Thousands of people every year file for Disability Insurance claim due to sickness or injury. So filing for a Disability Claim becomes very crucial. One of the important documents related to the insurance plan is the Summary Plan Description (SPD) which provides detailed information about the plan that is how the plan works, what the benefits of the plan are and how to file a claim for benefits. Generally the insurance plan’s administrator provides a copy of the SPD to the client.
There are various rules and regulations to be followed both by the insured and the insurance company in order for the proper processing of the disability claim. In order to make a decision in a disability claim the plan must make a determination of the disability.
- The Summary Plan Description (SPD) highlights the rights and responsibilities of the insured under theEmployee Retirement Income Security Act of 1974 (ERISA).
- The person insured must make sure that he meets the plans requirements and agrees to the terms and conditions mentioned in the SPD.
- Sometimes there is a waiting period before which the claimant cannot enroll and receive the benefits. This is mentioned in the SPD booklet.
- There are no filing fees for any claims.
- After a claim is filed one must make it a point to keep the records which can serve as a future reference as well as a proof.
- There is a specific time limit for filing a disability insurance claim.
- The claims under the Disability insurance must be settled
within 45 days from the date of claim. However in special cases an extra 30 days of time may be taken.
- In case of denial of the claim the plan administrator must inform the claimant in writing or electronically. A detailed information as to why the claim was denied must be mentioned in the writing.
- The claim must be made within 30 days after one has become disabled.
- The client will have to forfeit his claim if he claims after 26 weeks from the date of his disability.
- The claim can be made online by downloading a form or manually from the local district office.
- The claim is made with the Insurance carrier or with the employer whichever is convenient.
- Legal advice may be sought in case of the final denial of the claim.
- One may also contact the local Employee Benefits Security Administration (EBSA) office if he believes that the insurance plan has failed to follow the Employee Retirement Income Security Act of 1974 (ERISA) norms.
- Another criteria for a client to file a claim is that he should be under the care of a physician, chiropractor, podiatrist, dentist, psychologist or a certified mid nurse to receive the insurance benefits. There is a particular “Health Care Provider’s Statement” which must be duly signed by the concerned specialist.
- In case of the client getting to heal through spiritual means he must be under the care of a duly accredited practitioner to qualify for the insurance benefits.
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