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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.
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