CLHIA-ACCAP - Consumer Information

A guide to disability insurance

Issue link:

Contents of this Issue


Page 18 of 20

7 FILING A CLAIM What you need to do Make sure you understand the claims process and obtain all the forms necessary. Your benefits administrator and/or your insurance agent can advise you and help you make sure the papers are filled out correctly before you submit them. Make sure you file your claim promptly. There may be implications if you don't submit your claim within a certain amount of time after you become disabled. This time frame will be specified in your policy. Keep your insurance certificates and benefits booklets handy. A relative or adviser may need to access them to act on your behalf. Tho role of your doctor Your doctor (and/or other primary healthcare providers) will likely need to provide information about your condition. The insurance company may ask for more information or that you be examined by a designated physician. Proof of continuing disability will usually be required periodically throughout your disability. The role of the insurance company The insurance company will evaluate your claim based on the provisions of your plan. How does your plan define disability? Is there medical evidence to support that you are disabled according to the terms of your plan? Are you unable to perform your regular occupation, or are you unable to perform any form of gainful employment for which your education, training and experience may have prepared you? Your right to appeal If your claim is not accepted or if your benefits are terminated, you have the right to appeal this decision if you don't agree with it. Check the provisions of your plan to find out if there is a time limit to appeal, and make sure you know who and where, in the insurance company, to send your appeal information. If your appeal is turned down and you believe the decision is unjust, you may wish to contact the OmbudService for Life and Health Insurance to discuss your case. 16

Articles in this issue

Links on this page

view archives of CLHIA-ACCAP - Consumer Information - A guide to disability insurance