Need Help Making a Long-Term Disability Claim?
Becoming disabled and unable to work is a life-altering event, and filing a claim can feel overwhelming on top of it. This guide walks through the six steps involved in filing a disability claim, with clear, compassionate guidance at every stage.
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Filing a disability insurance claim can feel overwhelming when you're already dealing with health challenges and financial uncertainty. At Dorian Law, we aim to simplify this process and provide clear, compassionate guidance to help you file effectively and minimize stress.
This page outlines the essential steps for both group and individual disability insurance claims. Every claim is unique, and specific requirements vary by policy and insurer — always refer to your own policy documents and communicate directly with the insurance company or plan administrator for precise instructions. If you encounter obstacles or want experienced assistance from the outset, Dorian Law is here to support you.
"A special thanks to Brent, whose expertise and dedication were instrumental in achieving this successful outcome. His professionalism and persistence made a complex process much smoother, and we couldn't be more satisfied with the service we received. Truly amazing and life changing."
— William A., posted on Yelp when Brent was an attorney at Kantor & KantorStep-by-Step Guide to Making a Disability Insurance Claim
These six steps provide a general roadmap. Specific requirements vary by policy and insurer.
Understand Your Disability Insurance Coverage
Before you file, know exactly what your policy actually says.
Locate Your Policy Documents
For group policies, your employer's HR department can usually provide plan documents (Summary Plan Description, Policy Booklet). For individual policies, locate your policy paperwork directly.
Identify Your Policy Type
Determine whether you have group disability insurance through an employer or an individual policy you purchased yourself — this affects the governing law and claim procedures entirely.
Review Your Policy Carefully
- Definition of disability: "Own occupation" or "any occupation"? Does the definition change after a certain period?
- Benefit amount: What percentage of income is replaced, and what's the maximum monthly benefit?
- Elimination period: How long must you be disabled before benefits begin?
- Benefit duration: How long can benefits be paid — short-term, long-term, to age 65, to SSNRA?
- Exclusions and limitations: Are any conditions or circumstances excluded or limited?
- Claim procedures: Does the policy specify deadlines for filing?
- Offsets or reductions: Do provisions reduce your benefit if you receive other income, like Social Security Disability?
Notify the Insurance Company or Plan Administrator Promptly
The clock on your claim doesn't start until the right party knows about it.
Contact the Right Party
For group policies, notify your employer's HR department or plan administrator, and the insurer if known. For individual policies, contact the insurance company directly.
Report Your Disability
Provide your name, policy number (if known), Social Security number, the date you last worked, and why you're unable to work. Let the insurer determine your official date of disability.
Request Claim Forms and Instructions
Ask for the specific claim forms and required documentation. If the insurer has forms tailored to your particular condition or symptoms, ask for those specifically.
Ask About Deadlines
Confirm any deadlines for submitting the initial claim forms or supporting documentation.
Gather Necessary Information and Documents
Assembling everything up front prevents the claim from stalling on a missing document later.
Physician Support
It's critical to have your treating physicians actively support your claim, providing detailed medical information on diagnoses, symptoms, functional limitations, and inability to work. We can guide you on how to work effectively with your doctors to secure that support.
Complete Medical Records
Diagnosis and medical history, physician notes and reports, test results (imaging, lab work), treatment plans and progress notes, medication lists, and any Functional Capacity Evaluations (FCEs) or similar assessments.
Employment & Income Information
For group claims: employer name, address, HR contact, dates of employment, job title, and job description. For all claims: pay stubs, W-2s, and tax returns to verify pre-disability earnings. A detailed job description outlining essential duties and physical/mental demands is especially important for "own occupation" policies — we can help you analyze how your limitations affect your ability to perform those duties.
Witness Information (Optional but Helpful)
Names and contact information for family, friends, or colleagues who can speak to your condition and its impact on your life and work.
Provider Contacts & Policy Information
Contact information for every provider — doctors, specialists, therapists, hospitals, clinics — along with dates of visits, hospitalizations, tests, and procedures, plus your policy number and insurer contact information.
Complete and Submit the Claim Forms and Documentation
Keep copies of everything you submit for your own records.
Obtain an Attending Physician Statement (APS)
Insurers typically require your treating physician to complete an APS or equivalent form. Provide it to your doctor promptly and follow up to ensure it's completed thoroughly and returned. This is a critical step — we can help you communicate effectively with your doctors so the APS provides strong support for your claim.
Review the Claim Forms Carefully
Understand all required information and instructions before you begin filling anything out.
Complete Forms Accurately and Legibly
Fill out every section completely and truthfully — if you're estimating something, say so. This is not the place for hyperbole.
Submit All Supporting Documents
Assemble everything gathered in Step 3 — medical records, employment information, completed forms and APS — and submit using the insurer's specified method, whether mail or an online portal.
Follow Up and Cooperate with the Insurance Company
A quiet claim isn't necessarily a stuck one — but you should be tracking it either way.
Note the Submission Date and Method
Consider certified mail with return receipt requested for physical documents, as proof of delivery.
Follow Up Periodically
If you haven't heard back within a reasonable timeframe — typically 2–4 weeks, or as stated in the claim instructions — follow up on your claim's status. Be polite but persistent, and be particularly diligent about confirming receipt: it's very common for clients to hear that the insurer "never received" records that were, in fact, sent.
Keep Records of Communication
Document dates, representative names, and summaries of every conversation. Retain copies of emails and letters.
Track Your Claim
Use any claim tracking number or online portal the insurer provides.
Respond to Requests Promptly and Fully
Delays in responding to additional information requests can slow down claim processing significantly.
Understand the Claim Decision and Your Options
Once the insurer finishes reviewing, they'll send a decision letter approving or denying your claim.
If Approved
The letter will outline the benefit amount, start date, and payment method. Confirm these details and understand ongoing requirements for continued benefits, such as periodic medical updates.
If Denied
Carefully review the denial letter and understand the exact reason given. If the denial seems wrongful or unclear, don't hesitate to seek legal advice — we can analyze the denial, policy terms, and circumstances to determine whether it's justified and advise you on your appeal rights.
You must appeal within the stated time. If your claim is governed by ERISA, you may have as little as 180 days to appeal an adverse benefit decision — even a partial payment.
Failing to appeal within the deadline stated in the denial letter can prevent you from challenging the denial in court at all.
Common Issues and How Dorian Law Can Help
In most situations, we don't recommend hiring an attorney just to make an initial claim. But challenges do arise, and in some situations, having counsel involved from the start makes a real difference. We're experienced in assisting clients with:
Understanding Complex Policy Language
We review your policy and explain definitions, exclusions, and limitations in plain terms.
Gathering Persuasive Medical Evidence
We guide you on what documentation matters most and how to work with your doctors to obtain strong medical support.
Completing Claim Forms Strategically
We help you complete forms accurately, and in a way that best presents your case to the insurer.
Communicating with the Insurer
We can handle communications directly, ensuring your rights are protected and your claim is properly presented.
"Own Occupation" vs. "Any Occupation"
We strategically present your case based on the specific definition of disability in your policy.
Frequently Asked Questions About Making a Disability Claim
In most situations, no — we don't recommend hiring an attorney just for the initial filing. Most claimants can handle the process directly. But if your policy language is complex, your condition is hard to document objectively, or you'd simply rather have experienced guidance from the outset, involving counsel early can help you avoid mistakes that are difficult to undo later.
As soon as reasonably possible after you become unable to work. Notify the insurer or plan administrator promptly — your policy may have specific deadlines for filing, and waiting too long can complicate the claim even when the underlying disability is well documented.
Complete medical records related to your disabling condition: diagnosis and medical history, physician notes and reports, test results, treatment plans and progress notes, medication lists, and any Functional Capacity Evaluations. Active support from your treating physicians, including a thorough Attending Physician Statement, is especially important.
The APS is a form insurers typically require your treating physician to complete, detailing your diagnosis, symptoms, and functional limitations in their own clinical assessment. It's one of the most influential pieces of evidence in a disability claim — a vague or incomplete APS can weaken an otherwise strong claim, so it's worth following up with your doctor to ensure it's thorough and accurate.
Describe your actual job duties in detail, not just your job title. This matters most under "own occupation" policies, where the insurer evaluates whether you can perform the specific material duties of your job — a detailed, accurate description of what your work actually required, physically and mentally, gives your claim a much stronger foundation than a generic title alone.
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You Don't Have to Go Through This Alone
Filing a disability claim should be straightforward, but it isn't always. If you have concerns at any step, or your claim has been delayed or denied, we're here to help. The consultation is free.