Dealing with Insurance Companies: Managing a Disability Claim on Your Own

While we certainly do not recommend it, you may choose to handle your own short term disability or long term disability claim. A side note: we strongly recommend you do not handle an STD or an LTD appeal without legal representation.

If you decide to make a disability claim on your own, there are a few things you should keep in mind when dealing with an insurance company: (1) insurance companies are for-profit businesses with an eye on profits; (2) everything you provide to them during your claim goes into your claim file; and (3) you cannot rely on an insurance company to obtain documentation to support your claim.

Why are these things so important?

The first item – that insurance companies are for-profit businesses – matters because no matter how nice the claim representative is to you on the phone as you make your claim, she is also charged with looking for ways to deny your claim.  Insurance companies make money through premiums. The more claims they pay, the more money they lose.  Accordingly, they have a strong incentive to deny claims.  Do not be lulled into a sense of comradery but a friendly claim representative.  Do not think you are talking to a friend and provide all the information you have about your claim as if you were talking to a friend; you are not. You will do better to handle communications in writing, providing only the information requested of you in the claim forms and providing relevant medical records.

This brings us to the second item – everything you provide your insurance company goes into your claim file.  If your claim is denied and you lose an appeal and have to litigate, whatever you have provided – be that in writing or in telephonic communications – gets recorded in the claim file.  If you provide information that tends to support a denial, you cannot take that back. It will be in your claim file for the life of the claim.  The converse is also true and important – anything you would want a judge to see in support of your claim must make it into that claim file with your original claim or appeal; if you fail to provide information during one of these two periods and your appeal is denied, there is no chance to add it later.

And lastly, you cannot rely on the insurance company to obtain the documentation to support your claim.  They will have you sign an authorization to release your medical records. They may even request those records, but never assume they got all of your records or contacted all of your treating physicians. It is extremely important that you be certain your entire, relevant medical records are provided from each of your treating physicians.

Kantor & Kantor can offer you help with your short term and long term disability claims – from the initiation of the claim, through the appeal level and litigation of your claim, if necessary.  We can help you gather the appropriate evidence of disability, and help you in obtaining the support of your treating providers. Most importantly, we can provide peace of mind that your claim is being properly handled. Give us a call for a free consultation at (818) 886-2525 or use our  online contact form.

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