Filing a Disability Claim

Before You Make a Claim: Read Your Policy and Review Your Application

  • Read the definition of disability in your policy to determine whether or not your condition qualifies for benefits.
  • Have your treating doctor confirm and explain your disability in writing to the insurance company. Almost all policies require that you be under continuing care by a doctor to qualify for disability benefits.
  • Make sure the answers you give on your application are true and consistent with the medical records that your insurance company will obtain. Otherwise, be prepared to explain the inconsistency to your insurer during the claims process.

You May Not be Able to Collect Benefits During an Initial Elimination Period

Most disability policies contain an elimination period that requires you to be disabled for a certain period of time before you can collect benefits.

File a Claim as Soon as You Know You Are Disabled

It doesn't matter if you won't be eligible for benefits for several months - file your claim promptly upon discovering your disability. The insurance company has the right to know that you are currently disabled and that you will be applying for benefits. A failure to promptly submit a claim can result in the insurance company denying your benefits.

Confirm Communications With the Company in Writing

It's okay to speak to the adjuster assigned to your claim over the phone but follow up with a letter documenting whom you spoke to and what was said. When you send notice of your claim to your insurance company make sure to send it by registered mail, return receipt requested.

Keep a Claim Journal

Keep a running record of every phone conversation, in-person conversation, date, time, name of person spoken to, etc. Write for as long as it takes to clearly explain what transpired.

You have the right to tape record in-person meetings, telephone conversations, and/or insurance company scheduled doctor appointments. Just make sure to tell the others being recorded that you are going to do so.

The Insurance Company May Require the Following Information at Time of Claim

  • Medical records from any/all physicians that have treated you.
  • Employment records including job description and duties.
  • Income verification.

This information will be used to determine if you meet the definition of disability as it relates to your occupation and prior experience/earnings.  Policy definitions vary so this will be unique to your policy definition.  This process can take 30-60 days depending on how quickly the insurance company receives the requested information. 

The Insurance Company May Require Other Things Including

  • A call to your attending physician from the medical staff at the insurance company
  • An exam by an independent physician paid for and set up by the insurance company. 

If Your Claim is Denied You Have Certain Rights

  • You can submit an appeal to the insurance company.   
  • You can seek help from us – the Consumer Health Care Division at the Bureau of Insurance. 
  • You can seek assistance from an attorney.    

See the Bureau’s Disability Insurance FAQs for more information.