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Tips for Completing Your Long-Term Disability Claim and Update Forms

Types of Long-term Disability Forms Insurers Typically Require

When first applying for long-term disability benefits, initial claim forms are usually sent in a packet by the insurance company. These packets generally contain three types of forms: the claimant statement, the attending physician statement, and the employer statement.

The Claimant Statement

The claimant statement is your way to explain to the insurance company what your disabling condition is, why you feel as though you are disabled from it, and what your daily life is like. Along with the claimant statement there is typically a medical authorization form, which allows the insurance company to request medical records on your behalf.  The insurance company will likely ask for a list of your treatment providers. Providing a complete list of medical providers allows the insurer to request medical records from each so that the most accurate picture of your disability can be presented. You may also request and send these medical records yourself to ensure that your insurance company receives them.

Information regarding any other sources of income you receive, such as social security or veterans’ benefits, will also be requested by the insurance company in the claimant statement. Depending on your policy, your insurer may offset these benefits. For example, if an individual is paid $2,000 per month from their long-term disability policy and $1,000 per month in veterans’ benefits, the insurance company may deduct that $1,000 from your LTD benefits. This policy is generally intended to prevent people from getting paid twice for the same disability.

Tips for completing the claimant statement

When completing your claimant statement, it is crucial to be both accurate and precise. Do not downplay or exaggerate your symptoms and the effect your condition has on your life. When describing your limitations, use accurate, precise language and avoid extremes. For example, if your disability limits the amount that you are able to drive, one might casually say “I never drive,” in comparison with the amount they were able to drive before. However, if you were to write that you never drive on your claimant statement and the insurance company captures surveillance of you driving, your claim could be discredited.

“Typical Day Question”

On the claimant statement, insurers may ask what a typical day is like for you; this can include information such as what time you wake up and what your daily activities can include. With this answer, the insurance company may be looking to see if you engage in activities that indicate that you are capable of working. Once again, we encourage accuracy and precision as your goal when completing the claimant statement. Go into detail as far as your limitations are concerned and how you feel throughout the day. For example, if your condition leaves you feeling tired throughout the day and you require a daily nap, it is important to report it on the claimant statement as it can provide a clearer picture as to how your symptoms affect your ability to work.

Space Limitation

On many claimant statement forms, there is limited space provided to answer the questions being asked. Do not feel limited by the amount of space on the claimant statement. If your condition, treatments, or symptoms require further explanation, you can submit an attachment along with this form that goes into further detail. Answer the questions being asked as sufficiently as possible and if you feel as though these questions do not paint a full picture of your disability, go into further detail.

If you are attaching additional information to your claim form, be sure to note “see attachment” in the space provided so your insurance company will know where to look for this answer.

Attending Physician Statement

An attending physician statement is sent by your insurer to be completed by your doctor. This statement is meant to get your doctor’s opinion on your condition and symptoms as well as to inform on the treatment being administered. Doctors are asked to provide information detailing your limitations and future prognosis. Occasionally, these forms may be separated to describe either physical or cognitive/mental restrictions; be sure that your doctor is using the correct version of this form when addressing the symptoms you experience.

Effective communication with your doctor throughout the course of your condition is crucial to your long-term disability claim. Keeping your doctor informed with accurate descriptions of your symptoms can ensure that your medical records are consistent with the rest of your paperwork.

Tips for completing the Attending Physician Statement

We often recommend that our clients make an appointment with their doctor when it comes time to complete the attending physician statement for a few reasons. First, making this appointment ensures that your doctor sets aside time to complete the forms, which  can prevent missing deadlines. Making an appointment may allow you to leave with the form completed that same day. Second, this allows you to go through the form with your doctor to be sure your condition is documented as accurately and precisely as possible.

Employer Statement

An employer statement is usually completed by your human resources department or supervisor. On this form, employers are instructed to list your job duties, inform of the last day worked, the salary you collected, and other information of this nature.

Update Forms

Long-term disability insurers may require additional forms throughout the claims process, known as update forms. Update forms are intended to determine if the claimant’s condition has changed and are typically requested when the insurance company is reevaluating your disability claim. Update forms will likely contain another claimant statement and physician statement; employer statements are not generally included in update forms. The claimant and physician statements at this stage will likely be different from your initial forms, specifically asking about changes to your condition.

NOTE: The names of these forms may not match exactly what your insurer calls them, but the general intent of the forms is consistent across insurers.

What to Look for in Your Long-Term Disability Policy

It is incredibly important to read and understand your long-term disability policy before completing these forms. One of the main aspects of your policy you should pay close attention to is how it defines “disabled.” Definitions of disability vary per policy and insurer, and this definition often changes after one, two, or three years of collecting benefits. Definitions of disabled usually begin as pertaining to one’s “own occupation,” meaning that your disability prevents you from working at the job you did prior to becoming disabled. This definition can then change to an “any occupation” definition of disabled, which asks the question of whether your disability prevents you from working at any job.

Another aspect of your disability policy to be aware of are deadlines that may apply to the claim and appeals process. Long-term disability policies can require a claim to be submitted within a certain time frame. Missing the claim submission deadline can prove fatal to your long-term disability case. Additionally, there may be a deadline for the submission of the claims forms discussed above. You are responsible for gathering and submitting evidence to support your long-term disability claim. If you believe that you need more time to gather this evidence, you can call your adjuster to request an extension. Make sure to always get notice of this extension in writing.

If you are experiencing difficulty understanding your policy, try recruiting a trusted friend, family member, or attorney to assist you. If you would like to see if our office is able to assist you, contact our us at 401-331-6300 for a free consultation.

Category: ERISA Law

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