My next surgery, on the right knee, is scheduled for April 18, 2011. I received a letter from the No Fault insurer requiring that I appear for an IME (Independent Medical Exam) to re-examine my condition on April 20. Insert your own punch line here.
Financially I'm basically not bad off, but nervous of course because my Short Term Disability coverage will end on June 3 and I am currently submitting a claim for my Long Term Disability coverage through MetLife for any period thereafter that I continue to be disabled.
Submitting a claim for Short Term Disability and getting it extended is fairly easy. So long as I am genuinely disabled my attending physician / surgeon will certify it and that's about all there is to it.
With my Long Term Disability there is a lot of work to do, but it hasn't been too bad so far. MetLife sent me an initial package which consisted of a Personal Statement, a Physician's Statement, and a job profile from my manager at work. Then they do a phone interview. At this point it's been verified that I am injured and what my basic losses are in terms of income.
Then another package arrives, and this is where the real work begins. There is another personal profile basically asking the insured to describe their own disability and limitations. I am also required to show my work history for the past fifteen years and to apply for Social Security Disability. If I am turned down for Social Security Disability, I am required to appeal. Any money received from Social Security Disability, the insurance of the driver who hit me, or any other source providing for lost income will reduce the amount I receive from MetLife--so that my total compensation during my period of disability does not exceed my insured loss (which is 66.66% of my salary). Additionally, I must provide a pharmacy record to basically prove that my disability is not the result of a pre-existing condition. This process is meant to both confirm any income I may be receiving, and verify that my disability is the result of the particular incident which I claim caused it.
This is an important point about insurance in general. The sole purpose of insurance is to return the insured to the state or condition they were in prior to the loss. My bicycle for instance, which I discussed in an earlier post, had a loss paid equal to the cost of replacing the bicycle with a current, similar model--less depreciation of my old bicycle (which I object to, but them's the breaks); insurance doesn't pay for you to be in significantly better circumstances or with a superior replacement for your losses. Of course, being compensated for losses isn't necessarily a matter of money either. An insurance company may choose to repair or replace something that is damaged rather than write a check. The bottom line is, the compensation provided by an insurer for a loss should never be expected to exceed the value of the loss.
Having a loss is never like hitting the jackpot. Your goal in dealing with the insurance after an accident is to be compensated for your losses as well as for any personal injury--such as pain and suffering or a significant change in circumstances such as the loss of ability to live, work, and even love as you would have had the accident never happened.
Financially I'm basically not bad off, but nervous of course because my Short Term Disability coverage will end on June 3 and I am currently submitting a claim for my Long Term Disability coverage through MetLife for any period thereafter that I continue to be disabled.
Submitting a claim for Short Term Disability and getting it extended is fairly easy. So long as I am genuinely disabled my attending physician / surgeon will certify it and that's about all there is to it.
With my Long Term Disability there is a lot of work to do, but it hasn't been too bad so far. MetLife sent me an initial package which consisted of a Personal Statement, a Physician's Statement, and a job profile from my manager at work. Then they do a phone interview. At this point it's been verified that I am injured and what my basic losses are in terms of income.
Then another package arrives, and this is where the real work begins. There is another personal profile basically asking the insured to describe their own disability and limitations. I am also required to show my work history for the past fifteen years and to apply for Social Security Disability. If I am turned down for Social Security Disability, I am required to appeal. Any money received from Social Security Disability, the insurance of the driver who hit me, or any other source providing for lost income will reduce the amount I receive from MetLife--so that my total compensation during my period of disability does not exceed my insured loss (which is 66.66% of my salary). Additionally, I must provide a pharmacy record to basically prove that my disability is not the result of a pre-existing condition. This process is meant to both confirm any income I may be receiving, and verify that my disability is the result of the particular incident which I claim caused it.
This is an important point about insurance in general. The sole purpose of insurance is to return the insured to the state or condition they were in prior to the loss. My bicycle for instance, which I discussed in an earlier post, had a loss paid equal to the cost of replacing the bicycle with a current, similar model--less depreciation of my old bicycle (which I object to, but them's the breaks); insurance doesn't pay for you to be in significantly better circumstances or with a superior replacement for your losses. Of course, being compensated for losses isn't necessarily a matter of money either. An insurance company may choose to repair or replace something that is damaged rather than write a check. The bottom line is, the compensation provided by an insurer for a loss should never be expected to exceed the value of the loss.
Having a loss is never like hitting the jackpot. Your goal in dealing with the insurance after an accident is to be compensated for your losses as well as for any personal injury--such as pain and suffering or a significant change in circumstances such as the loss of ability to live, work, and even love as you would have had the accident never happened.
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