The Edge Series: What is “Proof of Loss?”

The lawyers in our firm are focused on helping people with disability policies and ERISA claims. We want to give you the edge in understanding your policy. Today, we want to help you understand what the term “proof of loss” means in your disability policy.

What is “proof of loss?”

Proof of loss is the evidence that supports your claim. The proof would be your medical records, opinions of your treating physicians on your restrictions and limitations, your pain diary, videos, and photographs. Your proof of loss should mention your disability, when it began, your last day of work, and what keeps you from doing your job now.

What are the time limits to provide “proof of loss?”

There are time limits when you are providing your proof of loss. That time limit is usually 90 days. Some policies will give you up to a year if there are valid reasons for you to need more time.

What are the dangers of “proof of loss?”

There are several dangers with this term, and policies can be confusing on this.

1. At any point, you could be asked to provide ongoing proof of loss by the insurance company.
The proof of loss is the beginning of your claim, but since your disability is paid by the month, you will likely have to continue to provide that proof of loss in order for your claim to move forward.

2. That proof may require forms to be completed by your doctor.
The forms may be inapplicable to your problem or even misleading. For example, some forms may ask how much you can lift when the problem is not with your lifting ability. Another example is when a form asks your doctor whether you can work a sedentary, medium, or heavy physical demand occupation when actually you cannot work any job.

3. There are time limits for your doctor to submit forms; however, scheduling an appointment with your doctor within that timeframe might not be possible.
It is very important that you have a doctor who you trust, who will take care of your physical issues, and will also help you complete the forms to prove your ongoing disability. If your doctor refuses to help, you will have to find another way to address the problem, or the insurance company will refuse to pay your claim.

Remember our ERISA attorneys and long-term disability lawyers are here to help if you run into problems. Contact us at the first sign of trouble with your disability claim.

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