Quiat on Claims
If At First...
Many times the first thing a caller will ask us is, “Do I really need a lawyer to help me with this disability income insurance claim?” One reason it is difficult for us to answer is that we may profit from telling the truth: “Yes, in the vast majority of cases you really do need a lawyer who knows disability income practice inside and out”.
Pursuing disability income claims is the way we make our living. But, there are much more cogent reasons for having a knowledgeable insurance practitioner in your corner. Your attorney works for you and knows all of the tricks and traps of filing and successfully prosecuting a disability income claim.
One of the most damaging things a claimant can do is get off on the wrong foot when filing the original claim. Filing a disability income notice of claim, where one requests the appropriate claim application forms is not the same as filing a notice of claim in an auto accident. Don’t be lulled into a casual notice of claim in disability income insurance.
Your first notice, even though it only requests forms, is most important because whatever you say to or file with the insurer will be retained throughout the life of the claim. Omit an important fact or describe it hazily and it will haunt your claim forever, being cited again and again by the insurance company at every point in the proceedings.
Before you file your claim, two issues must be resolved:
* You must make certain your treating physician agrees that your medical condition supports your claim for disability insurance.
* Your policy must be carefully read and understood to determine if your claim is covered and the required procedure for making a claim. The policy is your contract with the carrier and you can bet your bottom dollar that if your application can be deemed deficient under the policy terms, it will be.
Your claim should contain a clear statement of why you think you are entitled to disability income benefits and supply the evidence to support your claim. Just telling the carrier you are filing a claim is not enough. Details are necessary to move the claim forward. And, those details had better be correct and apropos because any omission or mistake will undermine your claim so long as it shall live.
The claim should include:
* Full details on the policy you are claiming under.
* Full details on the illness or injury which is the basis of your claim.
* Full details on your employer, your occupation and the duties of your occupation which you claim you can no longer perform.
* Copies of all medical reports and hospital records which substantiate your illness or injury.
* All occupational or vocational testing records you intend to use to support your claim that you cannot perform the duties of your occupation.
* All pay and income records to support your claim for benefits.
As you may imagine, all of these documents will be thoroughly examined by the carrier as to their pedigree and accuracy. Misstatements and omissions will be carefully catalogued and be used against you throughout the proceedings, no matter how many times you correct the misstatement or provide the omitted material.
Errors committed in your first submissions create a situation in which you not only have to prove your case, but also have to “unprove” the error or omission you made under oath.
Getting a disability income insurance carrier to pay on a properly submitted claim is tough enough. Getting the company to pay after defective or omitted claim documents is darn near impossible.
Why take the chance?