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Jacques Chambers, CLU, Benefits Consultant
In the years that I have worked with people transitioning from work to disability, I have found certain techniques and procedures that can be applied in most disability claim situations. Here are some suggestions that will help you organize the process and provide a sound foundation should problems arise:
Plan – Once you have a diagnosis or other indication that you may have to stop working at some time in the future, you should do a “Benefit Review” so you will know what benefits are available, what you have to do to become eligible for them, and how much income you will have when you stop working. The earlier in advance you do this review, the greater the possibility of making changes to enhance your benefits when and if you do become disabled.
If you have benefits through your employer, you should begin first by obtaining a copy of the Summary Plan Descriptions that employers are required to provide all employees. Personnel departments should have them available and you can request them, simply saying something like you are working with a financial planner and he/she needs them. This way, no “red flags” are raised.
Be careful switching to part-time work – Under the Americans with Disabilities Act (ADA), an employer must make “reasonable accommodation” for your medical condition to help you continue working. In many cases, however, the accommodation is reduced hours, with accompanying reduced pay. If you have a long term disability (LTD) program from work, the benefits are often tied to what you were earning at the time you stopped work. If you reduce your hours, you’ll also reduce your income and that will further reduce any LTD benefits you’re eligible for later.
If your hours drop low enough, you may even lose eligibility for the benefits since they’re usually only available to full-time employees.
Be careful how you tell your employer – When telling your employer that you are leaving, do not announce that you are leaving permanently and never plan to return even if that is the case. It is better to preserve your benefits and rights by telling the employer that your doctor is making you take some time off for your medical condition. When asked for how long, you can tell the truth; you don’t know for sure—at least a month or two. The employer will tell you what paperwork is needed to process the absence.
Don’t burn any bridges when leaving work – Tempting though it is to tell your bosses just what you thought of their ability, hold it in, even if you know you will never return to work there. Your employer is important to a smooth transition to disability and most employers recognize that helping an employee go on disability is good for the company as well.
DOING THE PAPERWORK
Copy! Copy! Copy! – Nothing should leave your hands that you don’t have a copy of. Every letter, every form, every application. Keep a copy!
Check all paperwork before submitting – Let the forms sit at least overnight and review them again before submitting them. If possible, look them over several times. It is amazing what additional information you will recall and be able to add, especially if your medical condition is one you have had for some time. People frequently forget about symptoms they have when they have lived with them long enough.
Don’t let small spaces on the forms scare you - I’m convinced some claim forms purposely have a tiny amount of space for answers just to keep you off-balance and encourage you not to say much. I don’t know of a single carrier or government agency that won’t accept additional sheets of information. Simply label “See attached” in the space on the form, and put your full answer on an attached sheet. Make sure you carefully label the question and answer.
You can’t overdo it with identification. It’s so easy for papers to get lost or misplaced. I recommend to my clients that they put their name and Social Security number (or other identifying number) at the top of every page of every form.
Don’t be too perfect – If you use a computer to complete your forms and they end up looking very “professional,” be sure to explain the time you had to spend getting them to look that good. You may even want to describe how many revisions you had to make and who assisted you with the process.
Track all documents – Send forms and correspondence “Return Receipt Requested.” While it isn’t foolproof, it can provide some help in tracking down lost mail. When possible, deliver Social Security forms and correspondence to the local Social Security office personally and request an itemized, written receipt or enclose a handwritten receipt and self-addressed stamped envelope and ask them to sign the receipt and return it to you.
PHONES AND FOLLOW-UP
Don’t sit and wait – Stay involved in the claim process. Contact the analyst and examiner to make sure mailed forms were received. Follow up with doctors who haven’t submitted their records. This not only reduces the time it takes to process the paperwork, but it helps personalize your claim to the examiner.
Maintain a phone log – Every time you talk to the insurance company or Social Security or your employer or anyone regarding your benefits, keep a written record of the call. Name, phone number, date and time of call, what was said, outcome or next step.
Get it in writing – The best record is the written record. It’s not always possible and it may be slower than phone calls, but it’s much easier to re-construct if necessary. What you are told by the insurance company over the phone doesn’t mean a thing. Some people will say almost anything over the phone, knowing that they won’t be held responsible. If they have to put it in writing, chances are they will make sure they are right before writing it down.
Try asking something like, “I have trouble remembering things and this is so complicated. Could you put that in writing and send it to me?”
Talk to the person, not the office – It’s easy to picture monsters and ogres working for the companies and squealing with glee when they refuse your claim (and there are enough like that to be really scary), but these people are mostly human and just trying to do their jobs. Treat each one as a person, try to be friendly, try to personalize the conversation, and you may find you have an ally who will help and not be an obstacle. Then again, don’t expect miracles.
Be generous with compliments – If the claims representative goes out of his/her way or gives you better than expected service, let them know.
Play dumb – You’re much more likely to get the attention and advice of a claims representative by playing the helpless, ill, lost-in-the-system role. Demands, orders and threats won’t help your case move any faster, at least not initially.
Watch what you say on the telephone – When you call an insurance company or Social Security, you often get the recording, “Your call may be monitored or recorded for quality assurance.” That means the phone call is being recorded. Even a comment like, “I’m fine thanks. How are you?” can be turned against you.
Don’t bother with threats – These people are regularly threatened with lawsuits and insurance department complaints. It doesn’t scare them, but it does make you “an enemy.” Don’t threaten legal action, but if warranted, take it. Exhaust all internal appeals processes first though.
Double-check what you are told - I’m sorry if this sounds very cynical; I don’t mean you should distrust everyone. However, in this case, you can’t be too careful. This is your life, your income, your continued health insurance we’re talking about, and no one cares about it as much as you do.
People will sometimes give you information off the top of their heads without realizing that the wrong information can cost you money and/or insurance coverage. You’re trying to find the answers to surviving in the future; they’re trying to get off the phone. It’s important that you try to double-check such information.
Give the full story – It is often amazing how one little piece of information, which may seem unimportant to you, can change the whole picture. Be sure when asking for advice that you give as complete a description of the situation as possible, and answer all questions completely. Focus on the facts and try to avoid assigning motives to someone’s actions.
The process of moving from work to disability is not an easy one. The paperwork is difficult enough without having to complete it when you are already preoccupied with health problems. By following these suggestions, you can make the process more organized and easier to follow. It also puts you back in control of the process so you are not at the mercy of the programs you are trying to access.
Oh, and one more thing: don’t be afraid to ask for help.
Confused about applying for disability? Click here
[Jacques Chambers, CLU, and his company, Chambers Benefits Consulting, have over 35 years of experience in health, life and disability insurance and Social Security disability benefits. For the past twelve years, he has been assisting people with their rights, problems, and other issues concerning benefits and disability. He can be reached at firstname.lastname@example.org or through his website at: http://www.helpwithbenefits.com.]
Copyright March 2004– Hepatitis C Support Project - All Rights Reserved. Permission to reprint is granted and encouraged with credit to the Hepatitis C Support Project.
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