Making a Disability Insurance Claim

disability insurance
We take you through the steps of filing a claim.

According to Money Sense, one in six Canadians will be disabled before the age of 50.

The first step in collecting on a disability insurance policy is to contact your insurance advisor, or your insurance company directly, to let them you would like to file a disability claim.

Depending on the provisions of your policy, your advisor or company will let you how long you must wait to start collecting your disability benefits and the paperwork that you will likely need to complete.

The form you will need to fill out is called "The Claimant's Initial Statement," and these are the steps you'll need to go through to complete your claim.

FIRST CONTACT
Once your Claimant’s Initial Statement is received by your insurer, your claim examiner will send you a letter acknowledging the receipt of your form. This letter will also provide you with the examiner’s telephone number in case you have any questions regarding your claim.

Your examiner will then review the claim once they receive both your Claimant’s Initial Statement and the Physician’s Initial Statement. Most claim forms are very complete and in most cases, no additional information will be required. If, however, additional information is required, your examiner will contact you directly.

INITIAL DECISION

The insurer will make an initial decision within 30 days of receiving the claim. One of four decisions are possible. A brief description of each follows.

  • Approval of the claim based on the evidence submitted

If the information on the claim form is sufficient and all the conditions of the policy are met, the first monthly benefit will be paid at the end of the month in which the waiting period has been satisfied.

  • Approval of the claim with further benefits, pending additional information

The examiner may be able to pay one month of benefits, with further benefits pending the receipt of additional medical information. This method is used most often when the disability extends beyond the normal recovery period. 

  • Request additional information before considering acceptance of the claim.

Some policies provide for coordination of benefits with Worker’s Compensation or No-Fault Auto Benefits. In these cases, the examiner will need to know the amount of benefits you are eligible to receive from these sources. Other times, the portion of the claim form completed by the physician does not provide sufficient medical information to support a claim for disability. In these situations, the examiner may have to write directly to the physician.

  • Claim not accepted

This occurs when the examiner determines that a term or condition of the policy has not been met. A letter of explanation will be provided by the examiner.

A Few More Tips

If the policy is under two years old, or if the insurance company suspects something may be offside, the insurance is likely to scrutinize your claim more closely.

If you are having difficulties with your disability insurance claim, you can visit our Insurance Claims Problems Page for some free advice from lawyer Andy Suboch.

LSM Insurance Tip: Make sure you keep your disability policy in a safe spot and your family knows about this policy. Some disability policies pay a small death benefit if the insured passes away.

Call us: 1-866-899-4849

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2 Comments

  1. priscilla 09/20/2014 at 1:54 pm

    Please asdvise me if I can work while my disblity claim with my companys insurance is in process

  2. LSM Insurance 09/20/2014 at 2:26 pm

    Hi Pricilla, You would have check your policy. If there are partial or residual disability benefits.

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