Myth #1 If you follow the rules, your insurance company will approve your claim.
It doesn’t matter if you have followed the rules and the claims process to a “T," the insurance company has their review process (which sometimes includes an automatic denial) that they follow and what you do is almost irrelevant. Unless of course if you do something that benefits them.
Myth #2 If you complete the form provided by your company, then you will start getting your benefits.
The form that you must complete to apply for your long term or short term disability benefits is only the beginning. You can finish every line and check every box, and the insurance company will still deny your claim. In fact, the form is only the beginning of a long, drawn-out process to get the insurance company to review your case and then evaluate whether they think you meet the requirements of the disability policy you or your employer pays for.
Myth #3 If you have already been awarded SSI, then your claim will automatically be approved.
Applying for long or short term disability is a different and separate process from Social Security disability or even workers compensation. You will have to meet a whole new set of requirements, and the process is very different from SSI. Social security is a government benefit, and your long or short-term disability insurance policy is generally held by a private insurance company that is either paid by you, your employer or a combination of you and your employer. There are regulations that impact that policy, but the claims process is very different than what you went through with SSI.
Myth #4 The “activity log” the insurance company sends you is to help them understand your disability and to benefit you.
Any and all documents that the insurance company asks you to complete, including an “activity log” will only be used to their benefit and not yours. They will review what you have written and use it to attempt to demonstrate that they can deny your benefits. Never assume what you are providing to the insurance company will be used to help you get them to pay out what you are owed.
Myth #5 Writing a letter to the insurance company outlining your struggles and how your medical condition affects your daily life will help get your claim approved.
Same as under Myth #4, you are creating a document that the insurance company will use to help them deny your claim. You can provide them with as much detail as you want, they are going to go through the process they have set up (which is slanted in their favor) to determine if they should approve or deny your claim. You can scream at them until you are blue in the face, but unless you follow the process outlined in your policy or through ERISA, what you provide is generally no benefit to you.
Myth #6 If your doctor says you are disabled, your benefits are automatically approved.
Your doctor has a vital role in helping you receive benefits that you may be qualified for, but they do not have the final say. The insurance company will take your medical record and review them along with any additional information they will gather to make a decision on your claim. You may be required to see an insurance company doctor or to speak with an analyst over the phone. They will ask you to complete a series of forms and may even subject you to additional testing. Only when they have the information they feel is needed will they decide on your benefits.
Myth #7 If your employer says you are too disabled to work for them, your benefits will get approved.
Your long or short-term disability insurance company will not rely on what your employer says to determine eligibility. There is an arbitrary system of tests and standards that each insurance company uses to determine if you can no longer do the job you are qualified to do. In fact, the insurance company will generally not have an accurate understanding of what your job entails. The decision they make is based on "industry standards" that the insurance companies themselves have established and pay people to review when they receive a claim application. So, just because your employer says your disability prevents you from doing your job does not mean that the insurance company you and/or they pay will approve your claim.
What can you do if your long term or short term disability claim was denied?
If you have applied for long term or short term benefits through your employer and were denied, you do have some options. Generally, most policies include an appeals process and those that follow ERISA do. Your denial letter will outline some of your rights, but it is crucial that you contact a knowledgeable attorney to ensure that your insurance company had followed the law and has made an accurate interpretation when they denied your benefits.
With any process, there are important deadlines that you must meet. To do so, you will need the assistance of an attorney. Let us review your denial letter and see if there is anything we can do to help. Get in touch with us today.