Disability insurance is basically income protection insurance — it replaces your salary if you’re sick or injured and can’t work. In order to actually use your benefits, you have to file a claim detailing your disabling injury or illness, and your claim must be approved in order to get payments
Whether you have disability insurance through your job or you went and bought yourself a policy, you’ll file a claim with the disability insurance company, not with your employer. You’ll need to follow instructions and provide documentation of your disability, and you may also be required to file a claim with Social Security Disability Insurance, which is a separate process.
What you need to make a disability claim
Every disability insurance company has its own instructions and forms for submitting claims, but generally disability claims usually require information like:
An insured’s statement: You’ll have to provide basic information about yourself, like your address, your sources of income, and where you work, along with details about your illness or injuries and the names of any doctors you’ve seen.
An attending physician’s statement: This is a form from your doctor that details your disabling illness or injury along with your treatment, and describes your level of physical or mental impairment.
An employer's statement: Your employer may need to describe your role and responsibilities, your disability’s effect on your ability to do your job, the date you stopped working, and whether you received any other disability benefits from work.
Your direct deposit info: You may be asked to provide your banking information, including a voided check, so that your insurance company can send benefits directly to your bank account.
A medical and financial release: Making a claim requires giving your insurance company permission to access records about your health, income, employment, and other personal information.
Make sure you pay attention to any claims deadlines. You may only have a certain number of days or weeks after a disability to file a claim.
What is a social benefit rider and why is it important?
Your policy may have a social benefits offset rider, which requires that you also apply for Social Security disability benefits when you file a claim. If your Social Security claim is successful, your personal disability insurance benefit may be reduced by the amount that you get from SSDI.
Where do you file disability insurance claims?
You file your disability insurance claim directly with the disability insurance company, not through your employer. Most of the time, you can file a claim via an online form or by phone, fax, or mail.
If your insurance company has a preferred method (or can’t accept claims made online, for example) it will provide the details for filing a claim in your policy documents.
How long do disability insurance claims take?
After you file a claim, it can take anywhere from a week to over a month for your disability insurance company to process your claim and make a decision and for your benefits to start.
Unfortunately, there’s not much you can do to speed up the process aside from filing all of your materials on time.
While you wait for your insurance company to process your claim, you should gather any medical documents you have. This will help to keep the claims process moving in case the insurance company requests more information from you.
What happens after your claim?
Your disability insurance company may accept or deny your claim, or ask for more information before making a decision.
If your claim is accepted, you won’t receive benefits right away. Disability insurance policies call for you to wait a certain amount of time after your disability (this is called an elimination or waiting period) before you start getting your payments.
Most long-term disability policies have 90-day elimination periods, while short-term policies often have waiting periods of two weeks or less.
If your claim is rejected, it’s not necessarily because you don’t qualify for benefits. You may not have provided enough information to your insurance company when filing your claim. If this is the case, you can appeal a denial.
How do you appeal a denied claim?
If your disability insurance claim was denied, you’ll receive a letter from your insurance company that explains how to file an appeal, including the specific information that you’ll need to submit.
You should start the appeal process as soon as possible to avoid missing any deadlines. Request a copy of the information that the insurance company has on file about your claim so you can catch and dispute any errors.
If your appeal is denied again, you may be able to file a lawsuit. A lawyer who specializes in disability insurance law can help you understand your rights and help you through the process of appealing the decision.
Filing for disability benefits from Social Security
The process for filing for Social Security Disability Insurance benefits (SSDI) is different from the process for filing a private disability claim.
You can file online or, if you’re not able to file online, you can make an appointment with a SSDI representative to apply for benefits. Be aware: filing online can take one to two hours. The Social Security Administration provides a list of what you need to apply: [1]
Personal information like your date of birth, any marriage and divorce dates, education, your children’s birthdays, any military service on your record, contact information, and bank account numbers for direct deposit.
Employment information for the last two years, including employers’ names, start and end dates, and total income.
Medical information, including any doctors, hospitals, and clinics where you’ve been treated, along with details about specific examinations and treatments, referrals, and medications.
SSDI claims can take months and you won’t receive benefits until at least six months after you file a claim, but, unlike the claims process for private disability insurance, you can speed it up if you have a terminal illness.
