May 2019 Volume LIV Number 3


Treloar & Heisel

November 2018 Volume LIII Number 6

How to File a Disability Income Insurance Claim

By D. Scott Fehrs, ChFC®
Chief Executive Officer, Treloar & Heisel, Inc.

Insurance is one of those things in life that you buy and hope to never use. Disability income insurance is one of the primary insurances that you really hope not to have to use. And yet, should that day ever come, you’ll be happy you bought it.

Pretty much everyone knows someone who was disabled through accident or illness, and – whether temporarily or permanently– was unable to return to work. When that happens, first is the immediate shock of what happened to you. "Will I be OK? Can I go to work again? How will I provide for my family?"

Assuming that you had the foresight to buy disability income insurance, the next question is "Will the insurance company pay my claim?" To some degree, every claimant experiences the dread of not knowing if his or her claim will be accepted.

Once you file your claim, the insurance company will need to ascertain a number of things about you. They need to know your occupation at the time of the disability, the nature of your disability, and your income. As simple as this may seem, a lot of energy goes into giving them this information so that they can produce an answer for you.
Being better educated about the claims process could put you in a better place emotionally, and help you move through this time efficiently. To help manage your anxiety, I thought I’d put together a few concepts you will need to understand:

The insurance company cares about your occupation at the time of disability. Say you bought your insurance policy when you were an oral surgeon, but now you are a consultant to a national implant company. Well, this change may make a difference as to how the company evaluates your claim. (By the way, how an insurance provider defines the word ‘occupation’ is one of the most important things a dentist needs to understand about a disability income policy.)

The elimination period is the period of time that needs to lapse before the insurance company starts accruing your benefits. Many people mistakenly believe that this is when you start receiving your checks – it’s not.

A personal disability policy will typically have a 90-day elimination period, though other options exist. A business overhead policy may have a 30-, 60- or 90-day elimina- tion period.

If you have a 90-day elimination period it’s important to realize that you’re not going to start receiving checks on the 90th day after your disability. You will start accruing benefits after 90 days with payments usually begin- ning a short time thereafter.

It’s easy to be cynical and say that insur- ance companies do not pay claims. They absolutely do pay appropriate claims, they just need to thoroughly research your claim. This process is known as due diligence.

Due diligence includes getting state- ments from your attending physician. It also includes getting your tax returns. While this may feel highly invasive, it has nothing to do with the insurance company being ‘nosy.’ The statements from your medical providers help the insurance company determine the nature of your disability.

Your financial statements help provide a picture of your financial health. Some companies will look back as far as five years to determine your income. This can be advantageous for you. We saw this in 2008 and 2009 when many clients’ incomes were down and our clients could look back as far as 2005 to determine income. So you see, it’s not necessarily bad to give them the informa- tion they seek.
You’d be surprised at how many (even high-earning people) don’t have adequate cash reserves. By now you will have figured that if an insurance company has a waiting period of 90 days before they even start look- ing at your paperwork, realistically, you’re not getting a check until at least 120 or 130 days after your disability event. This represents at least four months that you may need to pay for your ongoing expenses out of pocket.

You should have a minimum of 6 months’ worth of expenses in cash. Ideally, 9 months or even a year’s worth would give you peace of mind that you’re covered in the event of  an unexpected mishap.


Make sure your broker is experienced in handling claims like yours. Your broker could be your chief advocate during the claims process. Also, I can’t stress enough how important it is to work with your accountant, doctor’s office, and everyone else who is going to help you as you go through this process.

Let everyone on your support team know that time is of the essence. The faster they move to give the insurance company the in- formation it needs, the faster you’ll have your check in hand. Time is money!

If you follow these steps, you should be in good shape. Good luck with your claim

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