A Philadelphia Private Disability Attorney Can Assist with Disability Insurance Claims for Professionals

Are you suffering from an injury or sickness that is preventing you from working? Has this injury or sickness limited your ability to work? Can you no longer perform all of your job responsibilities? Does it take you significantly longer to complete your duties? Are you losing money due to injury or sickness? If you are a professional who purchased individual disability insurance, a Philadelphia private disability attorney at Seltzer & Associates can assist you in filing your claim for disability benefits. Properly filing your claim and providing appropriate and necessary “proof of loss” are critical to achieving success in your individual disability insurance claim. Contact us at once to begin the process for submitting your individual disability insurance claim with an experienced Philadelphia private disability attorney.

Understanding the Difference Between Private Disability Insurance Policies and Group Insurance Policies

Many employers offer full-time workers short-term and long-term group disability insurance policies as part of their employee benefits packages. These policies are tied to a specific employer, so if the employee changes jobs or goes out on their own — something many medical professionals and executives end up doing — they cannot take their coverage with them. Group insurance coverage can also change year to year, as can the premiums. The employer chooses which policy to offer its employees, and the terms and conditions for receiving disability insurance benefits. 

Many professionals — especially high-income earners like physicians, dentists, and others in the medical field — opt to carry individual disability insurance either to supplement a group plan or as their primary disability insurance. Having private disability insurance gives high-earning professionals more control over their disability insurance benefits, something many take into account when looking at their disability insurance options. The benefits of purchasing private disability insurance are indisputable, but only if you understand what you are buying and if the policy you choose meets your needs should you ever prove unable to work at the specialty you have trained for. 

Understand The Private Disability Insurance Policy You Are Buying

If you are trying to decide what type of individual disability insurance to purchase, and you want to make sure that you understand the different options being offered, it is a good idea to sit down with a Philadelphia private disability attorney to go over potential policies and their coverages before making a decision. At Seltzer & Associates, we can help you review prospective new policies by performing a comparison of policies so you can better understand how best to protect your financial needs. Working with your insurance broker, we can assist in providing you with an understanding of the policies you are reviewing for purchase.

What is individual disability insurance?

These policies are typically purchased by executives and professionals with high salaries and uninsured earnings. Often, employees who have a gap in coverage under a group long-term disability policy may also be eligible.

What are the key advantages of individual disability insurance? 

Individual disability insurance policies offer more flexibility, given the option to increase your supplemental policy.. With individual disability insurance, you do not need to worry about losing your group benefits if you had to leave an employer as those are only active while employed. Also, benefits are distributed as tax-free income while you are disabled as long as you pay the premiums with post-tax money. An experienced Philadelphia private disability attorney can help you navigate the complex details of these policies.

For example, private disability insurance can offer policyholders:

  • More comprehensive benefits because they are individually underwritten
  • Premium costs that won’t go up 
  • Better terms, such as “own occupation,” rather than “any occupation” 
  • Guaranteed coverage (non-cancelable and guaranteed renewable)
  • Set benefits, such as a certain amount a month, rather than an amount tied to income or salary
  • The ability to collect benefits tax-free; employer-based coverage is often considered taxable income

While there are many good reasons to purchase individual short and/or long-term disability insurance, there are also some drawbacks. Private policies can be costly and the terms can be difficult to interpret on your own. You want to avoid a situation where you find out later that the terms of the policy you purchased are not what you understood them to be. 

Before you shell out sums of money on a policy that, if invoked, won’t give you the coverage you need, sit down with an experienced Philadelphia private disability attorney to make sure you understand everything about the policy you are purchasing — including its provisions and requirements and how to go about filing a claim, if necessary. 

Our Philadelphia Private Disability Attorneys Explains Riders and Other Benefits 

A Philadelphia private disability attorney can also ensure that you are taking full advantage of your policy options and that you are well-protected in the event you become disabled. Most insurance companies offer riders to add to your policy. While each rider added will increase your premium, they provide valuable extra measures of security, above and beyond your standard disability insurance policies. Examples of common riders include:

Residual Disability:

If you have this rider you can earn benefits even if you are not fully disabled. If you suffer a partial disability and are able to work in a limited capacity, the residual disability rider helps to close the gap between how much you earned before your disability and how much you earn after your disability. This rider is a great way to protect yourself if you suffer a reduction or loss of earnings.

Catastrophic Disability:

This rider will protect you in a worst-case scenario such as loss of speech, hearing or sight to loss of the use of your hands and feet. It also protects you if you are unable to do day-to-day activities, such as bathing, eating, dressing, and using the restroom. With this rider, you will receive an additional benefit on top of your regular monthly benefit. 

Retirement Benefit:

With this rider, your insurance company will put a percentage of your premium into a monthly retirement account. It will go into a trust that will pay out once you are in retirement. It is a great way to continue to contribute to a retirement savings account, even when your income is reduced and you are only collecting disability benefits. 

Cost of Living Adjustment (COLA):

The COLA rider ensures that your benefit amount will increase in accordance with the rate of inflation. This rider is particularly important if you take out a policy when you are young. As the Consumer Price Index increases with years, so will your monthly disability insurance benefit. This rider is a way to ensure that your benefit will grow as your earnings grow over the years.

Future Increase Option:

Sometimes referred to as the future purchase option, this rider affords you the option to increase benefits without having to undergo any health evaluations. Thus, you are guaranteed to be insurable at the time of increase. You will only have to show that your income has grown and is eligible for the increase. Although there is usually a cap, this rider allows you to increase benefits to keep pace with your income and for life events such as when you get married or have children. Without this rider, you will need to undergo a new medical evaluation and have a new policy underwritten based on your current health should you wish to increase your coverage.

Specialty Coverage for Medical Professionals

It is imperative that you understand the claims process, understand your policy provisions and requirements, the defenses that your insurance company will employ in your claim, and receive guidance to take you through this process in the most effective way. Often, physicians, dentists, psychologists, nurse anesthetists, chiropractors, and other medical professionals have individual disability insurance policies which cover your inability to perform your specific occupation or your own specialty. While you may have paid higher premiums for this coverage, when your ability to work in your occupation has been affected by an injury or sickness it is important for you to understand your policy and know what provisions you must satisfy to obligate your disability insurance company to pay you benefits.

Your policy may contain:

  • “Own Occupation” coverage, your inability, due to your injury or sickness, to perform the material and substantial duties of the occupation you were performing when you became disabled.
  • “Modified Own Occupation” coverage, your inability, due to your injury or sickness, to perform the material and substantial duties of the occupation you were performing when you became disabled and not actually working in any other occupation.
  • “Any Occupation” coverage, your inability, due to your injury or sickness, to perform the duties of any gainful occupation for which you are qualified by training, education, or experience.

These provisions can often cause confusion for individuals unfamiliar with them. Additionally, disability insurance companies will often try to construct their own occupation for medical professionals as something other than limited to the performance of your clinical medical professional duties, such as an entrepreneur, administrator, lecturer, teacher, or chief of staff, thereby changing or modifying your occupation as covered under your “own occupation” coverage.

We will review your existing policies on a line item basis to help you achieve the best possible understanding of what Individual Disability Insurance coverage you have and when benefits should be payable. We will methodically analyze the definitions in your specific policy and help you understand how those definitions apply to your unique situation. We will help you understand if you are in or considering the claims process and how every policy provision may be employed by your disability insurance company as a potential barrier to paying your claim.

What a Philadelphia Private Disability Attorney Wants You to Know about Submitting a Disability Insurance Claim 

You’re injured or sick and your ability to work has been restricted. You purchased Individual Disability Insurance hoping you would never actually need it, but now you do. It’s time to apply for your disability benefits, do you know how to proceed? Let the team at Seltzer & Associates assist you in this complicated task and guide you through this difficult and complicated claim process.

Whether you are already pursuing a claim or are considering submitting one, we will help you understand the claims process, as well as how every policy provision may be employed by your disability insurance company as a potential barrier to paying your claim.

Don’t Wait Until It Is Too Late

It is important to begin the process of filing your claim for disability benefits as quickly as possible. Your policy will have notice requirements specifying how much time you have to file a claim. Waiting too long can decrease your chances of successfully obtaining Individual Disability Insurance benefits due to your injury or sickness or reduce the amount of benefits you may be able to obtain.

A Waiting Period Could Delay Your Disability Benefits 

In addition, your policy will likely have a waiting period — also referred to as the elimination period — which is the time period between the onset of your injury or illness and the receipt of benefits. Depending on the policy, this period could range from 30 to 365 days. Importantly, as a Philadelphia private disability attorney can explain, during the elimination period any short-term disability insurance coverage you have in place can kick in.

Provide the Appropriate Information

When filing a claim for disability benefits, you are required to provide the insurance company with proof of loss. In an Individual Disability Insurance claim, proof of loss includes statements from you regarding your disability and forms from your doctor explaining how your disabling condition in some way restricts or limits your ability to perform your important duties and earn income. Careful preparation in the early stages of your claim is essential and can help you avoid common, often critical, mistakes in submitting this information. It is essential for you to thoroughly explain your medical condition and occupation. It is most important your company understands and accepts the nexus between your medical condition and how it negatively impacts your ability to perform your material and substantial duties at work.

One of the most significant challenges individuals face in the claims submission process is getting the necessary medical records and information to the disability insurance company. The documentation necessary may be different from your doctor’s standard office notes. We will work with you and your doctor to make sure all necessary and pertinent information is provided to your disability insurance company.

Remember, your claim will be scrutinized by your disability insurance company’s team for any possible defect or inadequacy so as to end in denial and you must understand all information, from telephone conversations with the company to medical records submitted, will become part of the disability insurance company’s file. Therefore it is important to have a Philadelphia private disability lawyer, experienced in handling Individual Disability Insurance claims, assist you. We will guide you through the process and help you file your claim in the most effective and strongest possible way with the highest likelihood of being approved and paid by your disability insurance company.

Free Consultations with a Philadelphia Private Disability Attorney

Seltzer & Associates provides an initial consultation of your claim free of charge. Whether you need to file a claim or have had a claim denied or terminated, we can review your policy and pertinent documents for you without financial obligation. We will review the issues specific to your individual situation, including your policy provisions, medical records, and other documents you have on hand.

Individual disability insurance claims are unique to each individual. Your specific occupation, disabling medical condition, and individual policy you purchased require a collective analysis to determine how all of the parts best fit together. At Seltzer & Associates, a Philadelphia individual disability insurance attorney can help you understand the process of claiming individual disability insurance benefits and how to present your claim in the strongest possible way with the highest likelihood of being honored by your disability insurance company.

In addition to reviewing your potential claim, we will begin the process of explaining to you what you can expect to encounter as you engage your disability insurance company in the claims process. We will help you make the most informed and effective decision as to how to proceed in filing your claim and throughout the claims process for your individual disability insurance benefits. If you need assistance in understanding the Individual Disability Insurance policy you have or have any other issues, please contact Seltzer & Associates today for a policy review.