Eight Tips for Filing a Long Term Disability Claim
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Eight Tips for Filing a Long Term Disability Claim

Jun 29, 2020 | Disability Law, ERISA, Federal Disability Retirement, Long Term Disability

By Molly Friedman, Esq., 301.563.6685

  1. Talk to Your Treatment Providers

It is essential that your medical records will reflect your inability to work. Building strong medical records is critical to the success of your LTD claim. Speak honestly during appointments about the symptoms and limitations you are experiencing and how they impact your ability to work. You must be in treatment with a doctor who will support your claim before ceasing work. If you have not discussed the possibility of filing for disability benefits with your doctor, schedule an appointment via telemedicine or in-person appointment.

  1. Don’t Wait To File

The sooner you file, the sooner you are able to begin the process of receiving benefits. You may start the long term disability claims process by requesting a copy of your Long Term Disability Retirement claim forms and policy from your Human Resources Department. If the Human Resources Department is unable to provide a copy of the application, you may need to reach out to your carrier.

  1. Know What Type of Coverage You Have

You may have both Short Term Disability Insurance and Long Term Disability Insurance. Qualifying for Short Term Disability benefits does not guarantee you will receive Long Term Disability benefits.

Once you obtain a copy of your Long Term Disability Plan Document, review it carefully. Look for the definition of disability that you have to meet in order to qualify for benefits. Often, the definition of disability changes after the first two years of benefits. Additionally, many policies have certain clauses that limit coverage. Most policies have a “Pre-Existing Conditions” clause that may impact whether your condition is covered. Many policies place limits on time for recovery of benefits based on the nature of the disabling condition, such as mental health-based claims.

Keep the definition of disability and potential limitations in mind as you work on your application as the central question you are trying to answer.

  1. Know What to Expect In Your Application

An application for Long Term Disability Benefits contains several components. Be aware of each of the parts and follow up with your carrier to ensure you have completed and submitted all documents.

  • Employee Statement: This is the central piece of your initial application. It may appear to be a simple form, but is very important and should be filled out with consideration. Draft all your answers before you complete and submit your application. Keep in mind what symptoms and conditions you may be experiencing and what symptoms are preventing you from working. Be honest about the extent of your symptoms. Claims that seem too extreme may be deemed unreliable and cast doubt on your entire application.
  • Employer Statement: This section of the application needs to be completed by Human Resources at your employer. Follow up with them to ensure they are completing the document promptly. Your employer may request to see a copy of your Employee Statement, but providing it can be at your discretion.
  • Attending Physician Statement: An Attending Physician Statement is a form provided by the carrier for your doctors to complete.
  • Individuals receive competent and appropriate treatment from several different credentialed professionals, such as Licensed Certified Social Workers (LC-SW), physical therapists, and occupational therapists. However, insurance providers tend to place more weight on the medical opinions of doctors. Therefore, try to have the APS completed by a physician, or co-signed but a doctor who supervises the practice.
  • The best way to obtain an APS is to make an appointment with your doctor to discuss the document and review it together. That way, you can provide insight into other areas of treatment you receive that he/she may not be aware of. Also, inform your physician that they may be contacted directly by your insurance carrier. Make sure your physician knows what to expect and answers honestly. Doctors may be tempted to select the most extreme answers in an attempt to help. However, the best APS are ones that accurately reflect your symptoms and abilities.
  1. Create a Strong Medical Record 

As discussed in tip #1, medical documentation is at the center of any strong application for LTD benefits. Begin gathering medical records.

Start by making a list of all of your current treating physicians, including primary care practitioners that may not have treated you specifically for your disability.

Frequently, as part of processing your application, an insurer may request documentation from your physicians by a specific deadline. It is incumbent that you follow up with your doctors to ensure they meet deadlines.

Be sure to continue to treat regularly throughout the application process and any subsequent appeal process. For more information regarding the importance of consistent treatment, see my blog post here.

  1. Stay Organized 

The process of filing a Long Term Disability Claim can be confusing and complicated. The best way to ensure you are taking all the necessary steps is to stay organized. Keep all correspondence from your carrier and note any upcoming deadlines. If your claim is denied, there is a limited time to begin the appeal process.

Be vigilant about following up with your carrier. Once your application has been received and processed, you will receive written notice from your insurance carrier. This notice will confirm receipt of your application and provide you with a claim number. If you do not receive this document, contact the insurance company to follow up.

Your file will generally be assigned to an individual at the insurance company whose job it is to review your claim. Speaking with this individual without an attorney on the phone with you can be problematic. If the carrier wants to schedule an interview with you regarding your claim, it is strongly recommended that you consult with an experienced disability benefits attorney.

Respond to all requests from your insurer in a timely fashion. Respond to all requests to the best of your ability, even if they may seem duplicative. If you do not have information that was requested, such as a doctor you are no longer seeing, explain in writing why you cannot submit it. Also, pay attention to any correspondence sent from your carrier requesting you undergo an Independent Medical Exam, often referred to as an “IME.” The scheduling of an IME by the carrier is usually not good news for you, and you should consult with an attorney if you have not already.

  1. Be Aware of Your Activities and Online Presence 

When you are applying for Long Term Disability Benefits, it’s essential to monitor your social media and online presence. Be cautious about posting anything to social media that shows you participating in activities that may be viewed as contrary to your claimed disability, i.e., physically intense activities if you are experiencing chronic severe back pain.

Some insurance companies also use covert surveillance to monitor activities of claimants, looking for activities that seem to contradict claimed disability. Just like your disabling condition, your disability application should not prevent you from living your life. However, it is wise to be cautious.

  1. Work With an Experienced Long Term Disability Claim Lawyer

The process of applying for long term disability benefits can be difficult, especially during a tumultuous time of balancing health concerns with the loss of a career. If you aren’t well, the last thing you want to do may be to deal with an insurance company, or following up with doctors to obtain documents. At the Law Office of Andalman & Flynn, we have over 20 years of experience working with individuals through the process of how to file a long term disability claim. Working with an experienced attorney from the beginning of the application process can prevent common application mistakes that often cause individuals to be denied the benefits they clearly deserve.

About Andalman & Flynn, P.C.: Founded in 1998 in downtown Silver Spring, Maryland, Andalman & Flynn has forged a distinguished reputation for legal excellence. The firm represents individuals seeking disability benefits throughout the country and practices family law throughout Maryland and the District of Columbia. The firm focuses on cases that impact the rights of everyone, and are there for clients when responsive legal help is most critical. The firm has provided legal analysis on national and local television and radio, and their attorneys often testify before legislative bodies and are routinely invited to contribute to prominent legal publications. For more information about Andalman & Flynn, please visit the website at andalmanflynn.com or call 301.563.6685.