What happens to disability claims when the third party left?
October 31, 2016 9:53 AM   Subscribe

I'm filling out a claim for temporary disability and am stumped on the section about a third party--both of us (or neither of us) were responsible, and I thought I was okay and didn't get the person's contact info. Both "no" and "yes" seem dishonest/incomplete as an answer to if a third party was responsible, and there isn't room to explain the situation.

Some time back I was in an accident where there was no clear right of way. I was badly injured but thought, right after the accident, that I was okay and went home without getting the other person's contact info. It became clear within about 20 minutes that I was very much not okay.

I missed several weeks of work and am now filling out a claim for short-term disability. There's a section asking if a third party was responsible (the options are "yes" and "no"; there isn't room for an explanation) and asking for the person's contact info if so. I don't know how to answer this.

I've never had to fill out one of these claims before. How does it usually work when the situation's muddy like this? Do you just include a sheet, unasked, explaining what happened? If you choose "no" (or "yes" but write that the other person left) does the claim get rejected or do the premiums just go up?
posted by anonymous to Grab Bag (3 answers total)
 
If you have no information to provide, that's where you are. You can post a sign at the intersection and consult with police about any other way to track the information down. Some states have no-fault or PIP coverage within basic policies because it helps with low-level claims. If or when you or someone working on your behalf comes up with this information, then it is provided. The person who left the scene could have provided information just in case, they did not, so it's not all on you. This sounds like a quasi-phantom driver claim until the other driver is identified. IANAL
posted by childofTethys at 11:29 AM on October 31, 2016


My partner is a claims manager for short term disability requests. He recommends that you check "yes," leave the contact info blank, and include an explanation of what happened. Claims managers are often piecing together a claim based on the information available, and more information is usually better. If you filed a police report the insurance company will want that. He also notes that if you're getting wage replacement from anywhere else because of the accident it may exclude you from STD benefits. The insurance company will let you know what they need if the information you provide isn't sufficient.
posted by rabbitbookworm at 11:45 AM on October 31, 2016


Followup from the anonymous OP:
I followed rabbitbookworm's partner's suggestion and included a note explaining the accident and that the driver left (most likely because I thought I was okay and the other person presumably didn't doubt that). I also added some context to what I thought could be a misleading answer from the doctor's office, which listed my disability as lasting through January--likely when they expected physical therapy to end, although I had returned to work a few weeks after the accident.

At any rate, even though I listed my wages during my FMLA leave, I got a check from the insurance company for part of the time I missed. It didn't cover the entire time I missed due to doctor's orders, but the process for applying for short-term disability was so complex, archaic, and frustrating that I honestly hadn't expected any money at all. So I'm happy with it.

Thanks for the answers.
posted by LobsterMitten at 2:36 PM on November 27, 2016


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