’re talking about these.
But today, we’re just trying to give you some information on the general concepts and the general types of forms. It’s a really big topic. We’re going to move pretty quickly through it to give you a good overview of it. If you have any questions just type it into the comments and we’ll do our best to answer that. Our plan is to dive deeper into some of these issues and actually talk about some of the specific insurance company’s claim forms in future Facebook Lives. Today we’re going to give the overview and then in the future, you can expect to get some more detailed videos. So make sure you like us on Facebook so you get notifications of when we’re going to do those videos. Before we dive in, we’re going to start by talking a little bit more about the claimant statements and we frequently tell our clients this that it’s really important to read your policy and you need to understand the terms in your policy before you start completing these forms because you need to understand what your rights and obligations are. Leah, what are some examples of things in your policy that you should be looking for when or before you start filling out these claim forms?
Leah: Sure. One of the main things you want to look for is the definition of disability which will appear in your policy. Definitions of disability change from policy to policy from insurer to insurer and even in one policy’s definition of disability, the definition often changes after 12 months, 24 months or 36 months. It typically, not always but typically starts as whether you’re disabled from your own occupation or the work you were doing when you became disabled and after a certain period of time will change to whether you’re disabled from any occupation which will look at whether you can do any job. That’s the number one thing you want to look for because that —
Mason: I’m sorry. The definition of disability is important because you need to know what kinds of information and evidence you need to provide to the insurance company to prove your claim, right?
Mason: Sorry, continue.
Leah: No it’s okay. Another thing to look for in your policy is any deadline that might apply. Long-term disability policies often include that you have to submit your claim within a certain time frame. Otherwise, you may lose your rights, so you want to track that if that’s in there.
Mason: So if you’re filing an initial claim you might have a limited amount of time to file the claim forms with the insurance company?
Mason: And when you’re making an initial claim, sometimes- I’ll just talk from our experience, if someone comes to us and they need help making an initial claim, we don’t always have the claim forms off hands. Sometimes we’ll telephone and write to the insurance company telling them, giving notice of the claim, telling them when the date of disability is, what the nature of the disability just generally and asking for any claim forms that they require to be submitted. That’s on an initial claim. You don’t actually have to have the forms in hand necessarily to get the claim made to meet that deadline but I guess the moral of the story is you don’t want to wait after you become disabled to make your claim because of deadlines. You need to pay attention to what they are and meet them because depending on what state you’re in, what jurisdiction you’re in, being late could be fatal to your claim. Sorry I interrupted again.
Leah: No, that’s okay.
Mason: It was a great point.
Leah: Along those lines, although this usually doesn’t appear in the policy itself but when the insurance company sends you those claim forms, they’ll often put a deadline of when you must submit them and send them back to them and so that’s another important deadline that you need to track. They might put a deadline on your forms, your doctor’s forms and any of the employer’s forms and they tell you it’s ultimately your responsibility to get your doctor to submit the form, to get your employer to submit the form.
Mason: I see Melanie nodding her head because Melanie fills out claim forms or helps our clients gather the information, requesting the medical records and answering the questions. Sometimes we’re waiting for the medical records or waiting for the attending physician statement from the doctor and we need more time. What are some tips if you don’t have enough time? If you’re not going to meet that deadline from the insurer to get the claim forms in, let’s say the case usually is we’re waiting for the attending physician statement from the doctor. What are some tips for our viewers if they are handling this themselves to get some more time?
Melanie: Sure. First things first; you want to make sure that you get everything in writing. It’d be fine to place a phone call to you adjuster or the insurance company letting them know you need more time or you need an extension but make sure you confirm that deadline in writing. So that way if something happens down the road, you have proof that you got this extension from them. The other thing that you could do is if your forms are completed, you can submit those basically making a good faith attempt to complete the forms by their deadline and just let them know that you just need more time for the attending physician statement or the medical records or whatever it is that you’re waiting on. It shows the insurance company that you are making a good attempt to meet their deadline and that you’re just waiting on things pretty much beyond your control at that point.
Mason: It’s a good idea to not wait until the day before or the day of the deadline. I think we usually take a look about a week out, a week or two before the deadline and if we don’t have pretty good confirmation from the doctor that we’re going to get the form back to get to the insurance company. We tend to reach out at that point, so that we have enough time to have a with a dialogue with the insurance company and make sure that we’ve gotten a letter from them an writing confirming the extension or we’ve sent something to them doing that. I interrupted you for I think a second or third time Leah, because we just–
Leah: Lots of good information here.
Mason: Continue on, please.
Leah: The final thing is, as we’ve talked about, your policy is what governs your claim. It’s really important that you read it and understand it and if you’re having any trouble understanding it, it’s a good idea to reach out to a friend or family member or you can come to lawyers such as ourselves and they can help you understand it and make sure that you’re meeting your deadlines and submitting what you need to submit, so your claim is protected.
Mason: Good. Good advice. So let’s- we’re going to talk now more about the claimant statement and that’s the form that you will need to complete that explains the nature of your disability. It should, when completed properly, tell the story and explain what keeps you from working in your job or if the definition of disability is any occupation, what keeps you working reliably or consistently in any job. Let’s talk a little bit more Melanie if you could about the types of information that’s going to be requested in that form.
Melanie: Sure. So the claimant statement almost always ask for two things: a list of your treatment providers and any other income that you’re receiving. We’ll start with the treatment providers. It’s important to make sure that you provide them with a full and complete list of everyone you’ve seen relative to your disability so that they can request those records on your behalf. It’s also helpful for you to request those records on your behalf and then submit them yourself to ensure that the insurance company has everything they need to evaluate your claim but you definitely want to give them a complete list. Any physicians you’ve seen, any hospitals you’ve been admitted to or the walk-in that you’ve gone to, any facility that you’ve had testing done like an MRI or an X-ray. You want to make sure that they request everything and that they receive everything to evaluate your claim.
The next thing with the income, you want to make sure you report any other income that you receive to your insurance company. It could be Social Security benefits either disability or retirement, it could be Workers Compensation, it could be even veterans benefits that you get from the VA. This is important because depending on your policy, a lot of times they’re able to offset those benefits. So, essentially if you receive $2,000 for your long-term disability benefit but you receive $1,000 from Social Security, the long-term disability insurance company can deduct that $1,000 that you receive from Social Security and only pay you the $1,000 difference. You’re essentially receiving the same income, it’s just from two different places. It’s just to prevent basically getting paid twice for the same disability. The other big thing that they typically look for is what a typical day is like, what your activities of daily living are, what you do day to day that has either been changed or impacted by your disability. You want to make sure that you tell the whole story. What’s changed? What actually disables you? They’ll ask about your condition and your treatment as well and what steps you have to do to actually effectively treat your condition.
Mason: Great, thank you. Leah, what are some tips for our viewers? We probably have some people that are either- might be now staring at blank claim forms saying, what do I do? What are some tips for them when they’re doing that?
Leah: Generally, our advice is when you’re completing these claim forms you want to be accurate and you want to be precise. When you’re talking about your conditions and your symptoms, you don’t want to downplay your symptoms but you also don’t want to exaggerate either, you want to be just accurate about what you experience. And similarly, we always advise our clients that you should use more general language rather than extremes. That means using words like typically or generally, often rather than, “I always do something”, or “I never do something.”
Mason: That’s because in life there aren’t many definites, right?
Mason: The example that we commonly use is, let’s say you have a chronic pain condition and you’re able to drive yourself to a doctor appointment or to the grocery store. You can drive a couple of times a week but you’re not able to drive nearly as you did before. You can’t drive reliably or consistently. You certainly can’t do it every day necessarily and maybe after you drive a short distance you’re in increased pain. Or maybe you can’t take your pain medication before you drive so you have to structure your entire schedule around just getting yourself prepared and ready to drive to do that. If you’re talking to your friend you might say, “Man, I can never drive anymore, I have so much pain. I can never drive.” The fact is you can drive but you just can’t drive like you did before and it’s very difficult to do that. The way we speak to our friends and family is not always as precise as reality. Those more general terms typically reflects reality but if something is definite and you literally cannot drive and we have clients that cannot drive anymore and never drive, if that is accurate, then that is what you report. You just want to make sure that you’re reporting what is accurate. The risk is if you’re down to driving just to your doctors appointments because you have nobody to take you and you have to get there and everything that I just said is true, if you’re caught on surveillance making that trip to the doctor’s office and you’ve reported on your claim form that you can’t drive, you’re going to be called a liar. You don’t want that. That’s a really good point, Leah.
Leah: Another tip is, Melanie mentioned the typical day question. And again when you’re answering this you want to be accurate and precise but it’s just good to keep in mind that the insurance company, even though you’re talking about what time you wake up and what your activities are, they’re looking to see whether you’re engaging in activities that indicate that you’re capable of working even though they’re not specifically asking about work activities. That’s just one thing to keep in mind when you describe that but again, accuracy and precision are your goals.
Mason: I think people have a tendency to maybe be vague and I don’t think that’s really good to do. When you wake up is important and how you feel when you wake up. And I’ll give you some examples. Let’s say you wake up at 7:30 every day but it takes you 30 minutes to warm your body up and actually get moving. You’re not able to spring out of bed and hop in the shower and get going and eat. Maybe you don’t feel good when getting out of bed, maybe you have to wake up, take some medication, stretch for 10 minutes, go through a routine which would prevent you from being able to get to work on time and keep a set schedule. Maybe you have trouble sleeping chronically and because of that you’re tired during the day and you have to nap during the day or maybe you’re taking medication or you have a condition that makes you drowsy during the day and you need to nap. So, report if you nap. How frequently do you nap? Do you nap every day? Is it twice a week you nap? What happens? Do you need to lay down? Do you need to elevate your legs? In addition to just going through your day chronologically, talk about the factors or the impact that your condition has on your day and what you’re able to do and not able to do. It’s an important question and at the end of the day, you want to convey to the insurance company what it is to be you and what you struggle with on a daily basis.
Leah: Another tip is oftentimes these claim forms will be one, two, maybe three pages. They’re often very short which means they often give you very little space to answer the questions that the insurance company is asking. We always recommend, don’t feel limited to the space they provide you. If your condition, your symptoms and your treatments require a further explanation that does not fit in that space, you can submit an attachment with your forms to go into more detail and give the full explanation that is needed to fully document your disability and your condition.
Mason: That’s something we do for our clients and advise them on regularly is using that attachment. As Leah said, the claim forms rarely provides enough space to explain your situation. The questions can be confusing and they may not be asking the right questions that prompt you to give the answers that give that full picture of what you’re dealing with. I guess just to talk about the mechanics a little bit here. We typically tell the clients to have the- Let’s just pretend you have a blank sheet of paper here. Write your name on it, write the date. If you have claim number, put your claim number. You can write attachment to my claimant statement and then explain what it is you’re suffering from. I guess one way to approach it would be to first look at the questions that are asked on the claim form and answer those in that attachment and then read through that and determine, does this tell my story? Is there more to this that’s not being explained here? And then explain that. Do you have any other tips Melanie or Leah?
Melanie: No. I think that it was just make sure that you answer the questions fully regardless of the amount of space that you’re given and also if the question is not being asked, don’t be afraid to still answer the question that’s not asked. Still write the full story. For example, if you have cognitive impairment from medications but it doesn’t ask what the side effects of your medications are, it’s still important to note what those side effects are because it does impact your disability or contribute to your disability rather.
Mason: I guess going back to the mechanics of it all. If you’re relying on your attachment to answer one of the questions in the claim form. If question one asks what is a typical day for you look like and you’re explaining that in your attachment, on the claim form, write “See my attachment” so that you’re essentially incorporating the attachment by reference into the claim form and the insurance company will know to look and read that attachment for that answer. It’s great. Cool. Great tips. I think we’ll move on to attending physician statements now and that perhaps at least in my experience, the hard part here is just getting them done. The treating physicians are very busy. Their daily mission is to treat patients and not fill out paperwork. And so the hard part about these forms is getting these done. Melanie, what types of questions would you expect your doctor to have to answer on these forms?
Melanie: Sure. Typically the forms would look like asking about your treatment, what your symptoms are. Probably the most important aspect of these forms would be asking along the lines of what your restrictions and limitations are, either physically or sometimes cognitively or mentally. You want to be sure that your doctor is filling out the correct segment for your condition. For example, if you have cancer but you also have anxiety and depression, you want to be sure that your doctor is filling out the physical section of the form for your cancer and reporting your condition accurately to make sure that everything is consistent through your medical records. The other thing here too is they will also ask if you’re seeing any other physicians or a lot of times the insurance company will ask for your medical records as well. You want to be sure that you’re accurately and precisely reporting your symptoms to your doctor so that it’s documented not only in the forms and your forms but through your medical records as well.
Mason: Great. Do you have any tips Leah, for getting these forms completed?
Leah: Absolutely. We did earlier do a video about talking with your doctors, so you can check that video out and that will go into a lot more detail about this kind of information because that video will apply to this as well. We often tell our clients they should try and make an appointment with their doctor and they can either just bring the form with them, and then so while they’re there their doctor can fill it out. This is important for a couple of reasons. One, it ensures your doctor will set the time aside to do the form and ideally, you can leave with the form that day.
Mason: Overcoming the big hurdle and just getting it done.
Leah: Yes, getting it done so you can leave with it that day and make sure the insurance company gets it. Additionally, it allows you to go to the doctor, go through the form with your doctor and so you can accurately and precisely describe to him symptoms, what your condition, how it affects you. So your doctor can accurately report that in the attending physician statements as well.
Mason: Hopefully, over time you’ve been reporting your symptoms and how they impact your ability to function to your doctor over time. It’s important to do that before you get the claim form so that that is reflected in your medical records. Your medical records are key evidence that the insurance company is going to look to. Don’t just have these conversations with your doctor when it’s claim form time. Try to do it beforehand when you’re there for your regular visits. Don’t just say, I’m okay, thinking nothing’s really changed from last time. Go into detail and talk about what’s really going on with you at the moment.
Leah: Absolutely. One thing also to keep in mind both you and your doctor when filling out these forms is you want to be wary of the wording of the forms. Melanie touched on this a little bit. It will often ask about physical and behavioral or mental health restrictions. If you’re disabled from a physical condition you want to make sure that your doctor is addressing that aspect rather than the behavioral mental health if that doesn’t apply to you. Additionally, sometimes the insurance company will ask questions on the attending physician statements that don’t always reflect what your actual capabilities are. For example, we’ve seen forms where they ask what kind of work is this person capable of doing and the lowest level they can give you is basically sedentary work which implies that you’re still able to work eight hours a day, five days a week. But that might not be the case. Your doctor might think you’re unable to work at all but because that’s the lowest option, they just check it off and don’t think about the impact on your claim.
Mason: That highlights the importance of reading your policy- of reading and understanding the policy terms before you embark on the mission of completing the claim forms so that you can let your doctor know, hey, this is the disability test that I need to meet here. If you’re a surgeon and you can’t use your hands but your mind is fine and your policy is own occupation from your specialty as a surgeon, you may be disabled and entitles you to benefits just because you can’t use your hands. Even though you could maybe teach or do something else and so it’s important that you doctor know that but you need to know that first and read your policy. You also touched on the different types of forms for the physical conditions and the mental health conditions. Claimants that have conditions like Parkinson’s Disease or MS, the claims are maybe a little more challenging because there are so many facets and variations to the symptoms that people suffer as a result of them and there can be real significant physical symptoms. There can be significant cognitive and mental illness symptoms that result from those conditions and so you may need both forms. You have to really just kind of look at them and see what makes sense. If you think you have the wrong claim forms, you could reach out to the insurance company.
So let’s say you have a physical disability and they only sent you a mental health disability form. You can reach out and say, “Hey, look, I have a physical disability. Please, send me the claim forms for that.” Sometimes they’re available online. If things don’t seem right to you, if you think someone’s trying to lead you down the wrong path and you don’t fully understand what’s going on, it might be a good time to talk to a friend or a loved one you trust that can maybe give you some perspective on the situation and help you sort things out. It also might make sense for you to contact a lawyer to advise you on that. We do advise people on completing claim forms for the initial claims and the update claims. It’s something we deal with on a regular basis and it can be helpful to have some experienced eyes look at it to sort things out. Do you have any other tips regarding the attending physician statements?
Leah: I think that covered it pretty well. One thing I know we mentioned earlier is to keep in mind that the insurance company’s forms vary from insurance company and then you mentioned that also at times insurance companies can change on their own forms. If you’ve been on claim for a while, your doctor might have gotten used to filling out the same claim form every time they do an update and so he might almost be on autopilot. So it’s good to keep in mind again going back to reading it carefully and going through it with them. If they change it, that they’re not caught off guard and are still filling it out accurately.
Mason: Good. Well, I think we’ve touched on a lot here. I guess could you sum it up? So now and we’ve moved to this big topic and again the plan is to make this a series where we’re going to dive deeper into some of these issues and talk about the specific claim forms for the specific insurance companies and walk you through those. Like us on Facebook, so you get notification when those come out. Leah, can you sum up what we’ve gone through here, kind of give the checklist for our viewers that are dealing with this?
Leah: Sure. Number one, like we said read your policy is the first thing you should do, so you understand the deadlines and what kind of evidence you’ll need to submit in order to meet the definition of disability that applies to you. Second, because these forms can be tricky and time consuming and depending on your insurance company, they could be requested updates every few months. You want to make sure you’re submitting your forms on time or requesting an extension if necessarily well before the deadline, so you don’t lose out on any of your rights or benefits. When you’re filling out the forms as we’ve said many times accuracy and precision are your number one goals. That means don’t exaggerate your symptoms, your conditions but don’t downplay them either. Just be accurate. And use more general words, like generally, typically, often, unless you can accurately say that a definite, always, or never is correct. Finally, when it comes to the attending physician statements, it often helps to make an appointment with your doctor so you can go through the forms together and make sure he completes them on time. When you’re doing that you want to make sure again you’re reporting your symptoms to your doctor accurately and ideally you’ve been doing this all along at each of your appointments so that’s documented in your medical records.
Mason: Great. Certain claims can be complex depending on the circumstances of your disability or the terms of the policy. There’s no one size fits all type of advice in these situations but hopefully this was helpful and acquainting you with some of the concepts you’ll be dealing with if you’re handling the claims form yourself. If you feel like you’re in over your head, again if you have a friend or a loved one you trust that can advise you in this stuff, it makes sense to just bounce it off them. I don’t know if we mentioned it but once you have completed your claim forms and you have your packet ready to go, it would make sense to have someone read through it to make sure you’ve answered things correctly and you’ve accurately and precisely represented things. I mean, our client population is hardworking and wants to be working and they’re not complainers. So, they’re not great at reporting what’s wrong with them but someone who knows you and is around you may be better at identifying and saying, “Hey, look, you’re missing this. You should add this in because this is something that you deal with every day and you’re not reporting.” That’s a really good practice. If you’re in over your head and things are complicated, if you’re wrongly denied and you’re having trouble with your claim or the insurance company or you need to appeal, feel free to reach out to us. We provide free consultation and this is the kind of work we do each day. Thank you all very much for joining us today. And thank you for joining us today, and we look forward to talking again soon.