Claims Management

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Important Tips

Tip #10
Independently document your symptoms, medication side effects, doctors’ visits, and general wellness as much as you can. Medical records often have errors or do not completely reflect what was discussed during your visits. Keeping your own log

Tip #4
Be truthful and thorough when you present your medical conditions, especially if you have co-morbid or multiple conditions.

Claims Management:

If you are receiving long term disability insurance (LTDI) benefits, whether or not you have prevailed on appeal, you have an ongoing responsibility of managing your claim to avoid an interruption of benefits – this is known as Claims Management.

Most LTD plans require claims administrators (often an insurance company) to conduct periodic reviews at any point during your LTD claim and as often as necessary to determine whether you continue to meet the policy’s definition of disability. These reviews typically include but are not limited to: requesting updated medical records, completing various disability forms, and obtaining updated assessment forms from your treating providers, all of which must be addressed within a specified amount time.

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Claims administrators also obtain opinions from internal physician reviewers who are hired by the claims administrator to conduct an independent review of your file and issue a report. Claims administrators rely heavily on these physician reviews and, more often than not, give them more weight than your own physicians’ assessments. The claims administrator may also require you to go through additional testing, such as independent medical examinations or functional capacity evaluations. Often times, claims administrators will conduct surveillance on you without your knowledge and use this as a basis for terminating benefits.

For these reasons, it is extremely important to manage your LTD claim at all times and try to be one step ahead of the game.

Claims management can be overwhelming and time consuming for many people, which is why we are here to help you during this process. We will communicate directly with the claims administrator on your behalf and be your advocate in submitting all necessary information. We work closely with you to ensure we have the most up-to-date information. We guide you through the entire process.

Contact us to learn more about how we can help you.

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