What Happens if I Miss the Proof of Loss Deadline?

Most disability insurance policies have a Proof of Loss provision. Proof of loss refers to the need to submit supporting evidence of your disability claim. This can include claim forms, medical records, and test results.  Proof of Loss requirements also usually state an amount of time you have to file a claim. But what happens if you miss this deadline?

Don’t Make This Same Mistake

Many physicians and dentists, understandably, want to keep working as long as possible. It can be hard to know when to step away. This can be especially true with slowly progressive conditions (such as many musculoskeletal issues) or if isn’t clear whether symptoms will be permanent.

A physician or dentist in this situation may begin working part-time in an attempt to “get by” and hope things improve. In fact, they may even think they are doing their insurance company a favor by delaying filing a claim, without realizing that their policy may allow partial disability benefits if they are working part-time. However, delaying a claim may impact your ability to collect full benefits.

One example of this can be found in the case of Hsu v. Northwestern Mutual Life.[1]  At the time of his disability, Dr. Hsu was a physician specializing in interventional medicine.

Dr. Hsu suffered from constant right elbow pain, which was exacerbated with wrist extension and/or elbow flexion. Both activities were required in his profession.  Although his disabling condition had begun much earlier, he didn’t submit proof of his claim application until June 2019.

The Proof of Loss Deadline

Dr. Hsu’s policy with Northwestern Mutual (NWM) required him to provide notice of a claim “within 60 days after the start of any loss.” If this was not possible, “it must be given as soon as reasonably possible.” Further, written proof of loss was required 90 days after the end of each monthly period for which benefits are claimed, or as soon as possible but “[i]n any event . . . no later than one year and 90 days after the end of each monthly period for which benefits are claimed.”

After reviewing the policy’s Proof of Loss deadlines, the Court determined that Dr. Hsu had filed late and could not obtain benefits prior to March of 2018. However, the results in these cases can vary based on circumstances and policy language.

The Takeaway

There are many reasons that a doctor might put off filing a claim. He or she might be busy seeking additional treatment in an effort to find a way to abate symptoms or trying to keep working as long as possible, despite symptoms that impede the ability to safely practice.  However, delaying filing a claim may mean, as in Dr. Hsu’s case, that you miss out on benefits.

If you have questions about your disability policy’s Proof of Loss provision or the timely filing of a claim, please feel free to contact one of our attorneys directly.

Every claim is unique and the discussion above is only a limited summary of the court’s ruling in this case. If you are concerned that your insurer is not evaluating your claim under the proper standard, an experienced disability insurance attorney can help you assess the situation and determine what options, if any, are available.

[1] Hsu v. Northwestern Mutual Life, C20-88 TSZ, 2021 WL 735374 (W.D. Wash. Feb. 5, 2021)


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