You’ve had the policy since you started in your current job, but hoped you’d never need it. Unfortunately, an illness or injury has left you unable to work, and you think it’s time to file a claim. By understanding your policy and the application process, you may be able to save yourself time and aggravation.
As a workers’ compensation and long-term disability appeals attorney, I help clients who are struggling to get approved for the benefits they deserve.
What Does Your Policy Cover?
The first thing to do is to read and understand your policy. Each policy defines what the insurance carrier considers a qualifying disability to be, so you'll have to make sure your illness or injury meets those specific standards. Disability under your policy may be defined as a condition that prevents you from performing your current type of work, or it may require you to be unable to perform any work.
Your policy also outlines time limits for applying for benefits and any exclusions, such as pre-existing conditions and specific medical issues that aren't covered. Ensuring that you meet the requirements of your policy before applying can save you a lot of trouble down the road.
Supporting Your Claim With Medical Evidence
Whatever the specifics of your policy might be, the carrier will require you to provide medical evidence to prove you're disabled. This evidence includes records from your treating physician, lab test results, hospital records, and MRIs, or other scans.
Also, ask your doctor for a detailed description of your medical history and the physical limitations you're experiencing because of the illness or injury. The space allotted on the insurance company’s form might not be sufficient to provide these details, so a separate statement may be necessary.
What If You're Denied?
Even if you understand your policy and submit a complete application, you might be denied. In some situations, you may be able to file an appeal, but this is often a complicated process. If you have long-term disability insurance through your employer, the appeal process is probably subject to the rules established by the Employee Retirement Income Savings Act (ERISA). These rules are complicated, and not many attorneys are willing to help with an ERISA appeal.
However, my team at Monast Law does accept these claims and would be happy to take a look at your application to determine if an appeal is an option for you. Contact our office in Upper Arlington to find out if we can help.