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Why Do You Need A Plan Before Going on Disability?

Disability Wiki.

You hoped you would never have to do this.  But, here you are – about to go on long term disability. 

Do you have a plan? 

If not, you better make one because the process isn’t easy, and you have everything to lose.  Smart planning will make the transition smoother and substantially decrease your risk of claim denial.

If You Get Fired, You May Be Ineligible for Long Term Disability Benefits

Without a plan, you could lose your ability to receive long term disability benefits. 

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To receive long term disability benefits, your plan likely requires you be employed when you become disabled.  If you get fired before filing your claim and claiming disability, the insurance company may issue a denial saying you aren’t “eligible” to receive benefits.  If the insurance company does this, it will may refuse to look at your medical evidence.

Denial due to ineligibility can be extremely difficult to fix.  You need a plan in place to ensure you don’t get fired before going on disability.

You Can’t Miss the Deadlines

Without a plan, you could blow critical deadlines.

Every long term disability plan contains deadlines.  These deadlines usually include dates by which you must notify your employer, file a claim, and submit “proof of loss” (i.e., medical evidence).  The insurance company will take these deadlines very seriously.  If you fail to meet a deadline, the insurance company may deny your claim.

If your claim gets denied because you missed a deadline, you’ll have a big problem on your hands.  Depending on where you live, you may need to show good cause for missing the deadline, or that the insurance carrier was not prejudiced by you missing the deadline.  These are big hurdles to overcome.  You need a plan to ensure you don’t miss any deadlines.

You Need Sufficient Evidence

Without a plan, you may not have enough evidence to prove your long term disability claim.

evidence.jpgThe insurance company will require “proof of loss,” which usually boils down to medical evidence.  The proof required may be much more than you anticipate.  A simple letter from your doctor stating you’re “disabled” won’t cut it.  The insurance company will want supporting medical records, diagnostic testing results, and a much more detailed opinion from your physician.

Denial due to lack of sufficient evidence may be fixable on appeal.  However, the insurance company may take months to decide to re-evaluate your claim on appeal.  This means you could be without critical long term disability benefits for a long time.  You need a plan to ensure you have enough evidence before you submit your claim.

The Insurance Company May Interview You

Without a plan, you won’t know what to do if the insurance company demands to interview you.  These interviews are called “field interviews.”

During the interview, the representative will ask you a series of questions to:

  • Test your credibility
  • Assess the severity of your disability
  • Understand your job responsibilities
  • Learn more about your condition and treatment
  • Identify any inconsistencies in your claim and application paperwork

The representative will likely ask you questions about:

  • Why you went on disability;
  • Your diagnosis and symptoms;
  • What you do all day;
  • How long you can perform specific activities (e., sitting, standing, walking, typing, etc.)
  • Your hobbies and activities outside the house
  • Your plans for the future (e., plans to return to work)
  • Recent travel
  • Your family life (e., whether you have kids and/or a spouse at home)
  • Your treatment
  • Your medications
  • Any side-effects you may experience
  • Other income you receive (e., Social Security Disability or Workers’ Compensation)

If you aren’t prepared to answer these questions, your disability claim will be at a higher risk for denial.  Having a plan in place will help ensure you’re thoroughly prepared to answer these questions and “pass” interview.

The Paperwork Is Overwhelming and Full of Traps

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Without a plan, you’ll encounter trouble completing the long term disability claim paperwork.

The claim forms are dense and confusing.  They contain many detailed questions about your disability, work history, and treatment.  One small error or inconsistency is all it takes for the insurance company to deny your long term disability claim.

The paperwork also contains traps you could easy fall into.  For example, the claim forms will ask when became disabled.  The date you pick is critical – if the insurance company thinks your alleged date of disability isn’t supported by the medical evidence, your claim will likely be denied.  Having a plan in place will help ensure you complete the long term disability paperwork correctly, consistently, and carefully.

You Must Talk To Your Doctor

Planned communication with your doctor is key.  You need to talk to your doctor about your plan to file for long term disability because the insurance company will inevitably ask for your doctor’s opinion.  

If you leave your doctor in the dark, your doctor won’t know how to response to the insurance company.  In fact, your doctor may accidentally provide misinformation, which could lead to claim denial.  Having a plan to talk to your doctor about the difficulties you’ve been encountering at work will help ensure your doctor provides accurate information to the insurance company.

Disorganization Will Come Back To Haunt You

Without a plan, you’re more likely to become disorganized.  Disorganization will be your worst enemy because the long term disability claim process involves substantial paperwork, deadlines, and follow-up.

Without a plan and an organized file, you’ll become overwhelmed and confused by the process.  You’ll forget what evidence was already submitted to the insurance company, and what remains outstanding.  You’ll confuse deadlines.  You’ll lose the insurance company’s letters and request forms.

Having a plan and organized file in place will help prevent you from getting overwhelmed and confused by the process.  Try keeping a physical file containing the following tabs:

  • Correspondence
  • Medical Records
  • Claim Forms
  • Copies of Submissions

Also, add all deadlines to a calendar because missing a deadline may easily result in denial. 

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