Disability Claims Process - FAQ

Your best bet is to contact a qualified law firm and start to assemble all the paperwork in your possession that supports your disability, including medical records, correspondence with the insurance company, etc.

Not necessarily. There are many internal deadlines (created by the policy) and statutory deadlines (created by law) that may apply to your case. Often your insurance company does not examine all the appropriate deadlines that may apply to your particular case and, regretfully, sometimes misstates those deadlines. A knowledgeable ERISA lawyer should be able to correctly identify the applicable deadline and see if your case can be placed "back on track."

The information in your appeal is very important because it establishes, in part, the "administrative record" that forms the basis of any future litigation of your case. Therefore, you should not undertake to prepare your own appeal -- at least without the help of a disability insurance lawyer knowledgeable in ERISA law.

Your physician is a very important component in your application for disability benefits. It is imperative that he/she supports your request for benefits. Therefore, you should make certain that your doctor fully understands your request and why, in your opinion, you believe you cannot perform part-time or full-time work. If your doctor still refuses to participate, consider obtaining a "second opinion" from another specialist in the medical field of your disability.

It is always a good idea to obtain copies of your medical records on a periodic basis. If the records are inaccurate or incomplete (or illegible), talk to your doctor about your concerns. Generally, he/she will be very willing to assist you in understanding your records and making certain they completely and accurately reflect your true medical condition. When you go to see the doctor, be sure that he notes the symptoms and the dysfunction, and it's a good idea to give him the notes that you've made -- being sure to mention specific functional problems.

Sometime your doctor will require reimbursement for the copying costs. This is most certainly true if you request a third-party company to copy the records for you. Generally, though, the costs are not exorbitant -- unless your records are voluminous.

Typically your doctor will complete the forms for you as a part of his care and treatment of you. If additional opinions are needed during the course of an appeal or litigation, then your doctor may request appropriate reimbursement for providing those opinions.

Most ERISA policies require the insured individual to "cooperate" with the plan administrator. Failure to cooperate may form a basis for denying benefits. But that is not to say that all insurance company requests are appropriate. Therefore, if you receive a request from your insurance company, it is best to consult with an ERISA-knowledgeable lawyer to determine how best to respond.

It can and often does. Surveillance can be used to determine what tasks of daily living you are capable of performing, like driving, carrying items or children, leaving the house to shop or socialize, engaging in sports activities.

Insurance companies often misuse the results of surveillance to form a basis for denying your claim. Therefore, if you believe you are being surveilled, it is imperative that at the very least you contact a disability insurance lawyer to determine your rights in this area.