Disability claims: what typically happens next

• Notice of claim: You (or your employer) notify the carrier that you’re unable to work due to sickness or injury.
  This usually must happen within a defined window—often 20–30 days.
• Date of disability: The insurer establishes when your condition first prevented you from performing your job.
  This date drives waiting periods, benefit eligibility, and retroactive calculations.
• Employer statement (if applicable): Group policies typically require confirmation of job duties, hours, and last day worked.

In disability insurance, “being sick” and “being disabled” are not the same thing.

• Attending Physician Statement (APS): Your treating provider completes a detailed form describing diagnosis, limitations, and prognosis.
  Incomplete or vague APS forms are the single most common cause of delays.
• Office notes and records: Insurers review visit notes, test results, imaging, and treatment plans.
  The records must support functional impairment—not just symptoms.
• Consistency matters: What you report, what your doctor writes, and what your job requires must align.
  Contradictions slow claims and trigger additional review.

A diagnosis explains what you have. Documentation explains what you cannot do.

• Elimination period: Commonly 30, 60, 90, or 180 days from the date of disability.
  Think of this as a time-based deductible.
• No partial acceleration: Benefits generally don’t pay “pro rata” during the waiting period.
• Retroactive review: The carrier often completes approval near the end of the elimination period.
  This is why first payments can feel delayed even when the claim is valid.

Disability insurance replaces income after time—not immediately after diagnosis.

• Functional questionnaires: Detailed forms about daily activities, sitting/standing tolerance, lifting, and concentration.
  These are compared against medical notes and job duties.
• Employer or income verification: Insurers confirm earnings to calculate benefit amounts.
  Self-employed and commission-based earners often face extra documentation requests.
• Independent Medical Exams (IMEs): In some cases, the carrier requests an exam by a neutral physician.
  An IME doesn’t automatically mean denial—it means uncertainty.
• Updated medical records: Ongoing treatment records are requested periodically.
  A gap in care can be interpreted as improvement.

Disability claims aren’t “set and forget.” They’re monitored, updated, and revalidated.

• Own-occupation: You’re disabled if you can’t perform the duties of your specific job.
  Common in individual professional policies.
• Any-occupation: You’re disabled only if you can’t work in any reasonable occupation.
  More common after a time threshold in group policies.
• Partial / residual disability: Benefits may pay if you can work but earn significantly less.
  Requires income tracking and ongoing proof.

Many claim disputes come down to definitions—not diagnoses.

• Weeks 1–4: Claim intake, initial medical requests, employer statements, and elimination period tracking.
• Months 1–3: Medical review, clarification requests, approval decision near the end of the waiting period.
  First payments often arrive after this phase.
• Ongoing (monthly/quarterly): Continued proof of disability, updated records, income verification for partial claims.
  Benefits continue as long as eligibility is met.

A long claim isn’t a bad sign—it often means the policy is doing exactly what it’s meant to do.

Why does my doctor need to keep filling out forms?
Disability benefits are contingent on ongoing impairment. Updated medical support confirms continued eligibility.

Can my claim be denied even with a real medical condition?
Yes. The issue is whether the condition prevents you from working as defined by the policy—not whether it exists.

What happens if I try to return to work?
Many policies encourage trial work or partial return through residual benefits, but income must be reported accurately.