What does it take to get approved for disability insurance benefits? If you are seeking disability insurance benefits this video and article will cover many of the frequently asked questions that disability income policy holders ask our disability insurance attorneys. Topics covered include the differences between a group policy and individual disability insurance policy and why getting regular treatment from your doctors is so important.
GREG DELL: Hi, I’m Greg Dell with attorneys Dell & Schaefer. And I’m here with attorney Cesar Gavidia. And today’s disability question is, “Is it hard to get approved for long-term disability insurance?” And Cesar, this is a question that we get a lot, not just from people that call us, but from people that we see on the– people we come into contact all the time when they say, hey, what do you do?
And you say, I’m a disability insurance attorney. And they go, oh, I have that. Is it hard to get approved? And what’s your– I mean, so many things must be going through your mind when you hear that question.
CESAR GAVIDIA: Yeah, I mean, it’s a general question. It’s relative, right? So if you’re someone with stage 4 cancer, God forbid, and you file a disability claim because you’re terminally ill, and you can’t function, and you can’t go to– you can’t go to your doctor’s appointments. You have to get transported there or something, then clearly it’s not going to be difficult for that person to be approved.
But for the average person, for someone who’s going to be potentially having the nuances of their occupational duties and the details of their specific limitations. And they have doctors that maybe they’re not sure are going to support their disability claim, or not sure what they should say for them to be approved for their disability claim, that person may encounter some challenges, sure.
GREG DELL: And in terms of when we say, get approved, what are other factors in terms of the type of policy that a person has that could make it more or less difficult to get approved?
Factors that Make it Difficult to get Approved for Disability Income Benefits
CESAR GAVIDIA: Well, I just think when you’re thinking in different types of policies, one of the things that is really critical is the definition of disability, right? If you have a disability policy that insures you for disability in your own occupation versus a disability standard of being able to work in any gainful occupation, then just by the definition of disability, you’re going to have a much harder time getting approved from disability from any gainful occupation than you would from disability in your own occupation, possibly.
Group Disability Insurance Policy vs. Individual Disability Insurance Policy
GREG DELL: And I also think one of the big things in terms of the type of policy you have is whether you have a policy that’s governed by ERISA, which is usually an employer-provided policy, or if you’re the type of individual that bought a policy on your own from a disability insurance company through the use of an agent. And that’s a complete situation where you get what you pay for because the disability private policy is usually 10 times the cost per dollar for every dollar of coverage versus the employer-provided one, because the policy definitions are and the language is so different. And one’s governed by ERISA, the employer-provided one. And the other one isn’t, which gives you rights to jury trials.
CESAR GAVIDIA: Right. Innately, just by being an employee benefit policy, one governed by ERISA, there’s going to be huge advantages to the insurance company. So just by their very nature, they’re going to be much – it’s going to be much more challenging to be approved on an employee-benefit ERIS disability claim than it would be on an individual disability policy.
Why Medical Treatment is so Important in a Disability Claim
GREG DELL: And then the other thing about “is it hard to get disability benefits approved” is well, have you seen a doctor? What’s the status of your medical treatment? Touch just briefly why is medical treatment so important in a disability claim?
CESAR GAVIDIA: Well, just from the very onset, there are disability insurance companies – and it’s because it’s a legal standard in many places – that if a doctor does not – if you have not seen a doctor in or around the time that you stop working – and what I mean by in and around the time – within a week or two of stopping work. And that doctor’s not saying, you need to stop working. You can no longer continue to function in your occupation, then the insurance company could very well challenged your claim and say you’re not entitled to benefits.
Every Month a Disability Insurance Claimant has a Duty to get Medical Treatment Regularly
So just from the very onset, without that support there, without having seen that doctor within that time frame, you may not get approved just for that reason. And then going forward, it’s not just about establishing that moment that you stop working. It’s about establishing every month thereafter, because every month, you have a duty to continue proving your disability, and to ensure that your doctors continue supporting it. Because at any point that that fails to happen, the insurance company’s going to deny your claim.
GREG DELL: But does the claimant have to keep going to the doctor continuously?
CESAR GAVIDIA: Absolutely. There’s appropriate care provisions in these disability policies. Now, sometimes you’ll see language that says, “if we deem, or if we find–” and “we” is the insurance company– “that ongoing treatment is no longer of a benefit to you, or you no longer need to continue seeing your doctor, then we won’t require it.”
But I often explain to clients and to people that it’s a trap, OK? Because what’s happening, even though perhaps it’s being established you don’t have to – you no longer have to see your doctor; we’re not going to require as many frequent visits to your doctor, what you’re doing is actually you’re working against your own claim. You’re working against yourself because the documentation’s not going to be there.
The recorded history of your complaints, of your symptoms, of your ongoing problems, of your ongoing limitations is not going to be there. And you’re just setting yourself up to be denied. So I always counsel people, continue seeing your doctor, even if you don’t have– if the insurance company’s only asking for an update every six months, every year, continue seeing them by month, every two months, or every three months. Don’t let more time than that pass by.
GREG DELL: So Cesar, I think the simple answer to, is it difficult to get disability benefits paid, is to you’ve got to be prepared. And you’ve got to make sure that you have appropriate doctor support, that you have the backing of employers or co-workers to have a difficulty.
I mean, you got to have a real issue that prevents you from being able to either do the duties of your occupation, if that’s what the definition of disability is, which is usually what it is the first two years of any policy, and then possibly unable to do the duties of any gainful occupation. But it is not going to be like the process when you bought your policy, and you just went ahead and applied for coverage, and they go, OK, send us your tax returns. You’re approved.
It’s a whole other animal. Cesar, we’ve done tons of videos in terms of how to apply, what to do if you’ve been denied, tips for applying for benefits, how to get supported – I mean, so many videos which leads me to suggest to people watching this video that we encourage you to subscribe to our YouTube channel where you can watch all these other videos.
And more importantly than that is that call us. Call Cesar or myself, any of our lawyers for a free initial consultation. Let us review your disability policy. We want to let you know what’s at stake in your claim and how we can help you no matter what stage you’re at. Our offices are – we’re available to represent you anywhere in the country. And we welcome the opportunity to speak with you to discuss your claim.
If you need assistance with a disability insurance claim, contact any of our disability insurance lawyers for a FREE consultation to discuss how we can assist you.