Disability Insurance Claim Articles

What Your Disability Claim File Should Include

By Jeffrey L. Greyber, Esq.

A disability claimant’s maintaining a thorough claim file will greatly assist a policyholder attorney in unraveling a claim denial.  Here are some examples of steps that disability claimants should take toward laying a good foundation for policyholder attorneys like me:

• Get a full, certified copy of the insurance policy in effect at the time of disability onset.  Sometimes, in the group insurance setting, the policy is referred to as a summary plan description or benefits booklet.  Once you have this document, at a minimum, familiarize yourself with the definition of “disability” or “disabled.” 

• Explain to the treating physician that you have disability insurance and that it would be greatly appreciated for the physician to keep a thorough record in the event that a disability claim is someday submitted and the carrier requests medical records.  Also, make sure your treating physician would someday be onboard to submit attending physician statements to the insurance company on your behalf.  If the treating physician is not receptive to this and you are seriously contemplating a disability claim, you may wish to start treating with another physician who would be willing to be of assistance in the disability insurance claim process.

• Keep a daily journal of disability symptoms, pain levels, and the manner in which the disabling conditions compromise daily functional abilities.  The journal should also chronicle treatment, rehabilitation, and / or medication efforts.

• Keep a journal of all phone calls with the insurance company.  This journal should be kept contemporaneously with the phone calls.  In other words, memorialize the phone call in your journal during the phone call or shortly thereafter, not days or weeks after the fact.  And, if you are up for it, it is great to follow a phone call with a letter to the insurance company.  “To Whom It May Concern:  On January 14, 2015, we discussed the following over the phone:  (1)  XXXXX, (2)  YYYYY, (3) ZZZZZ.”  The purpose of this kind of letter is simply to memorialize the phone call, not convey additional commentary or opinion to the carrier … rarely is it helpful to volunteer information to an insurance company.

• Have friends, family, work colleagues, and / or et cetera familiar with your disabling conditions, symptoms, and limitations standing ready to attest to same by, for example, letters to the insurance company.

• If the symptoms and limitations associated with your disabling conditions are visible, perhaps have someone videotape your struggles.

• Maintain copies of all correspondence exchanged between you and the carrier.  Maintain copies of all correspondence, medical records, and / or billing records exchanged between your medical provider(s) and the carrier ... indeed, ask your medical provider to CC you on anything and everything sent to the carrier. 

• Maintain copies of all claimant and / or attending physician statements provided to the carrier. 

• If the carrier requests a recorded statement, strive to have a third-party with you to witness the interview, and / or request that the statement be transcribed, and / or request that the statement be videotaped

• Similarly, if the carrier requests an IME (independent medical examination), strive to have a third-party with you to witness the examination, and / or request that the examination dialogue be transcribed, and / or request that the examination be videotaped.

• Gather documents (e.g., pay stubs, bank statements, tax records) evidencing income from a few years prior to the date of disability onset through the present.  These records will sometimes show a dip in income following the onset of disability.  These records do not necessarily need to evidence as much in order for your disability claim to be approved, but the chances of a prompt claim approval will increase if this is what these records show.

Although you, the disability claimant, can carry out the aforementioned suggestions without a lawyer, it would be wise to consult with a lawyer before submitting a claim and during the claim process.  For example, claimant and attending physician statements can turn into traps that the carrier will try to use against you later … it would be wise to have an attorney take a look at these statements before submitting them to the carrier.  This is just one example as to how an attorney can help you navigate the many landmines that the carrier will lay in front of you during the claim process.

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Notes To Selves Regarding The Denial Of The Rolling Stones’
$12,700,000 Claim

By Jeffrey L. Greyber, Esq.

Recently, a $12,700,000 claim submitted by the Rolling Stones / Mick Jagger was denied.

I am not privy to the policy language underlying the Rolling Stones’ claim, so I cannot opine as to the (im)propriety of the carrier’s claim decision. But the above article inspired me to point out a few things to life and disability insurance claimants / policyholders.

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Is Your Disability Occupationally Disabling?

By Jeffrey L. Greyber, Esq.

I often hear something like this from disability claimants: “I don’t get it … all of my medical providers uniformly attest that my ailments are disabling, yet the carrier is still giving me a tough time … what gives?” Well, when I look into the “what gives” part of that, I sometimes find that the carrier is grappling with the mental or physical component of the claimed disability; i.e., debating the findings and / or opinions of the policyholder’s medical providers. But, more often, I find that the carrier is grappling with how the disability compromises the insured’s ability to maintain employment.¹ So, what can you do to help quell (or even preempt) the carrier’s concern that your disability does not preclude you from maintaining employment?

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