Here’s a checklist to use before you file a claim. The goal is to avoid the numerous pitfalls and tactics used by the Long Term Disability insurance company to deny or delay your claim.
Top 10 Questions Doctors and Dentists Need to Ask Before Filing a Long-Term Disability Insurance Claim
1. Obtain your original policies
If you can’t locate them, don’t rely on your HR department or agent to have your exact policy at hand, but contact them immediately and make sure they are giving you a copy of the policy you purchased. A private LTD policy you bought from an agent in 1995 is not going to be the same one you’ll get today, so this matters. And the specifics matter.
2. Read the policies and find out two key points
Do you have an option to file a Residual or Partial LTC claim if you are able to or want to work but in a reduced capacity? If you are older than age 65, you will not be able to. Next, determine if your policy is insuring your Own Occupation – that is, the job you perform at the time of disability —or Any Occupation – a job that is reasonably similar to yours in salary but not necessarily one you are trained in.
3. Look in the policy to see the timing requirements for claim notification and proof of loss
If you have not practiced medicine in six months and are not under the care of a treating physician, you will want to call our office to find out what your next steps are. The time constraints and documentation of a disability are not flexible. You may need to take a few additional steps to protect your claim, speak with long-term disability insurance lawyers in New York City.
4. Similarly, do you have a formal medical diagnosis, a treatment plan, and a treating physician?
We often find doctors have self-diagnosed and relied on professional colleagues to get them started on treatment. Avoiding paperwork and reporting by having a colleague conduct a diagnosis and treatment plan is one of the best ways to undermine your claim. Even if your best friend is the chief of thoracic surgery at a major teaching hospital, your claim needs an official diagnosis, tests, and a treatment plan. If you went down this path, call our office.
5. Have you spoken to an experienced long-term disability claim attorney with experience representing doctors, dentists, and others in the medical field?
A long-term disability attorney for dentists claim understands the specific challenges medical professionals face. A long term disability insurance claim is not like a claim on your homeowner’s policy. There are legions of employees and sub-contractors working for the insurance company to protect its profits. If there is a pitfall, a weakness in your claim documents, or a social post showing you playing volleyball with a shoulder injury, it will be found and used to deny your claim.
6. Are you prepared to assemble the documents you will need to support your claim?
When the monthly benefit level is high, so are the demands for documents. In addition to medical support, you will likely be asked for tax returns, business records if you have your own practice, and payroll information if you are an employee with a large medical system. We advise claimants to create two pieces of documentation in addition: one, a diary of all appointments or trips outside of your home and two, another diary for your symptoms. You may not remember what you were doing or how you were feeling two months ago, but with detailed daily notes, you will have a record.
7. Does your condition meet the policy’s guidelines for disabilities?
Long-term disability insurance policies often contain exclusions for conditions, including pre-existing conditions and especially mental health disabilities. While a battle to achieve parity for mental health treatment is still going on in Congress and the courts, the provisions in the policies you own determine whether or not you will be considered disabled. If your claim is denied because you do not meet the level of disabilities, do not simply accept such a conclusion and walk away from your valid claim. Talk with Jason Newfield to find out what your rights are and what your next steps need to be to combat the disability insurance company. For instance, see our Success Story about how we helped an oral surgeon overcome delays of two years by Northwestern Mutual.
8. If you are not able to safely perform the patient care of your profession and continue to practice, you put yourself and your patients at risk
Jason Newfield represented an anesthesiologist suffering from the brain fog of chemotherapy—she had to stop treating patients, despite an outward appearance of normalcy. The same applies to fine motor skills for a surgeon or cognitive abilities from an emergency room physician. If you are still practicing but know you are not 100%, it’s time to stop and speak with a long-term disability insurance attorney.
9. Gaps in medical treatment
Are you complying with medical treatment from an appropriate physician? Your medical record needs to show that you are going to doctor appointments consistently and following treatment instructions. If you have been on claim and have been treated for a while, and your doctor says they do not need to see you anymore, you will need to have a conversation about how this impacts your claim: you need to have regular appointments to continue a record of treatment. Many professionals don’t realize this until it’s too late. Read our blog post that explores how vague or unsupported disability claims from dentists are often ignored.
10. Surveillance showing activities contradicting disability limitations
Anything you do outside of your home is considered fair game for surveillance. The strange car parked across the street could have a small video camera recording you going in and out of your home, and your new social follower might be an investigator working for the insurance company. We have worked with claimants whose activities were deemed proof of their ability to work, even though it took them two weeks to recover from attending a wedding for one of their children. If you’re unsure, this blog post breaks down how even multiple valid claims can be questioned.
Conclusion
Bonus: Posting about your life on social media is not wise if filing a claim for disability insurance benefits.
Any claimant with a high monthly benefit should expect to have their claim challenged at any stage of the claims process. Having an experienced long-term disability insurance attorney on your side protects you and your family. To get started, call Jason Newfield for your free consultation.
