It is important to understand your rights under the law and your disability income policy. Knowing what to expect and how handle issues that may arise can make a difference in whether your claim is approved. Below are some questions you may have if you are contemplating filing a claim for disability benefits or have concerns about the review of your claim. The questions below may not answer many questions or concerns unique to you. Call our offices to get the answers you need.
FAQ – Individual Disability Insurance
- Do I need assistance to file a claim for benefits?
- How long until the insurance company makes a decision on my claim?
- Must I appeal the denial of my claim for benefits?
- My policy insures my “own occupation”, can I work in another occupation and still receive benefits under my policy?
- The insurance company wants to send me to an Independent Medical Examination (IME). Do I have to go?
- Why does the insurance company want to send a company representative for a field visit to interview me?
Do I need assistance to file a claim for benefits?
Without question. The information provided on the claim form is the most important aspect of filing a claim for disability benefits. This information will follow you through the entire review of your claim and may even prove to be the sole reason for the denial. The insurance companies often request specific information and documentation, some of which you may not feel is relevant to your claim or are uncomfortable providing.
Our firm can represent you in your claim for benefits. We will ensure the claim form is completed in a manner that strengthens your claim for benefits. We also protect your rights throughout the claims process by providing the insurance company with only the information they need to conduct their review.
How long until the insurance company makes a decision on my claim?
It depends. Under Florida law, insurance companies must provide the claimant with notice of a decision within a reasonable amount of time. While some claims are approved fairly quickly, others may take months before the insurance company makes a decision. Insurance companies often continuously request information as a ploy for delaying making decisions on claims. It is important to stay in control of your claim by timely submitting information, constantly following-up with the insurance company, and enforcing deadlines.
Must I appeal the denial of my claim for benefits?
Look at your policy to see whether you are required to file an appeal before you can file a lawsuit. If the policy does not contain a provision requiring you to file an appeal, then you are not obligated to do so and can file suit against the insurance company for breach of contract.
My policy insures my “own occupation”, can I work in another occupation and still receive benefits under my policy?
Yes. However, the other occupation must not be similar to the occupation from which you are claiming disability. Additionally, be sure the definition of disability in the policy will remain “own occupation” and not change to “any occupation” as is the case with many policies. If the definition changes to “any occupation”, chances are the insurance company will terminate your benefits if they are aware that you are engaged in other employment.
The insurance company wants to send me to an Independent Medical Examination (IME). Do I have to go?
Many disability policies have a provision that allows the insurer the right to have you examined by a physician. If your policy has such a provision, then they arguably have the right to have you examined. Insurance companies often attempt to expand upon that by trying to have you submit to a Functional Capacity Evaluation (FCE) even though the policy only allows them to conduct an IME. Additionally, while it is preferable to assist with the review of your claim, you do not have to submit to examinations or evaluations that may be painful or harmful to your well-being.
Why does the insurance company want to send a company representative for a field visit to interview me?
Insurance companies often try to collect first hand information from a claimant in order to find inconsistencies in information you previously provided to them. They will then use any inconsistencies against you by denying your claim for benefits. Our firm has experience with assisting clients that face this very issue.