{"id":352932,"date":"2016-04-04T10:46:31","date_gmt":"2016-04-04T15:46:31","guid":{"rendered":"https:\/\/content.findlaw-admin.com\/ability-law\/injury\/accident-injury-law\/disability-insurers-and-the-claim-process.html"},"modified":"2024-05-09T23:04:21","modified_gmt":"2024-05-10T04:04:21","slug":"disability-insurers-and-the-claim-process","status":"publish","type":"page","link":"https:\/\/www.findlaw.com\/injury\/accident-injury-law\/disability-insurers-and-the-claim-process.html","title":{"rendered":"What To Expect From the Disability Insurance Claim Process"},"content":{"rendered":"\n<div class=\"wp-container-core-columns-is-layout-9d6595d7 fl-sectionWithSidebar fl-container fl-flex fl-flex-wrap fl-gap30\">\n<div class=\"fl-page-articles fl-section-main fl-section-main-full-width\"><h1 class=\"fl-no-margin-top\">What To Expect From the Disability Insurance Claim Process<\/h1>\n\n<section class=\"fl-gutenberg-byline\">\n    <div class=\"fl-gutenberg-byline-content\">\n                    By <a href=\"https:\/\/www.findlaw.com\/company\/our-team.html\">FindLaw Staff<\/a> | Legally reviewed by <a\n                href=\"https:\/\/www.findlaw.com\/company\/our-team\/katrina-wilson-esq\/\">Katrina Wilson, Esq.<\/a>\n                | Last updated\n        <time>\n                            May 09, 2024\n                    <\/time>\n    <\/div>\n\n    \n    <details class=\"fl-gutenberg-byline-toggle fl-gutenberg-byline-legally-reviewed\">\n        <summary>\n            <i class=\"fl-gutenberg-byline-icon\" aria-hidden=\"true\"><\/i>\n            Legally Reviewed\n        <\/summary>\n\n        <div class=\"fl-gutenberg-byline-toggle-content\">\n            <p><em>This article has been written and reviewed for legal accuracy, clarity, and style by <a href=\"https:\/\/www.findlaw.com\/company\/our-team.html\">FindLaw\u2019s team of legal writers and attorneys<\/a> and in accordance with <a href=\"https:\/\/www.findlaw.com\/company\/company-history\/editorial-policy.html\">our editorial standards<\/a>.<\/em><\/p>\n\n        <\/div>\n    <\/details>\n\n    <details class=\"fl-gutenberg-byline-toggle fl-gutenberg-byline-fast-checked\">\n        <summary>\n            <i class=\"fl-gutenberg-byline-icon\" aria-hidden=\"true\"><\/i>\n            Fact-Checked\n        <\/summary>\n\n        <div class=\"fl-gutenberg-byline-toggle-content\">\n            <p><em>The last updated date refers to the last time this article was reviewed by FindLaw or one of our <a href=\"https:\/\/www.findlaw.com\/company\/our-team\/contributing-authors.html\">contributing authors<\/a>. We make every effort to keep our articles updated. For information regarding a specific legal issue affecting you, please <a href=\"https:\/\/lawyers.findlaw.com\/?fli=bylinelink\" target=\"_blank\" rel=\"noopener\">contact an attorney in your area<\/a>.<\/em><\/p>\n\n        <\/div>\n    <\/details>\n<\/section>\n\n\n    <div class=\"fl-callout-text article-blockquote\">\n        <p>An injury or illness may be severe enough to qualify as a disability. If you have a disability insurance policy, it can give you consistent income. But to get disability benefits, you&#8217;ll have to file an insurance claim. Insurance providers often deny disability claims.<\/p>\n\n    <\/div>\n\n\n\n<p>Suppose you become disabled as a result of a car accident or another type of personal injury. Disability insurance can provide benefits and protection to you, but obtaining those benefits can be a long and complicated process.<\/p>\n<p>There are various factors affecting the ease of obtaining benefits. These include:<\/p>\n<ul>\n<li>The type of\u00a0<a href=\"https:\/\/www.findlaw.com\/injury\/accident-injury-law\/what-is-disability-insurance.html\">disability insurance policy<\/a>\u00a0you have<\/li>\n<li>Your policy or plan&#8217;s terms<\/li>\n<li>Whether your insurance comes from an employer or is an individual disability insurance policy<\/li>\n<\/ul>\n<p>This article will walk you through seeking disability benefits from an insurer. It discusses how to file a claim and what to do if your claim is denied. The article also addresses how to appeal a decision regarding your claim.<\/p>\n<p>In each of these phases, legal advice can help ease the burden of paperwork and communicating with insurance providers. Get a <a href=\"https:\/\/lawyers.findlaw.com\/disability\/\" target=\"_blank\" rel=\"noopener\">disability lawyer<\/a> to be your advocate before you begin your claim.\u00a0<\/p>\n<h2>How To File Your Claim<\/h2>\n<p>If you become disabled due to an illness or injury that prevents you from doing your job, the first step to receiving benefits under a disability insurance plan is to\u00a0<a href=\"https:\/\/www.findlaw.com\/injury\/accident-injury-law\/applying-for-disability-benefits.html\">file a claim<\/a>\u00a0with your disability insurer. This is a separate process from applying for any\u00a0<a href=\"https:\/\/www.findlaw.com\/socialsecurity\/disability.html\">Social Security disability benefits<\/a>\u00a0you might be eligible to receive from the Social Security Administration (SSA).<\/p>\n<p>Filing a claim typically requires you to fill out a form describing your injuries and job responsibilities. You&#8217;ll also need to provide your salary and other financial information.<\/p>\n<p>Additionally, your doctor must submit a statement. That statement must:<\/p>\n<ul>\n<li>Detail your injury<\/li>\n<li>Describe your treatment plan<\/li>\n<li>Verify that you&#8217;re not able to return to work with your current injury<\/li>\n<\/ul>\n<p>Once your claim is submitted, the insurance company may approve it and begin disbursing benefits. The insurance company may also deny your claim.<\/p>\n<h2>What To Do if Your Claim Is Denied<\/h2>\n<p>Although disability insurance is intended to help you in your time of need, your disability insurer may deny your claim for several reasons. Your claim may be rejected because:<\/p>\n<ul>\n<li>Your particular medical condition isn&#8217;t a qualifying disability under your policy<\/li>\n<li>You missed the deadline for filing your claim<\/li>\n<li>Your insurer doubts your doctor&#8217;s conclusions regarding your claimed disability<\/li>\n<\/ul>\n<p>So, what happens if your claim is denied? The answer depends on the type of disability insurance at issue and the policy terms. Suppose your disability insurance coverage is through an employee benefits package. In that case,\u00a0<a href=\"https:\/\/www.findlaw.com\/injury\/accident-injury-law\/erisa-and-disability-benefits.html\">federal law requires<\/a>\u00a0you to follow a strict administrative process for appealing a denial before filing a lawsuit.<\/p>\n<p>On the other hand, if you bought private disability insurance through an insurance broker, you&#8217;re subject to the terms of that policy. Your policy may allow you to file a lawsuit demanding benefits immediately. You may also need to go through an administrative appeal process first.<\/p>\n<p>Your insurer is required to act in good faith when reviewing your claim. If the insurer fails to do so, you can bring an\u00a0<a href=\"https:\/\/www.findlaw.com\/injury\/accident-injury-law\/bad-faith-disability-claim-denial-lawsuit-basics.html\">action against the insurer for bad faith<\/a>\u00a0denial of your claim.<\/p>\n<h2>The Importance of an Administrative Appeal<\/h2>\n<p>Whether you&#8217;re required by federal law to follow an\u00a0<a href=\"https:\/\/dictionary.findlaw.com\/definition\/administrative.html\" target=\"_blank\" rel=\"noopener\">administrative<\/a>\u00a0appeal process or follow a disability insurance policy&#8217;s terms, you can usually appeal before resorting to litigation. The appeals process often requires you to follow specific guidelines and strict deadlines. Failing to do so can lead to the denial of your appeal, which prevents you from being able to have your case heard again by the courts. Following the appeals process correctly is often the only way to retain your rights.<\/p>\n<p>The claims and appeals process can sometimes make or break your later case in court. If you bring your case before a judge, the judge may be required to decide your case based solely on the information in your file. The appeal may be the only chance you have to challenge a denial. This involves using letters or reports from employers, doctors, psychologists, or other experts.<\/p>\n<h2>Filing a Lawsuit After a Failed Administrative Appeal<\/h2>\n<p>The type of lawsuit you can file following a failed appeal may differ depending on whether you have employer-provided disability insurance or your own insurance policy. If you have private insurance, you can usually\u00a0<a href=\"https:\/\/www.findlaw.com\/litigation\/filing-a-lawsuit\/how-to-sue\/\">file a standard lawsuit<\/a> with a trial where you present evidence and call witnesses. In contrast, lawsuits regarding employer-provided disability insurance are controlled by federal law.<\/p>\n<p>In either case, a judge may give the most weight to the information within your file. Your file will contain all the documents and paperwork for your claim and appeal. This is why providing as much supporting information as possible during the administrative appeal process is so important. If you fail to obtain medical records and letters from doctors or other experts, you may limit the evidence a judge can consider in deciding your case.<\/p>\n<h2>Ensuring Coverage for Long-Term Disability Claims<\/h2>\n<p>Suppose you&#8217;re successful in obtaining disability insurance benefits following an appeal or after a\u00a0<a href=\"https:\/\/www.findlaw.com\/litigation\/filing-a-lawsuit.html\">lawsuit<\/a>. You must still carefully monitor the terms of your policy to ensure ongoing eligibility for long-term disability coverage. After two years of continuous disability, insurers often deny further disability payments due to changes in insurance policies.<\/p>\n<p>When you file your initial disability insurance claim, you must show you can&#8217;t perform your specific job. However, after two years, many insurance policies change this requirement to force you to show that you can&#8217;t do any job. As you can imagine, this can be difficult to establish unless you have catastrophic injuries.<\/p>\n<p>If there isn&#8217;t adequate support in your file to show you can&#8217;t work any job, your disability insurer may send another denial letter. If this happens, you may face the unwelcome prospect of another appeal and lawsuit.<\/p>\n<h2>Get Legal Advice From a Disability Attorney<\/h2>\n<p>Perhaps you&#8217;re considering filing a claim with a disability insurer after sustaining car accident injuries or other impairments such as a traumatic brain injury, spinal cord injury, or back injury. In that case, contact a\u00a0<a href=\"https:\/\/lawyers.findlaw.com\/disability\/\" target=\"_blank\" rel=\"noopener\">disability lawyer<\/a>\u00a0to discuss your legal options and preserve your rights, or speak with an\u00a0<a href=\"https:\/\/lawyers.findlaw.com\/erisa\/?fli=dcta\" target=\"_blank\" rel=\"noopener\">ERISA lawyer<\/a>\u00a0if you need help with an employer-sponsored disability benefit claim.<\/p>\n<p>Receiving disability benefits can help ensure you&#8217;re able to receive proper medical care, pay existing medical bills, and cover future medical expenses for ongoing medical treatment arising from serious injuries. Meeting with a lawyer can also help you determine whether you have a viable personal injury claim. If so, a\u00a0<a href=\"https:\/\/lawyers.findlaw.com\/personal-injury-plaintiff\/?fli=dcta\" target=\"_blank\" rel=\"noopener\">personal injury lawyer<\/a>\u00a0can represent you in your personal injury case or help you obtain a personal injury settlement as an accident victim.<\/p>\n\n\n<div class=\"was-this-helpful\">\n    <div\n            class=\"was-this-helpful__question-container\"\n            aria-labelledby=\"was-this-helpful__question\"\n            role=\"group\"\n    >\n        <span\n                id=\"was-this-helpful__question\"\n                class=\"was-this-helpful__question fl-text-lg-bold\"\n        >Was this helpful?<\/span>\n        <button\n                class=\"was-this-helpful__button fl-text-sm\"\n                aria-label=\"Yes\"\n                value=\"yes\"\n        >\n            <span class=\"was-this-helpful__button-text fl-text-bold\">Yes<\/span>\n            <i class=\"was-this-helpful__button-icon\">\n                <svg width=\"22\" height=\"22\" viewBox=\"0 0 22 22\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                    <g id=\"thumbs-up\" clip-path=\"url(#clip0_604_3418)\">\n                        <path id=\"Vector\"\n                              d=\"M6 21H3C2.46957 21 1.96086 20.7893 1.58579 20.4142C1.21071 20.0391 1 19.5304 1 19V12C1 11.4696 1.21071 10.9609 1.58579 10.5858C1.96086 10.2107 2.46957 10 3 10H6M13 8V4C13 3.20435 12.6839 2.44129 12.1213 1.87868C11.5587 1.31607 10.7956 1 10 1L6 10V21H17.28C17.7623 21.0055 18.2304 20.8364 18.5979 20.524C18.9654 20.2116 19.2077 19.7769 19.28 19.3L20.66 10.3C20.7035 10.0134 20.6842 9.72068 20.6033 9.44225C20.5225 9.16382 20.3821 8.90629 20.1919 8.68751C20.0016 8.46873 19.7661 8.29393 19.5016 8.17522C19.2371 8.0565 18.9499 7.99672 18.66 8H13Z\"\n                              stroke=\"#666666\" stroke-width=\"2\" stroke-linecap=\"round\"\n                              stroke-linejoin=\"round\"><\/path>\n                    <\/g>\n                  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11.0745 20.2154 11.4432C19.7859 11.8119 19.236 12.01 18.67 12H16M9.00003 14V18C9.00003 18.7956 9.3161 19.5587 9.87871 20.1213C10.4413 20.6839 11.2044 21 12 21L16 12V0.999995H4.72003C4.2377 0.994543 3.76965 1.16359 3.40212 1.47599C3.0346 1.78839 2.79235 2.22309 2.72003 2.7L1.34003 11.7C1.29652 11.9866 1.31586 12.2793 1.39669 12.5577C1.47753 12.8362 1.61793 13.0937 1.80817 13.3125C1.99842 13.5313 2.23395 13.7061 2.49846 13.8248C2.76297 13.9435 3.05012 14.0033 3.34003 14H9.00003Z\"\n                              stroke=\"#666666\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\"\/>\n                    <\/g>\n                    <defs>\n                        <clipPath id=\"clip0_604_3423\">\n                            <rect width=\"22\" height=\"22\" fill=\"white\"\/>\n                        <\/clipPath>\n                    <\/defs>\n                <\/svg>\n            <\/i>\n        <\/button>\n    <\/div>\n    <span class=\"was-this-helpful__taken-action fl-text-sm-bold\"><\/span>\n    <div class=\"was-this-helpful__feedback-container\">\n        <div class=\"was-this-helpful__choose-option-message\" role=\"status\">\n            <p class=\"was-this-helpful__choose-option-message-text\"><\/p>\n        <\/div>\n        <form class=\"was-this-helpful__feedback-form\">\n            <div class=\"was-this-helpful__feedback was-this-helpful__feedback--positive\">\n                <fieldset>\n                    <legend class=\"was-this-helpful__feedback-form-title\" tabindex=\"0\">Why was this helpful?<\/legend>\n                    <div class=\"fl-radio-button-field fl-flex was-this-helpful__feedback-form-title\">\n                        <input\n                                id=\"was-this-helpful__radio-button--understandable\"\n                                class=\"fl-radio-button-field-input\"\n                                type=\"radio\"\n                                name=\"positive-feedback\"\n                                value=\"Easy to understand\"\n                        >\n                        <label\n                                class=\"fl-radio-button-field-label fl-text-sm was-this-helpful__radio-label\"\n                                for=\"was-this-helpful__radio-button--understandable\"\n                        >Easy to understand<\/label>\n                    <\/div>\n                    <div class=\"fl-radio-button-field fl-flex was-this-helpful__feedback-form-title\">\n                        <input\n                                id=\"was-this-helpful__radio-button--solved-problem\"\n                                class=\"fl-radio-button-field-input\"\n                                type=\"radio\"\n                                name=\"positive-feedback\"\n                                value=\"Solved my problem\"\n                        >\n                        <label\n                                class=\"fl-radio-button-field-label fl-text-sm was-this-helpful__radio-label\"\n                                for=\"was-this-helpful__radio-button--solved-problem\"\n                        >Solved my problem<\/label>\n                    <\/div>\n                    <div class=\"fl-radio-button-field fl-flex was-this-helpful__feedback-form-title\">\n                        <input\n                                id=\"was-this-helpful__radio-button--other\"\n                                class=\"fl-radio-button-field-input\"\n                                type=\"radio\"\n                                name=\"positive-feedback\"\n                                value=\"Other\"\n                        >\n                        <label\n                                class=\"fl-radio-button-field-label fl-text-sm was-this-helpful__radio-label\"\n                                for=\"was-this-helpful__radio-button--other\"\n                        >Other<\/label>\n                    <\/div>\n                <\/fieldset>\n            <\/div>\n            <div class=\"was-this-helpful__feedback was-this-helpful__feedback--negative\">\n                <fieldset>\n                    <legend class=\"was-this-helpful__feedback-form-title\" tabindex=\"0\">Why was this not helpful?<\/legend>\n                    <div class=\"was-this-helpful__choose-option-message\" role=\"status\">\n                        <p class=\"was-this-helpful__choose-option-message-text\"><\/p>\n                    <\/div>\n                    <div class=\"fl-radio-button-field fl-flex was-this-helpful__feedback-form-title\">\n                        <input\n                                id=\"was-this-helpful__radio-button--missing-info\"\n                                class=\"fl-radio-button-field-input\"\n                                type=\"radio\"\n                                name=\"negative-feedback\"\n                                value=\"Missing Information\"\n                        >\n                        <label\n                                class=\"fl-radio-button-field-label fl-text-sm was-this-helpful__radio-label\"\n                                for=\"was-this-helpful__radio-button--missing-info\"\n                        >Missing the information I need<\/label>\n                    <\/div>\n                    <div class=\"fl-radio-button-field fl-flex was-this-helpful__feedback-form-title\">\n                        <input\n                                id=\"was-this-helpful__radio-button--complicated\"\n                                class=\"fl-radio-button-field-input\"\n                                type=\"radio\"\n                                name=\"negative-feedback\"\n                                value=\"Too complicated\"\n                        >\n                        <label\n                                class=\"fl-radio-button-field-label fl-text-sm was-this-helpful__radio-label\"\n                                for=\"was-this-helpful__radio-button--complicated\"\n                        >Too complicated \/ too many steps<\/label>\n                    <\/div>\n                    <div class=\"fl-radio-button-field fl-flex was-this-helpful__feedback-form-title\">\n                        <input\n                                id=\"was-this-helpful__radio-button--dated\"\n                                class=\"fl-radio-button-field-input\"\n                                type=\"radio\"\n                                name=\"negative-feedback\"\n                                value=\"Out of date\"\n                        >\n                        <label\n                                class=\"fl-radio-button-field-label fl-text-sm was-this-helpful__radio-label\"\n                                for=\"was-this-helpful__radio-button--dated\"\n                        >Out of date<\/label>\n                    <\/div>\n                    <div class=\"fl-radio-button-field fl-flex was-this-helpful__feedback-form-title\">\n                        <input\n                                id=\"was-this-helpful__radio-button--negative-other\"\n                                class=\"fl-radio-button-field-input\"\n                                type=\"radio\"\n                                name=\"negative-feedback\"\n                                value=\"Other\"\n                        >\n                        <label\n                                class=\"fl-radio-button-field-label fl-text-sm was-this-helpful__radio-label\"\n                                for=\"was-this-helpful__radio-button--negative-other\"\n                        >Other<\/label>\n                    <\/div>\n                <\/fieldset>\n            <\/div>\n            <div class=\"was-this-helpful__form-buttons-container\">\n                <button\n                    class=\"was-this-helpful__feedback-button was-this-helpful__feedback-button--positive at-feedback-submit fl-button secondary\"\n                    type=\"submit\"\n                >\n                    <span class=\"fl-button-content\">Submit<\/span>\n                    <i\n                        class=\"fa fa-angle-right medium\"\n                        aria-hidden=\"true\"\n                    ><\/i>\n                <\/button>\n                <button\n                    class=\"was-this-helpful__feedback-button was-this-helpful__feedback-button--cancel fl-button primary disabled\"\n                    type=\"reset\"\n                >\n                    <span class=\"fl-button-content\">Cancel<\/span>\n                    <i\n                        class=\"fa fa-times-circle medium\"\n                        aria-hidden=\"true\"\n                    ><\/i>\n                <\/button>\n            <\/div>\n        <\/form>\n    <\/div>\n    <div class=\"was-this-helpful__thank-you-message\" role=\"status\">\n        <i class=\"was-this-helpful__thank-you-message-icon fa fa-check\"><\/i>\n        <p class=\"was-this-helpful__thank-you-message-text\" aria-live=\"polite\"><\/p>\n    <\/div>\n<\/div>\n<\/div>\n\n\n\n<div class=\"fl-section-sidebar\"><div class=\"fl-editors-summary\" data-testid=\"fl-editors-summary\">\n    \n    <div class=\"fl-editors-summary-content\" data-testid=\"fl-editors-summary-content\">\n                    <h2>Can I Solve This on My Own or Do I Need an Attorney?<\/h2>\n                <div class=\"fl-editors-summary-content-main\" data-testid=\"fl-editors-summary-content-main\">\n            \n        <\/div>\n        <ul class=\"fl-list-style-none\">\n                            <li data-testid=\"fl-editors-summary-content-item\">\n                    <i class=\"fa fa-check medium fl-editors-summary-content-item-icon\" aria-hidden=\"true\"><\/i>\n                    A lawyer\u2019s advocacy can help ease your stress during the claims process\n\n                <\/li>\n                            <li data-testid=\"fl-editors-summary-content-item\">\n                    <i class=\"fa fa-check medium fl-editors-summary-content-item-icon\" aria-hidden=\"true\"><\/i>\n                    Disability insurance providers have lawyers on their side, so hiring your own lawyer may be beneficial\n\n                <\/li>\n                            <li data-testid=\"fl-editors-summary-content-item\">\n                    <i class=\"fa fa-check medium fl-editors-summary-content-item-icon\" aria-hidden=\"true\"><\/i>\n                    An attorney can represent you during disability insurance benefit disputes or appeals\n\n                <\/li>\n                    <\/ul>\n                    <div class=\"fl-editors-summary-content-description\" data-testid=\"fl-editors-summary-content-description\">\n                <p>A disability lawyer can help protect your benefits. Get dedicated support for your disability insurance claim or dispute.<\/p>\n\n            <\/div>\n                            <div class=\"fl-editors-summary-content-link fl-flex\" data-testid=\"fl-editors-summary-content-link\">\n                <i class=\"fa fa-angle-right medium\" aria-hidden=\"true\"><\/i>\n                <p class=\"find-attorney\"><a href=\"https:\/\/lawyers.findlaw.com\/disability\/#USER_GEO\/?fli=esum:FL3905\" target=\"_blank\" rel=\"noopener\">Find a local attorney<\/a><\/p>\n\n            <\/div>\n            <\/div>\n<\/div>\n\n\n\n<div class=\"email-subscription fl-mb30\">\n    <div class=\"email-subscription-header\">\n        <div class=\"email-subscription-header-content\">\n            <h3 class=\"fl-callout-sm fl-no-margin\">Stay Up-to-Date With How the Law Affects Your Life<\/h3>\n        <\/div>\n        <div class=\"email-subscription-header-image fl-flex fl-items-end\">\n            <img decoding=\"async\"\n                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