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Information about all aspects of finances affected by a serious health condition. Includes income sources such as work, investments, and private and government disability programs, and expenses such as medical bills, and how to deal with financial problems.
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Disability Insurance claims must be made on the insurance company's form.

A claim form for a disability insurance policy usually consists of three sections: one for you, one for your physician, and one for your employer. Each is important in getting the claim approved.

The following sections of this article describe:

How To Get The Claim Form

Claims have to be made on the appropriate insurance carrier form.

If your insurance is through your employer, get the claim form from the employer, usually the person or department in charge of Human Resources.

If you have an individual policy you can obtain it most easily from the insurance agent. It is usually also obtainable directly from the insurance company, possibly on the company’s web site.

It is advisable to request several copies of the claim form so you can practice filling out your portion before you actually complete the one you’ll send in. If you can’t get several copies, then photocopy the form so you can practice on the photocopies and save the original until you are certain of how you want to complete the form.

How To Complete Your Portion Of The Claim Form

People often worry that what they say on the claim form is going to decide their claim. While it can be important, it's not worth worrying about. Just do your best.

The forms generally ask such questions as:

  • Basic identifying information (name, address, date of birth, Social Security number).
  • The name and mailing address of all your medical providers (such as doctors, clinics and hospitals).
  • When you first had symptoms.
  • When you stopped work.
  • About your health condition, including your symptoms. This is not always the case since the insurance company will mostly rely on your medical records for that information.
  • For you to sign a medical release so that the insurance company can obtain all your medical records. The insurance company won't process your claim without this release.

There are several things you can do to improve your chances of an approval:

Practice: Practice filling out the claim on a copy or on a pad before you submit a final draft. Know what you are going to say and how you're going to say it.

Don't, however, get overly concerned with neatness and spelling and appearance. The practice is for what you're going to say, not for neatness. Too messy may be unreadable. Then again, too neat may cause the people at the insurance company to wonder just how sick you are.

For example: Your occupation involved computer work, so it's easier for you to complete the form by computer. It comes out looking like a professional document. This won't necessarily cause a denial, but it may make the claims analyst wonder why you can't do computer work if your claim form looks so professional.

Mistakes: Correcting a mistake by crossing it out is okay. However it is not advisable to use "Whiteout". Whiteout can raise questions about what you're trying to hide.

If your symptoms include lack of concentration, short-term memory loss, or other brain function problems, don't attempt to hide how they affect your completion of the claim form. Also, if the form took hours to complete, say so and state just how long. It gives the company an idea of the difficulty you might face working if you have difficulty completing a form.

Space to answer a question: Don't let a limited amount of space on the form intimidate you.

It's very common for an insurance company to ask, "Why are you unable to work?" then give you only a tiny space to answer it. In such cases, write "See attached" and write your answer on blank paper.

At the top of each of the extra pages, include:

  • Your name.
  • The insurance policy number.
  • The question you answering. (Either note the question number, or repeat the question.)
  • The page number if you are attaching more than one page.

All questions: Answer all questions.

If a question doesn't apply to you, write "N/A" as an answer (or other term if requested on the form). For example, if you're male, write "N/A" next to "Have you ever been pregnant?"

Writing something like "N/A" lets the claim analyst know you didn't ignore or overlook anything.

Dates: Don't worry about exact dates for years past.

For example, the form asks when you first had symptoms of the condition. You've been dealing with it for four years and are filling out the form in the year 2013. It's ok to write, "Early 2009."

If there is a possibility that the insurance company can turn down your claim on the basis that you had an existing health condition at the time you applied for the policy, we suggest that you consult with a lawyer before completing the form. (To learn more, see: How To Choose A Lawyer.)

Symptoms and Job Duties:

If you are asked for symptoms, focus on those that keep you from working. Be specific in describing each symptom.

If you are asked about job duties, list all of them. Focus on the major job duties that you have the most difficulty performing.

To help hone your memory, consider completing a work and a daily activities worksheet. We include two types of worksheet: one of which only requests general information and the other requests very detailed information. You can choose which worksheet to use depending on how you view your chances of being determined to be disabled from a medical point of view.

Reasonable Accommodation: More and more claim forms are asking "Have you attempted to work with a Reasonable Accommodation?"

This question refers to the federal Americans With Disabilities Act which requires employers to make such accommodations to employees with a disability.

Check your policy to see whether it requires that you attempt such an accommodation before filing a claim. If there is no such requirement, answering "No" to such a question will not cause your claim to be denied. There is no need for you to include any detail in answering this question.

In fact, in many instances a reasonable accommodation is to reduce the number of hours worked. Reduced hours could reduce your salary and in turn could reduce any disability benefits for which you may then qualify.

Trick Questions: People have been known to be concerned when completing claims forms that there will be questions meant to trip you up.

We are not aware of any trick questions on these claim forms.

When you answer questions, instead of wondering if a question is a trick, think about how to answer the question in the manner most likely to obtain the insurer's agreement that you are disabled, while still answering the question honestly.

Employer Portion Of The Claim Form

Whether your insurance coverage is through your work, or you have it on your own, your employer will usually be asked:

  • To verify your dates of employment.
  • To list your job duties and/or submit a job description of your position.

It is critical that the insurance company has an accurate description of your duties. It's the only way the company will know exactly what "your regular occupation" consists of so it can determine whether your health condition prevents you from doing your job.

Many employers' job descriptions are out of date or don't accurately reflect your actual duties. Even worse, general descriptions may not come close to describing your real job. Travel, for example, is often just hinted at in a description. If the employer says you "…supervise sales activities," this doesn't tell the insurer that the sales force is in six offices over three states and you're expected to visit each 6 times a year. Often it is the omitted duties that cause the greatest difficulty in performance.

The normal procedure is for employers to gather the information for a claims form and then send the completed form directly to the health insurance company. We strongly advise that you revise the normal procedure and ask the employer to give you the papers to send into the insurance company. You can explain your desire to do this as wanting to be sure that the package is complete and accurate before it is sent to the company. If you follow this suggestion you will know what was said by the employer so you can check it for accuracy. If the employer won't give you the form, at least ask to see what is written before it's sent.

Group Plans: If you are filing your claim under a group plan, the employer will be asked details that will confirm your eligibility and size of the benefit. Questions for the employer will include:

  • Your date of hire.
  • Date coverage began for you.
  • Last day you worked.
  • Salary at the time you stopped work.

Individual Policies: Even if your claim is for an individual policy, the insurance company will still request an employer's statement. If there is currently no employer either because you have not been working or because you are self-employed, the task of demonstrating that you are disabled is going to be much harder.

Physician's Portion Of The Claim Form

In this portion of the form, the insurance company asks your doctor about your condition and your ability to work. Specific questions which are usually included are:

  • The date the doctor first treated you for the condition that is disabling you.
  • The date you became too disabled to work.
  • The medical diagnosis.
  • A list of your symptoms.
  • The doctor's impression of your ability to work.
  • Your prognosis (the doctor's opinion of what he or she expects your health condition to progress).

The difficulty with this portion of the form is that doctors frequently will not spend the time necessary to give the claims analyst an accurate picture of your condition. This is often due to the doctor's limited time. Also, the insurance company does not pay for this paperwork so your doctor is doing it "for free." Sometimes part of the problem is due to a doctor's attitude that "I'm his/her doctor; if I say he/she's disabled, then he/she is disabled." You can imagine what the claims person will think about that.

Make sure your doctor understands that you don't need to meet some vague notion of "disabled" but need to be shown to be "unable to perform the material duties of your regular occupation." Encourage your doctor to focus on specific symptoms, not just lab results. For most situations, the lab results are primarily important to provide objective confirmation of symptoms you have told the doctor you suffer from.

Do what you can to encourage your doctor to fill in each answer completely and thoroughly. Ask him or her to focus on why you can't do your job. Make sure the doctor knows what your job is.

The doctor's portion of the claim form is not something that should be dashed off while you're in the exam room. Consider leaving it with the doctor. Then call a few days later to make sure it's done. Go pick it up yourself. Many claim forms have been filed away while the claimant mistakenly thinks it was mailed to the employer.

When you pick up the claim form from the doctor, review it. Make sure that it is complete and the answers thoroughly describe why you can't work.

Don't be alarmed if the doctor makes your condition more serious than you thought it was. While the doctor's goal is to provide accurate information, it will likely be couched in terms that are geared to getting your claim approved.