Posted on :September 1, 2015ByLowenstein Disability Lawyers
Filing the documentation for Long Term Disability only begins a long and often tedious process. In this article, a Los Angeles disability lawyer explains what to expect once the initial filing has taken place.
Once you have completed the initial filing, the review process begins. The insurer will re-examine your situation to ascertain that you still meet the qualifications for Long Term Disability benefits. Initial approval is only the beginning. You will be expected to demonstrate that you remain eligible over time and failing to do so can result in a denial of benefits. You should seek the assistance of a Los Angeles disability lawyer to represent you if you feel your benefits are being wrongfully denied.
The terms under which your LTD claim is eligible for review should be specified in your plan. Unless otherwise defined, requests for additional documentation can be made from time to time without any specific timetable being in effect. You will need to provide information concerning your medical condition, work capabilities or lack of same, Social Security information, results of medical evaluations and so on. You should expect an eligibility review between six and nine months prior to the end of your second year of benefits. After the first 24 months, having shown that you cannot perform your accustomed work due to your disability, you and your Los Angeles disability attorney will be required to demonstrate that you cannot work in any capacity.
Normally, the insurer is not required to notify you or your Los Angeles disability lawyer that they are contemplating an eligibility review, but the usual practice is to send you a letter informing you of their intention and asking for such information, records or documents as may be applicable.
It is always best to be prepared for the likelihood of a review. You should follow up on any notifications for requests of medical or other information that are sent to you or to your physicians. Simply because a letter was sent to your doctor does not immediately indicate that the appropriate responses will be forthcoming. You should be proactive in that respect. By maintaining contact with all medical providers and ensuring that all requests sent to them have been properly processed and fulfilled, you reduce your chances of a denial of benefits based on noncompliance on the part of your medical team. Further, there are other guidelines you can follow that will also reduce the risk of a denial, such as:
? Do not allow yourself to take an eligibility review personally. Their purpose is not to insult, annoy, discriminate against or otherwise unjustly persecute you. Although, it can often be easy to succumb to such feelings. If you delay your responses, refuse to send requested documents and become adversarial or hostile, you accomplish nothing for your own good and can actually harm your own situation. Failure to comply with the claims analyst?s instructions and requests will only result in a denial that could have been avoided. The best thing to do is to give them what they want when they want it and simply get it over with.
? Act in a timely manner. In the same spirit, make certain that all documentation, test results, medical reports, results of all independent medical examinations or IME?s, functional capacity evaluations or FCE?s and so on are sent within the prescribed deadlines. Delays can only harm you.
? Keep in touch with all involved medical personnel to ensure that they have fulfilled any requests for reports, results or other documentation in an equally timely manner. Doctors are notoriously busy people, and it is up to you to make certain that your claim is not denied because the medical personnel allowed it to fall through the cracks. It may be necessary to remind the doctor that your treatment can adversely be affected if they do not do their part towards the processing of your documentation. If you need information on how to best approach this, you should contact your physician?s office directly.
You bear the primary burden of gathering and submitting the information required for your claim. By following up with your medical practitioners, completing all forms and documentation and making the appropriate submissions in a timely and accurate manner and complying with such requests as are made by the insurer, you can facilitate the process and hopefully reduce the level of stress that an eligibility review can cause.
The final responsibility may be yours, but nothing says you must bear it all alone. If you are involved in a Long Term Disability claim and need help, contact Janna Lowenstein, your Los Angeles disability lawyer, by calling 800-954-7752 today.