Watch this video to understand how a long-term disability insurance adjuster looks at your newly filed claim for disability benefits.
The step-by-step process a claims adjuster goes through in evaluating a long-term disability claim:
- Verification of Insurance Coverage: Confirm the claimant was actively at work at the onset of disability. In order to be entitled to benefits, you must have been insured under the policy. “Confirming coverage” is the first thing a claims adjuster will do.
- Occupation Analysis: Determine the claimant’s occupation and the substantial material duties of that occupation. Most long-term disability insurance policies define “disability” as the inability to do your own occupation (and usually) as that occupation is performed in the national economy.
- Medical Record Evaluation: Examine the medical records for documented restrictions or limitations that prevent the you from performing your occupation as it is generally performed in the national economy. Do the medical records make clear what your restrictions on limitations are? Then, the insurance company will look to make sure that these restrictions are scientifically valid. Generally speaking, if you doctor simply writes down what you tell the doctor about what you can’t do, that will not be enough to get benefits.
- Diagnosis Verification: Assess if the documented restrictions and limitations align with the diagnosed condition. Having been diagnosed by a medical specialist is very helpful, but not always necessary. Having your general practitioner offer an opinion on your (“one in a million” disease probably won’t cut it.
- Pre-Existing Conditions Check: For recent employees, verify if the claimed disability is related to a pre-existing condition. “Lookback periods” differ. If you have any question about whether your disability will be covered, or whether will be judged to be due to a preexisting condition, consult with an experienced long-term disability attorney first.
- Claim Submission Review: After submission of all required forms, the adjuster will conduct an extensive interview with the claimant. A pre-interview consult with an experienced long-term disability attorney can be very helpful.
Other Long-Term Disability Resources
Be sure to visit the BenGlassLaw Long-Term Disability YouTube Channel
I Just Got My Long-Term Disability Denial Letter. Now What?
How to Appeal a Long-Term Disability Denial
How Do I Find the Right ERISA Long Term Disability Attorney? The Key to Success