Tips for Submitting a Claim

When you file a claim for long-term disability insurance, you are the “claimant.”

Follow the Rules in Your Policy

• If you don’t have a copy of your plan, ask for it from your insurance company. If you get LTD through your employer, ask for it from your employer in writing via a trackable method . Email, certified mail, and fax, are all acceptable ways – just make sure you have a record that you asked for it.
• You will have to follow the steps to submit a claim, follow deadlines, and follow the appeals process if you are denied.

Check for Common Exclusions & Limitations

• Look for “Objective Evidence” requirements & “Subjective Symptom” limitations—even with a cancer diagnosis, the insurance company may claim that your pain, fatigue, or brain fog is “self-reported.”
• Look for “Mental/Nervous” limitations—if you are depressed, the insurance company may claim that is causing your inability to work.

Provide Evidence

You will need to submit evidence to explain why your medical condition is keeping you from working. You may be required to submit this evidence to the insurance company:

• Claimant’s Statement (about how your medical condition is impacting your ability to work)
• Attending Physician Statement (Is your doctor a specialist? If yes, say so)
• Employer’s Statement (ERISA plans only)
• Authorization for Release of Medical Information (to the disability insurance company)
• Usually also need to have a phone interview (to answer questions and explain how your medical condition is impacting your ability to work)
• Detailed job description
• If relevant, also provide:
  • Social Security award, state disability award, VA rating, disability retirement, etc.
  • Performance reviews
  • Health journal (diary of symptoms)
  • Statements from supervisors/co-worker/subordinates, caregivers, family, and friends
• Work with your health care team
  • Talk to your health care team about documenting all of your symptoms with objective evidence, if possible
  • Make sure your doctor understands what your job entails – physical and cognitive aspects
  • Create an outline of all medical records that support your diagnosis, symptoms, side effects from treatment and medications, and co-morbid conditions that may impact your ability to work
  • Be sure you are explaining any changes against a baseline—do not say “doing better” unless qualified against a benchmark, say “doing better but still limited in my ability to …”
  • The longer your treatment relationship with your health care provider, the better – it’s OK to get a second opinion, but “doctor shopping” looks bad

Pitfalls to Avoid

• Your claim is based on your credibility. Don’t overstate your restrictions and limitations. Never say never, always avoid saying always. Answer all questions honestly.
• Assume you may be surveilled by the insurance company (e.g., watched, followed, pictures taken, etc.). If you are seen doing any activities you claimed you were unable to do, this will be used against you.
• Assume the insurance company is tracking what you do on social media. Avoid social media posts by yourself or others that may be taken out of context. If your friends can see your posts or “tags,” assume the insurance company can, too. For example, if you post about the one short hike you were able to go on last month, rather than the 29 days of fatigue and pain you faced before and after that hike, the insurance company may think that you are able to work and end your benefits. For more information, see our Checklist to Participating in Camps & Adventures .