When Can I Make a Disability Insurance Claim?


There can be a wide difference of opinion as to when to make a disability insurance claim. Either you or your employer may decide that you are no longer capable of working. Your doctor may even agree. But the final determination – at least as it relates to the payment of benefits under your disability insurance policy – will be made by the insurance company, and the insurance company alone.

So when should you make a disability insurance claim?

As Soon as You Know You’re Disabled

If a reasonable person can conclude that you have had a disabling event, and there is third-party evidence to support it (doctor’s determination, medical tests, etc.), then you should file a claim with your insurance carrier as soon as possible. You must clearly indicate the date of the onset of the disabling event and/or your last day of employment.

This does not necessarily mean that your insurance company will agree with your determination. However, the process has to start somewhere, and it will start with you. In some situations, the process may be handled by the human resources department of your employer, but you will need to take a very active role nonetheless.

The determination of disability status, and of the payment of benefits, is often a back-and-forth process. You will submit a claim, and your insurance company will ask for more information. Your doctor will provide medical records, and the insurance company will ask for more information. There may also be disputes on certain conditions and definitions.

The point is, going from the point of disability to the receipt of benefits can be a time-consuming process. The sooner that you get rolling, the quicker everything will happen.

Review Your Disability Insurance Policy

Somewhere in the early stages of your disability, you should be very intentional about reviewing your disability insurance policy. Since each claim is a little bit different, you’ll want to be sure that yours fits within the definitions contained in the policy.

You may find out very early on that your disabling event is specifically excluded in the policy. This can include, for example, a disabling injury that occurs while you are operating a motor vehicle under the influence of alcohol or illicit drugs. You can try making a claim anyway, but the task will be much harder if the disabling event isn’t covered in the policy, for whatever reason.

And even if it is, you’ll need to be prepared to deal with any specific requirements necessary to establish your claim.

Waiting or Elimination Period

Virtually every disability insurance policy includes a waiting or elimination period. This is a required amount of time that must pass between the time a disabling event occurs, and when payment of benefits begins. The exact amount of time required will be spelled out in your disability insurance policy. It can range anywhere from a couple of weeks to a year, but 90 days is very typical. That means you should expect to go 90 days between your last day at work and your first receipt of benefits.

The waiting/elimination period functions like a deductible with homeowners, health, and auto insurance, in that it limits the insurance company’s liability. It effectively removes first dollar responsibility on a claim. This not only reduces the insurance company’s risk, but it also results in a lower premium for you.

The waiting/elimination period is another strong reason to begin the disability process as soon as possible. You’ll want to make sure that the official date of disability is clearly established as early as possible, as that will be the beginning of the waiting/elimination period.

Make Sure All Communication With the Insurance Company is Documented

Whether we like it or not, the relationship between an insurance company and a premium-paying-client-turned-beneficiary can be that of natural enemies. You want to receive benefits, and the insurance company is reluctant to pay them because it will reduce their income.

Keeping that reality and mind, you should be sure to document any and all communication with the insurance company at all times. This means handling any important communication either by mail (certified as necessary) or by email, and keeping a copy of everything.

You should also record the results of any phone conversations in some sort of journal or phone log. Be sure to get the name of the person you’re speaking to, their employee number, email, direct phone number, the date and time of your conversation, and the details of the discussion. Follow-up with a written summary of your discussion with an email to that person.

It should go without saying that you should be meticulously collecting any documentation exchanged between you and your employer, or between you and any health care providers. This will represent important evidence proving your claim.

Having clear documentation isn’t just about successfully filing your claim either. The more information that you have, and the more concise that it is, the quicker you will be able to move the whole process forward.

Continue Paying Your Disability Insurance Premiums Until It’s Official

Most disability insurance policies come with a premium waiver provision, that eliminates policy premiums during the time that you are disabled. However, the waiver only applies when you are officially declared to be disabled by the insurance company. Only then you can stop making premium payments on the policy.

If you stop making payments before the insurance company makes the official determination, it is likely that your policy will be canceled at the very time that you will need it most. For that reason, do not stop making premium payments when either you, your employer, or even your doctor determine that you are disabled. The waiver will only apply when the insurance company declares it to be an approved case.

Disability insurance is much more complicated than most other insurance types. Let us help and guide you through the process. We can help you select the right policy for you, and explain any confusing terminology. Getting the wrong type of coverage could be the equivalent of having no disability coverage all. Don’t let that happen! Fill up the form below.

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