Dealing with a disabling injury or illness can be super stressful and expensive. If you have an individual disability insurance policy and qualify for benefits, it can be a real game changer.
How do you file a claim?
First, contact the agent who sold you the policy. They should be able to guide you through the process. If that agent is no longer in business, call the carrier directly.
In general, here are some things you can expect during the claims process after contacting your agent or carrier and reporting a claim:
Claim Forms
A claim examiner will send the necessary forms to you. Complete the claim forms and send back to the insurance company as soon as possible so they can begin reviewing the claim. A written acknowledgement of receipt of the claim usually goes out within 10 days.
Claim examiner
After the claim has been initially reviewed, the claim examiner will call you. During the call you can ask questions about the claims process and the examiner can explain any unique policy provisions. A field claim representative visit will be initiated by the claim examiner. The visit can happen anytime during your claim. This is an opportunity for you to ask questions and for the field claim rep to gather additional info needed to process the claim.
Who is contacted?
Your medical providers will be contacted and asked to provide a copy of your medical records. Your employer may be contacted too to verify duties/occupation, salary, and date last worked. Additional info may be requested if needed. Other disability carriers that you may have coverage with or had coverage with at the inception of the disability claim may also be contacted.
Documents needed
Financial documentation may be requested, including but not limited to your W-2 statements, IRS tax forms, and monthly profit and loss statements, depending on the circumstances of the claim.
It’s important to send the claim information as soon as possible so that they can start processing your claim.
Claim approval
You can expect to receive a claim status update every 30 days until a determination has been made. Once your claim has been approved, they will periodically ask you for updates regarding the condition to verify that you are still eligible for benefits.
Elimination period and benefits paid
All disability policies have an elimination period or number of days you must be disabled before benefits are paid. The number of days can be found on the policy schedule page in your policy. Benefits begin at the end of the policy’s elimination period and once eligibility for benefits has been established.
All benefits will be paid to the owner of the policy, unless assigned to another person. If the person who is supposed to receive payments is incompetent, they’ll make payments to the that person’s legal representative. Any monthly benefits for a period less than 1 month will be paid out at a daily rate of 1/30 of the monthly benefit. Benefits are paid in arrears which means the first benefit check is due 30 days after the end of the elimination period.
The Bottom Line
Call the agent who sold you the policy to start the claim and guide you through the process. They are there to help you at claim time. If they are no longer working, call the carrier directly.