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Disability Insurance: How To Complete The Claim Form

Physician's Portion Of The Claim Form

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In this portion of the form, the insurance company asks your doctor about your condition and your ability to work. Specific questions which are usually included are:

  • The date the doctor first treated you for the condition that is disabling you.
  • The date you became too disabled to work.
  • The medical diagnosis.
  • A list of your symptoms.
  • The doctor's impression of your ability to work.
  • Your prognosis (the doctor's opinion of what he or she expects your health condition to progress).

The difficulty with this portion of the form is that doctors frequently will not spend the time necessary to give the claims analyst an accurate picture of your condition. This is often due to the doctor's limited time. Also, the insurance company does not pay for this paperwork so your doctor is doing it "for free." Sometimes part of the problem is due to a doctor's attitude that "I'm his/her doctor; if I say he/she's disabled, then he/she is disabled." You can imagine what the claims person will think about that.

Make sure your doctor understands that you don't need to meet some vague notion of "disabled" but need to be shown to be "unable to perform the material duties of your regular occupation." Encourage your doctor to focus on specific symptoms, not just lab results. For most situations, the lab results are primarily important to provide objective confirmation of symptoms you have told the doctor you suffer from.

Do what you can to encourage your doctor to fill in each answer completely and thoroughly. Ask him or her to focus on why you can't do your job. Make sure the doctor knows what your job is.

The doctor's portion of the claim form is not something that should be dashed off while you're in the exam room. Consider leaving it with the doctor. Then call a few days later to make sure it's done. Go pick it up yourself. Many claim forms have been filed away while the claimant mistakenly thinks it was mailed to the employer.

When you pick up the claim form from the doctor, review it. Make sure that it is complete and the answers thoroughly describe why you can't work.

Don't be alarmed if the doctor makes your condition more serious than you thought it was. While the doctor's goal is to provide accurate information, it will likely be couched in terms that are geared to getting your claim approved.


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