What Should You Expect When Completing a Short Term Disability Claim Form?

Disability Claim Forms vary by insurer.  Regardless of the format of the form, it is important to properly complete the form. Equally important, employees need to stay mindful of traps the insurer may set when the insurer seeks information from the employee documenting the disability claim.

Disability forms often can be broken down into three parts:  information to be completed by the employer, information to be completed by the employee and information to be completed by the employee’s medical providers.  Starting with the employer, here the Claim Form seeks information describing the job classification such as whether the job is considered sedentary or has physical requirements ranging from “light” to “heavy”.

For the physician portion of the claim form, the insurer may ask for a primary and secondary diagnosis as well as a listing of objective findings. Often the form will ask if the patient has been hospitalized including the date of admission and discharge.  Insurers ask doctors to list treatment plans for the patient which may include medications, therapy and/or surgery.  It is important to see if the doctor will go beyond merely completing a form and instead provide a more detailed narrative that builds an administrative record in support of the claim. 

For the employee section of the claim form, insurers often provide one or two lines to provide “details” regarding your disability.  Here is where you want to establish a narrative that tells the story of the employee’s disability.  Do not limit yourself to the application. Attach addendums that spell out in detail how the disability arose.  This is an opportunity to describe the material duties of the employee’s occupation which can include information like a typical day at work and the requirements of the job. 

Do not be limited by the application. Attach treatment notes, objective test results, medical reports, vocational evaluations or any other item that builds a record proving disability. Because many disability claims proceed under ERISA, the employee often will not have an opportunity to testify in support of his or her claim.  Instead, the administrative process is where you submit evidence to support the claim. To do that, you want to explain why the employee cannot specific duties of their occupation in detail.