If you are considering filing a claim for disability insurance benefits, it is advisable that you meet with an attorney experienced in the area before submitting your claim for payment. Disability provisions vary greatly in the language used, and coverage is often circumscribed and restricted by qualifying words and phrases. Accordingly, each policy of insurance must be individually reviewed to determine whether a particular claim is covered and, if so, how that claim is best presented to ensure payment.
Blindly Attending an Independent Medical Exam
After submitting your claim, you may be asked to submit to an "independent" medical examination by someone chosen and paid for by your insurance carrier. You may also be asked to undergo exams by someone other than a physician. Before submitting to an "independent" medical exam or any other exam or evaluation, you must first ensure that your carrier has a right to conduct the exam per the policy language. For example, a neuropsychological exam is conducted over several days by a psychologist, not a physician, and the subjective findings from such an exam are often used by the carrier to deny benefits. If your policy requires that you submit only to "medical exams" or exams "conducted by a physician," there is certainly an argument that you need not submit to neuropsychological testing. Further, you may wish to be accompanied by an attorney or other legal or medical representatives who can monitor your "independent" medical exam.
Believing All Mental Conditions Are Excluded or Subject to Limitations
Most disability insurance contracts differentiate between mental and physical disabilities. More recent policies cut off benefits for psychiatric conditions after two or three years. Insureds often blindly accept their carrier's decision to deny or limit benefits based on these conditions without considering numerous relevant factors, including whether there are any physical aspects to the mental condition, whether the mental condition has a biological/organic cause, or whether another, covered condition was the legal cause of the disability. Without exploring these issues in detail, insureds often blindly accept that certain conditions are limited or excluded from coverage when in fact they are not.
Inadequate Communication With Treating Physician
You should not discuss your claim or that you are considering filing for disability insurance benefits with your treatment provider until after you have had several visits. Physicians are often reluctant to support claims for benefits if they question your motivations. A physician who has treated you without success will likely be more willing to cooperate. It is also important that you communicate your symptoms and limitations to your treating physician in an organized and detailed manner so that all relevant information is recorded in your medical records, which your insurer will ultimately request. When you finally speak to your physician about your claim, ensure that he or she understands the definition of "disability" under your policy, so that he or she can accurately opine as to your inability to work.
Quantifying Your Time
You should be wary of insurance companies asking you to compartmentalize in percentages what your activities you engaged in pre- and post-disability. To the extent that there is any cross-over, companies will often deny benefits or provide benefits for merely a residual disability. It is important that you broadly describe your important duties -- rather than your incidental duties -- so that your carrier has a clear understanding of the thrust of your occupation. For example, in response to a question about principal duties and the percentage of time spent at each duty, an anesthesiologist may be better of stating "100% surgical anesthesia" rather than compartmentalizing each and every incidental task (e.g., patient intake, supervising nurses during surgery, post-operative visits) into discrete percentages. The reason is your insurer may erroneously consider an incidental task a "principal duty," and therefore downgrade the amount of your benefits.
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