Many people understand that they have disability insurance coverage, but aren’t sure whether, when, or how to make a claim. This confusion often results in people delaying in submitting a claim, which can potentially jeopardize their right to coverage. Below is a guide to some of the issues you might consider in determining whether to make a disability insurance claim.
First, remember that the specific insurance policy language will determine whether you have a claim for disability benefits. Always be sure to double check the actual insurance policy language – or have a lawyer do so for you – before making any decisions. Also be mindful that the insurance policy may be comprised of many separate documents. For instance, there may be an insurance policy contract, declarations pages, riders, amendments, and endorsements, all contained in what might appear to be separate documents. And if your disability coverage is subject to ERISA, other employee benefit plan documents such as a Summary Plan Description may also affect your rights.
In particular, you will want to be familiar with how the policy defines “disability.” Most disability insurance policies define “disability” to mean, basically, you can’t work because you are ill or injured. But the devil is often in the details. For example, does the policy require you to be unable to do your current job, or any job within your skillset, or any job at all? Is a software engineer with cognitive impairment from a brain injury disabled if they can still flip burgers? Slight differences in the definition of “disability” can be critical.
Second, have a clear understanding of the medical basis for your disability – i.e., the injuries, illnesses, or other conditions that affect your life and prevent you from working. You don’t need to be a doctor to make a disability claim, but having a clear picture of the diagnoses and limitations relevant to your disability will help you submit your claim clearly. Absent clarity, some unscrupulous insurance adjuster may try to take advantage of the confusion to mischaracterize your claim as falling within one of the policy’s exclusions.
Third, be mindful of whether you have discussed with your employer any potential accommodations that could help you perform your job despite your disability. Most of the time, employers are legally obligated to make minor changes to your job to enable you to continue working despite your disability. If you can keep working with a reasonable accommodation, you may not be entitled to disability insurance benefits – and may not need them in the first place!
Fourth, be mindful of any applicable time limits to make a claim. Be sure you are submitting your claim to the right people, using the right documentation, and meeting the right deadlines. Don’t put yourself in a position of losing out on coverage through technicalities.
These are just a few of the many things you may want to consider when deciding whether to claim disability insurance benefits. Please keep in mind that many other issues can come into play – and the best way to protect your legal rights is to talk to a lawyer!
Seattle Insurance and ERISA Blog 