by Chris Roy
Attorney & Owner of Roy Law Group
Cancer is one of the most common causes of long-term disability. This is due to the physical and psychological toll of cancer itself, and also the cancer-related fatigue (CRF) and weakness related to treatment and recovery. Even under the best conditions, filing a cancer-related long-term disability claim can be stressful, complicated, and an overall physically and emotionally exhausting process.
Now, as we have learned from the recent COVID-19 pandemic, situations emerge from time-to-time that can add new layers of complexity to the claims process. This can cause delays in communication from your disability insurance company and even scheduling timely appointments with your medical providers. You may have to wait even longer for your disability benefits or even face a denial for failure to meet your insurance company’s unreasonable deadlines. Ultimately, these processing delays and a potential denial of benefits can be financially devastating for you and your family at an already difficult time.
Fortunately, while some factors might be out of your direct control, there are still some things you can do for a faster, smoother, and potentially more successful disability claim-filing process.
Tips to improve your chances of an approved claim
1. Understand your insurance policy and proof of claim requirements
As you prepare to file your claim, it’s important to remember that your insurance company is not on your side. In fact, it will be looking for any excuse to deny your benefits. All it takes is one simple mistake on your part when filing your claim for it to result in a denial.
Remember, the terms of your agreement are located in the insurance policy itself (not the summary plan description or other ancillary and related documents). If you do not already have a copy of your policy, then get a copy right away and read it, especially any sections related to filing a proof of claim. If your insurance is provided through your employer, you can consult your Human Resources department to obtain a copy. If you purchased an individual plan, your insurance company or insurance agent should be able to provide you with a copy.
The proof of claim section of your policy tells you what you need to do to get your claim started, including the applicable timeframe. Read the “proof of claim” section carefully and do not miss the deadline by which you must file your claim or you could be out of luck. Many policies indicate the proof of claim must be filed within 90 days of your date of the disability.
Your insurance policy documents will also provide other important information about filing your claim, including:
- Additional timelines you are required to meet
- Your policy’s elimination period (i.e., the period between when you become ill and when you can start receiving benefits)
- What supporting documentation must be submitted with your claim
- The definition of “disabled” within the context of your insurance policy
- Your right to appeal in the event of a denial
2. Provide as much medical evidence as possible
A cancer diagnosis alone is not enough for your disability claim to be approved. You will need to prove that your medical condition meets your insurance policy’s definition of a disability.
You can strengthen your claim by including all medical evidence possible, which will carry more weight with the insurance company. Ideally, you should gather all relevant medical records before you file your claim.
Some examples of medical evidence you should include with your claim:
- Biopsy results or pathology reports
- Imaging reports (e.g., MRI, CT scans) as well as the actual imaging itself
- Surgical history (or a report from your physician on why your cancer is inoperable)
- Details of your cancer treatment, including frequency of treatment and side effects
- List of any and all medications and their side effects
- Medical background and history to show a decline in health
- Supporting statements from your medical providers
It’s better to include as much supporting evidence as possible with your initial claim. If you wait for your insurance company to request more information later, this could just drag out the process even more.
It’s important to note that cancer-related disability claims are most commonly denied after treatment ends, despite the long-lasting side effects. The severity of post-treatment CRF can be unpredictable and impossible to measure through objective tests. That’s why you should maintain regular visits with your physician and keep a record, like a symptoms journal, in order to have documentation of your condition over time.
It’s also important to note that insurance carriers are required to look at all of your medical conditions in combination. So, just because your primary condition is related to cancer and treatment, you may have co-morbid conditions that compound the problem, and those are all relevant. Some common diagnoses that are often left out of claim documentations are sleep apnea, depression, anxiety, and other conditions that cause general symptoms of pain and/or fatigue.
3. Respond promptly and accurately to any requests
Your responsiveness and ability to meet all deadlines will be critical to the success of your claim. Any delays or missing information on your part could mean your insurance company will take longer in making a decision.
Respond promptly and accurately to any and all “reasonable” requests for additional supporting information. Written correspondence is best for the sake of documentation purposes, rather than by telephone.
If you are struggling to keep up with requests from your insurance company, you should seriously consider consulting a long-term disability lawyer for general advice. Many long-term disability law firms do not charge for initial consultations or the provision of general advice. In any event, don’t risk missing any key information that could delay your claim or cause it to be denied.
Be prepared, proactive, and do not count on your insurance company to look out for your best interests
The more you do to prepare in advance of filing your disability claim, the better your chances of a positive outcome. Take a proactive approach, rather than a reactive one, to try to avoid any unnecessary delays or mistakes. Because typical processing times could be impacted by unforeseen events, like the COVID-19 pandemic, your preparedness is especially key at this time.
Always remember, your insurance company will not look out for your best interests, and it is ultimately up to you to prove your disability claim.