Have "own Occupation" DI. Submit Disability Application Now or Wait?

Discussion in 'Disability Insurance Forum' started by disen, Aug 29, 2017.

  1. disen
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    disen New Member

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    Hello! I have a disability insurance policy that is "own occupation."

    My employer is currently allowing me to avoid the part of my job that is problematic (heavy lifting, which has been causing severe back pain).

    However, at some point they will understandably need me to resume that part of the job.

    My hope is that physical therapy will improve my symptoms and I can resume my usual job duties, so I am reluctant to apply for DI benefits now. Additionally, if I wait until Jan 1st, if I do ultimately need disability benefits, it will be calculated based on a higher salary.

    However, if I wait, I am worried the DI company will say "You haven't been doing any heavy lifting in 8 months, so it is not part of your occupation, and we won't pay."

    So, safe to wait? Or should I apply now just in case?

    Thank you!!
     
  2. MaxReaver
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    MaxReaver Expert

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    I have sold "own occ" DI - one of my clients was my wife who subsequently suffered a brain tumor. She is still on the mend but hanging tough...I have the following advice:

    I would not wait to file a claim. It can take weeks or months for your DI provider to get all the records and facts in to make a decision. They won't pay benefits until they have enough info for a decision and some institutions suck at getting them the records. If, for example, you have 90 day elimination and it takes them 4-5 months to get all the records, you will not get paid for 4-5 months but it will be retro to the 90 day elimination.

    I do not see any advantage to waiting. It can be a slow process - get started now.
     
  3. LGilmore
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    LGilmore Guru

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    Do you have a residual disability rider with your policy? Is it a group or individual policy? What company?

    Can you give us the definition of disability in your policy?

    File.

    Having been disabled for a year, it does take a while as Max pointed out. The longer you wait, the longer it is going to take.
     
  4. kpbdy99
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    kpbdy99 Expert

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    For Pete's sake, FILE the claim. The worst that happens is they say "no," and when they say "no," they'll explain why. But if they say "yes," your on claim. That's what the insurance is for - use it!
     
  5. David Block
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    David Block Expert

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    You're saying you have an own-occupation policy but that you do heavy lifting? Was that part of your original job description or something that came to be over time? No matter, in order to properly evaluate a successful or potential claim, anyone would need to read the contract. Also, if you believe you have a "questionable" claim, there are people who specialize in helping individuals file their claims. I can recommend someone if you would like.

    If you would like me to review your contract for verbiage pertinent to your situation, please contact me directly and I will be happy to assist. I wish you all the best for a successful and complete recovery.
     
  6. Caryn Montague
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    Caryn Montague New Member

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    It sounds like you are working full time, with accommodations. You have not had a reduction in income or a separation from employer. (Guys.....where exactly is the claim, own occ or otherwise?)

    As David mentions, someone should review your coverage and and have a heart to heart with you. Whether you have a group plan or your own policy can matter. And, while you're answering questions, now is the time to look at the other insurance coverages you have because you do have other benefits that tie into a disability claim, should you make one. (Do you have life insurance waiver of premium, hospital plan, short term disability, where are your retirement plans, etc.)

    What is important is that you know what you have, have a well documented medical history and show you are compliant with medical care, be able to show your accommodations at work (and outside) as well as how your life/income producing ability has changed.

    Assuming all your ducks are in a row, then I can see possibly putting the carrier on notice but I cannot see anything coming back, from the little you've shared, save for a denial letter. And, with the denial letter you look at an appeal. IMHO, I'd rather get the initial filing straight, supported and then consider my chances. Just my 2 cents.
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