Documenting a Disability Claim (Benefit Tips ® - © 1999)
The purpose of disability insurance is to replace employment income while an employee is unable to work, as the direct result of their disability. The financial instrument used to achieve that purpose is an insurance contract.
While many disability insurance claims are resolved to everyone’s satisfaction, some are contested. As with any contract, the final step in resolution is litigation.
The challenge of the claimant is to make it as easy as possible for the insurer to approve the claim, while collecting enough evidence to prevail in the event of litigation. The claimant needs copies of the following documents in order to protect their interests:
- insurance contract
- enrolment form
- job description
- claim form
- attending physician statements
- notes or recordings of interviews
- daily medical journal
- claim payment cheque stubs or statements
The most helpful step, in building a comprehensive claim file, is to obtain a supply of blank “Attending Physician Statements” and have each physician complete one at the end of each visit. The claimant sure to discuss the findings with the physician and request a copy before it is submitted to the insurer. This eliminates delays and can improve everyone’s understanding of the recovery process.
It is imperative that the claimant has detailed and an accurate record of all meetings and telephone interviews with investigators and recovery personnel. Be sure to obtain advice from your lawyer and notify the other party before recording these interviews.
The claimant should keep a daily journal of how they feel, change in medications, therapy received, recovery achievements, setbacks, appointments, work schedules, etc.
Keep in mind that the claim adjudicator’s function is to approve legitimate claims, control costs and deny illegitimate claims. Expect a healthy dose of scepticism and don’t resist an independent medical exam, a functional-capacity assessment, rehabilitation or retraining. The claimant’s responsibility is to mitigate the loss and move toward self-reliance as quickly as possible.