What is the Process of Disability Insurance Claim?

Disability Insurance abbreviated as DI is a form of Insurance that protects the insured from future risks such as an accident or psychological problems which hampers him from doing his job. Paid sick leave, short term disability benefits (STD) and long term disability (LTD) benefits all fall under the Disability Insurance.

Before one files the claim one must be fully aware of the Employee Retirement Security Act of 1974 also known as ERISA .This law protects the disability benefits and sets the benchmark for those who process the plan.

The Summary Plan Description or SPD which comes with the Insurance Plan provides a detailed overview of the plan that is, what are the benefits of the plan and how to file the claim. The Insurance Plan’s administrator generally hands over a copy of the SPD to the claimant.

The SPD must be thoroughly checked to make sure that the person meets the plan’s requirements to receive the benefits. In case of an emergency the treating physician becomes the authorized representative for the person insured and can file the claim. A copy of the file claimed should be kept for records.

The time frame given for a disability insurance claim to be decided is not more than forty five days. In certain exceptional cases it may be extended for another thirty days.

The above mentioned time limit does not hold good for two exceptional cases. Those who are under single employer have a collectively bargained grievance process whereas those who are under multi employer are given a special time frame for filing their claims.

These days The Employment Development Department (EDD) has devised a way to file Disability Insurance via electronic filing system. DI claims can now be filed online by downloading the electronic form or a request via email.

The Physician or Practitioners Certificate is very essential for processing of the claim. The receipt number of the claim is provided to the treating physician for processing of online medical certification.

The Claim is generally processed within fourteen days once The State Disability Insurance (SDI) matches both the portions of the claim from the claimant’s side as well as the medical practitioner’s certification. A Notice of Computation is generated once the claim is processed which shows the benefit award for the claim and the wages used to calculate the award. An EDD Debit Card is issued from the Bank of America if one is found eligible for the Disability Insurance Benefits.

In some cases a claim may be denied ,the claimant is then served a written notice explaining as to why the claim was denied and specific information as how to file an appeal. The claimant gets 180 days for a full and final review of his denied claim. During this time new evidence or information is submitted to the insurance company. If the appeal for the claim is denied then legal advice may be sought to further reestablish the claim. If the plan fails to follow the ERISA’s requirements then one may also contact the nearest Employee Benefits Security Administration (EBSA) office for safeguarding ones rights under ERISA.

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