The Edge Series” What is “The Claim?”

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 “the claim” means in your disability policy.

The claim is a request for the insurance company to pay benefits in your disability policy.
The most common way to generate a claim is to complete claim forms and submit them. Providing notice of the claim such as by phone call, email, or letter to your insurance company will usually get the claim forms sent to you. If you haven’t received claim forms in the time promised to you, then give the company the information on your own.

To provide notice of claim on your own, we recommend that you draft a letter providing the following information:

  • Full name
  • Address
  • Phone number
  • Email address
  • Policy
  • Plan information
  • Medical records
  • Any statements from your doctors explaining your disabled condition
  • What you want the insurance company to do and when.

Send that letter by certified mail, facsimile, or email. If possible, send it all three ways. For mail, make sure to send it to the address noted in the policy or plan for providing proof of notice or proof of claim.

Once you have furnished your claim forms, the insurance company will investigate your claim. Usually, it has a certain amount of time to make a decision. If the claim is decided unfavorably, you can challenge that decision. There is a time limit in the plan or policy to do that, and you have to follow the time limit to keep your claim alive.

If you meet all your time limits and there is still disagreement, then your claim may proceed to litigation as long as you meet the time limit for filing a lawsuit. Missing those time limits for filing a lawsuit can destroy your claim. Your claim continues to exist as long as time limits and policy requirements are met.

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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