Should you be wondering whether you are unable to perform your occupational duties because of sickness or injury? This is a very hard question to even ask yourself, let alone to answer. After all, we may not think about it until we have gone through many stages of struggle. Therefore most people are generally not familiar with their disability coverage provisions, whether Employer sponsored, private or public, and how those benefit claims are decided. Then, when the situation becomes urgent there is a complex set of issues to recognize and address quickly. Unfortunately that usually happens during a time of great difficulty, urgency and distraction. There is a better way.
Consider this hypothetical:
Joe worked his way up his career path for 25 years. His duties grew and his stress load increased over time. Family issues coupled to make him depressed. He slept poorly and began drinking heavily. His performance and income diminished. Management duties were transferred from him and he was demoted. Joe’s depression was not observed. His heavy drinking symptoms were observed but not discussed. He began attending Alcoholics Anonymous but relapsed several times. Joe was finally laid off by his Employer on the premise that his position was eliminated while others not similarly impaired remained employed. His disability claim was denied since the insurance company saw his inability to work as due to causes other than sickness or injury–the elimination of his position. There is a very tough knot to be untangled now and it will require time and expert assistance to do it.
Disability can happen suddenly or gradually, as the ability to perform occupational duties diminishes over time. Therefore, disability insurance claims raise a number of “moving targets” for consideration by the insurance company. Here is a short list of some of them: Is there a health related loss of time or duties? If so, did it begin while the insurance was in effect? How are occupational duties to be defined under the policy and applicable state law, especially for physicians, attorneys and other professionals? If occupational duties have changed over time, which ones apply to your claim? Is your partial or total loss of income adequately documented as due to the disability? How do your activities reflect your ability to perform? If you continue to work, is that proof of your ability or are you merely attempting to work in an impaired state?
A person’s ability to recognize that they may have a partially or totally disabling impairment as defined by the policy and state law is quite variable. Most people try to push forward in an attempt to overcome adversity on their own. It is usually only later, when things have become catastrophic, that a claim is submitted. This greatly complicates the resolution of the “moving target” issues. The Insurance Company will see the claim as simply as possible, making assumptions about some issues because of a perceived lack of “persuasive” documentation. Their medical, vocational and financial people will all weigh in but will rarely differ as to a “general perception” of the claim. This “general perception” may be influenced by a culturally defensive posture at the Insurance Company–they see a lot of claims and often feel a need to be skeptical. It has a “snowball effect”–each reviewer influencing the next. The impact of this “general perception” cannot be overstated. It is shared among the people evaluating aspects of the claim through notes in the claim file and sometimes through “off the record” conversations, gestures or other indicators. However if you take action in a timely, appropriate and effective manner, your claim will contain documentation supporting and promoting a more claim-positive “general perception” that will work in favor of your claim from the outset. We want to help you make it easier for the Insurance Company to say yes than no because it is the right thing to do.
Whether your impairment is sudden, gradual, total or partial, there is no reason not to ask yourself whether you are unable to perform your occupational duties because of illness or injury. It is a sad fact that sometimes trying to “tough it out” works against perfecting a claim for disability benefits. Deciding when and whether to file a disability claim requires a great deal of knowledge of the process. Whatever the right decision may be–for you to file a claim now or not or to create a record that may in some future claim influence the Insurance Company to form the right “general perception”– it should be made on a fully informed foundation. Pride, fear, privacy concerns and a lack of basic information can lead to delay and a difficult knot to untangle–like Joe’s.