Living with chronic illness can mean steady doctor appointments, persistent pain, sleepless nights, financial difficulties, and even insurance complications. Insurance problems come up frequently for people who have a long term disability (LTD) policy.  Insurance companies often make it very difficult to satisfy their requirements for getting a LTD claim paid. LTD is different than Social Security disability. [If you aren’t sure whether or not your employer provides LTD benefits you should ask your HR representative immediately!]  Becoming familiar with these five common LTD insurance issues can help prepare you to (1) become your own best advocate and (2) fight for the disability benefits to which you are entitled. 

  1. Keep in mind that you have the burden of proving not just that you suffer from RA, but that the condition prevents you from working.  You must provide evidence that your illness is debilitating enough to entitle you to LTD benefits.  The first step is to become familiar with your insurer’s definition of disability. You know that your rheumatoid arthritis (RA) has unquestionably altered your ability to function at work. Your family knows this. Your physicians know this. Insurance companies, however, often remain doubtful and require “objective evidence” as proof of your disability. Anyone who has experienced RA in some form or another understands the absolute irony of this situation. RA is often referred to as an “invisible illness” because a great deal of the damage is not visible to others. Furthermore, the imperfections with diagnosis, treatment, and understanding of autoimmune illnesses create the perfect foundation for long-term disability insurance denials. This can pose a difficult challenge for those suffering with RA, especially when communicating the severity and impact of their illness to physicians, family and friends, employers and even insurance companies. Unfortunately, the burden of proving your disability is yours. What can you do about it? 
  2. Keep a journal and take copious notes. Many people, including your insurer, have no idea what a day in the life of chronic illness is like. Document and explain this. As an expert on your pain and symptoms, only you can explain the far reaching impact that your illness has created. Take the time to record this information. This way, you will be prepared in the event that you need to prove and objectify your condition. This information is also helpful for communicating and describing your symptoms accurately with your physician.  Consider bringing the journal to your doctor visits to make sure your doctor notes everything relevant about your condition.
  3. Follow the advice of your treating physician. Once you have found a physician qualified to treat your illness, be sure to communicate honestly and effectively. Always tell your doctor the whole truth, including any reactions or side effects from medication. Try not to miss appointments, and follow the advice and recommendations from your physician. If you do not feel the advice your physician is providing is appropriate for you, document why that is the case. Following your doctor’s orders, and communicating honestly, will lend credibility and consistency to the serious nature of your illness.
  4. Prepare yourself for effective communication with your insurance company. Before you pick up the phone to call your insurance company, make sure you write down exactly what you would like to say. When you are on the call, try to get the name, title, phone number, and email address of the person you are speaking with. Write down everything that has been said in the conversation. After the call, confirm the conversation in writing – sending it in to the insurance company through certified mail or email. Remember, if you can’t prove it, it never happened.  For this reason, it is important to try to keep all of your communication with your insurer in writing.
  5. Making your long-term disability claim. Ask your employer or insurance company to send you a Summary Plan Description and all Benefit Plans provided by your employer.  Once you have a copy of your Summary Plan Description and/or the policy, you can refer to the policy for the specific claims submission procedure implemented by your employer. The steps for submitting a claim can vary depending on your employer, however, the process usually begins when you contact your employer or insurer to tell them that you need to submit a disability claim. You will then be provided with a number of forms to complete and sign for your claim. Make sure that you complete ALL required forms…failure to do so will most likely result in a denial for “failure of proof.”

Dealing with RA, in addition to the many complications that come along with obtaining long-term disability benefits, can be emotionally overwhelming and financially devastating.  If you have questions about your long-term disability policy or insurance denial, do not hesitate to contact us for guidance and support.

We understand, and we can help. (800) 446-7529