Will Your Disability Insurance Be There When You Need It? Not Necessarily.
Author: Terrance J. Coleman
#1: WHAT YOU SHOULD KNOW BEFORE SUBMITTING A DISABILITY CLAIM
After dutifully paying premiums for years for your expensive disability insurance coverage, you may think that submitting a claim for benefits after you can no longer work due to illness or injury should be a simple matter. Unfortunately, the same insurer that gladly took your premium dollars for years may not be so eager to pay benefits in your time of need.
Doing a few things before you submit your claim for benefits, however, may help protect your ability to receive the benefits you deserve.
a. Be Informed; Read Your Policy. You should carefully review your disability policy and the application you submitted when purchasing the coverage. Basic coverage features are usually set forth in the Declarations Page, including the monthly benefit amount, the waiting period, usually 30-180 days, before benefits start to accrue, and the maximum benefit period. It is important to review the policy's definition of Total Disability, and whether your policy provides for Residual or Partial Disability benefits in the event you can work only part-time. Often, policies sold in California contain a more stringent definition of Total Disability than the definition mandated under California law. If you have any questions about your rights under your policy, don't hesitate to talk with a lawyer that specializes in representing policyholders like you.
b. Obtain Your Own Medical Records. You should know that your insurer will not simply rely on your treating physician's opinion that you are disabled. Instead, it will obtain all of your medical records to see if it can find any inconsistencies in your doctors' contemporaneous chart notes. By obtaining and reviewing your medical records before submitting your claim to the insurer, you will have an opportunity to correct or clarify any inaccurate or missing information.
c. Complete The Claim Forms With Great Care. In order to initiate a claim for benefits, you will be required to submit a signed claim form, identifying the nature of your disability, when it began, why you cannot work, and other information. Great care must be taken in completing the form, and any inaccuracies or missing information can cause unnecessary delays or problems in receiving your benefits.
d. Know Your Rights.
Under the laws of Insurance Bad Faith in California your insurance company must:
- Treat you honestly, fairly, and in good faith
- Investigate all possible bases to pay your claim
- Thoroughly investigate your claim
- Provide you all information you may need to protect your rights under the policy
- Give your interests at least as much consideration as it gives to its own interests
- Pay all legitimate claims fully and promptly
- Promptly acknowledge all communications from you
- Keep you advised of the progress of your claim
- Advise you of all benefits, coverages, and time limits that may apply to your claim
- Not condition payment of undisputed amounts on the settlement of disputed claims
- Comply with all state or federal regulations, which may apply to your claim.
#2. TIPS TO HELP PROTECT YOUR INSURANCE CLAIM
- Don't assume the insurance company intends to fully protect you. Instead, assume that the insurance company intends to resolve your claim for the lowest amount it can.
- Know your basic rights
1. Obtain and read a copy of your policy. (Click here for more information on how to interpret an insurance policy.)
2. Obtain a copy of the applicable insurance regulations (Click here for more information on the California Department of Insurance Regulations.)
- Do not rely on oral representations from an insurance adjuster. Confirm all important promises in writing.
- Keep all insurance documents during the claim in one file.
- DO NOT exaggerate your claim. Your credibility is critical to a fair claim settlement.
- Ask the insurance company to provide you with a copy of important documents.
- Maintain a copy of any statement you provide to an insurance company.
- If an insurance company representative comes out to visit you, ask for a copy of his/her report on the visit.
- You may tape record any in-person conversations with either insurance adjusters or experts of the insurance company, provided it is clear they know that they are being taped.
- If you are sent to an independent medical examination, in most instances you may either tape record it or video tape it.
- Maintain a log of all significant events including correspondence, contents of phone conversations, meetings and interviews and, if relevant, medical appointments.
Get a Fair Appraisal With the Help of Pillsbury & Levinson
The lawyers at Pillsbury & Levinson, LLP, represent individual policyholders in disputes with insurers. We will review your policy and help you challenge the insurance company's evaluation or denial.