If you become sick or injured and can no longer work in your occupation or medical specialty, it might be time for you to file a claim.
By definition, there are two types of claims: total disability and partial disability.
Most individual policies have a true own occupation definition of disability which says if you become sick or injured and can no longer perform the duties of your occupation, you are considered disabled. If you are a physician and cannot perform the duties of your medical specialty, your policy should pay benefits even if you are able to work in another medical specialty or occupation.
The other way to file a claim is if you have a partial disability or “residual” disability according to the policy language. This says that if you are sick or injured and have a 15% or 20% loss of income (depending on the poilcy), you can file a claim. Your policy will pay benefits in proportion to your loss of income. This comes into play a lot if you are still working in your occupation but on a limited basis. Once you have a 75% or more loss of income, most policies will consider you to be totally disabled and will pay full benefits. Typical claims are back injuries or cancer treatment.
If you have a group disability policy through your employer, read the language carefully. These policies might be own occupation for the full benefit period, for a short benefit period or they may require you to be totally disabled.
Assuming you satisfy the definition of disability on your contract, you may file a claim. Here is the typical procedure:
- Notify the company. It is important to notify the company as soon as you think you will be filing a claim. This will allow them time to process your claim and hopefully pay you in a timely manner.
- Once you notify the company, you will fill out paperwork that will include questions about your claim and will authorize the company to retrieve records from your treating physician.
- The claims adjuster will communicate with you directly throughout the entire process.
- We advise our clients to keep track of their finances and income received from the date of diagnosis or accident. This will be helpful if your claim is a partial disability.
- If you are unsure how to process your claim, we at Set for Life Insurance are here to assist you and point you in the right direction to ensure your claim is being properly processed.
Keep in mind that most policies have elimination periods of 90 days which means that benefits will be paid after 90 days have elapsed from the date the claim starts.
For more information about disability insurance claims, feel free to reach out to Set for Life Insurance today!