If you’re receiving long-term disability benefits, you may find yourself in a confusing situation. It’s not uncommon for disabled people’s conditions to improve (or ebb and flow). However, the disability insurance company may argue that you’re no longer eligible for monthly benefit payments based on your improved circumstances. What are you supposed to do?
Disabled individuals typically must take steps to improve their condition. However, when you start gaining function, your LTD insurer may start scheduling medical examinations and asking tough questions. In this blog, our experienced disability insurance lawyers explain how you should handle this situation and what you should do if your benefits are cut off.
Disability Insurance Companies Can Define “Disability” in One of Two Ways
As your medical conditions evolve, the insurance company will want to occasionally reassess your eligibility for benefits. When this happens, the claims adjuster will return to your policy’s definition of disability. So, it’s important that you understand this definition. Most LTD policies define “disability” in one of two ways:
- Own occupation: You are disabled if your medical conditions or injuries prevent you from doing your actual job.
- Any occupation: The insurance company will pay your LTD benefits if you are unable to perform any type of work.
While most employer-sponsored, group LTD plans use the more stringent “any occupation” language, some private LTD policies contain an “own occupation” definition.
Your policy’s definition may significantly impact your right to ongoing long-term disability benefits. For example, suppose you work as an emergency department physician. After a mild or moderate traumatic brain injury, you’re unable to continue this employment due to problems with your attention, concentration, and executive functioning.
However, with intensive therapy and counseling, you eventually regain some of your short-term memory and find coping mechanisms that could help you do simpler, less stressful jobs. If you have an “own occupation” policy, your benefits would likely continue after your modest improvement. With an “any occupation” policy, you may receive a termination of benefits notice.
- Related Article: 5 FAQs About Private Disability Insurance Claims
When Should I Report Changed Circumstances to My LTD Insurance Company?
Whether you must report a change of circumstances depends on the “materiality” of the change. A change in circumstances is material if it will influence your eligibility to receive disability benefits or the amount of benefits that you might receive.
For example, let’s say you are currently receiving benefits for a total disability, but you underwent a surgical intervention that improved your condition. You are now only eligible to receive “residual benefits,” and you would have to notify your insurer.
Not all material changes are linked to the disabling condition itself. The basis of disability insurance benefits is that you are incapable of working. So, if your former employer offers to change the duties of the job to better suit your new limitations (and offers you the position), then you will likely have to notify your insurer of this change.
If your change in circumstances could affect your eligibility for benefits, you should report it to the insurance company. In many LTD policies, there is a required reporting schedule that you must follow. Under this schedule, you’ll probably have to update the insurance company on your health and medical treatment annually (some policies ask for an update every six months). However, there may also be an additional voluntary reporting requirement. If you need help understanding your reporting obligations, consult an experienced LTD attorney.
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What Will Happen After I Update the Insurance Company About My Disability Claim?
Once you’ve notified the insurance company about a change in your circumstances, the insurer will start to reassess your eligibility for LTD benefits. This may involve a series of tactics:
- Requests for updated medical records: The insurance adjuster reviews your recent medical records to assess the severity of your condition and capabilities
- Independent medical examinations: The insurance company pays a doctor to examine you and write a report that outlines your current limitations
- Consulting physician assessments: Rather than examine you, the insurance company’s doctor simply reviews your medical records and issues a report
- Field interviews: An insurance company representative meets with you in person to discuss your change in circumstances
- Surveillance: Private investigators track you both in real life and online, looking for evidence that you’re capable of returning to work
This process can feel invasive and uncomfortable, which is why so many disability insurance claimants choose to negotiate an insurance buyout or settlement instead.
The Insurance Company Just Stopped My Benefits. What Should I Do?
First, don’t panic if the insurance company terminates your monthly benefits. However, you do need to act quickly. Depending on whether your LTD plan is privately funded or employer-sponsored, you may face strict filing deadlines for an appeal. To give yourself the best chance for success, you need to start building your case right away.
For most LTD claimants, the first step in their appeal is contacting an experienced disability insurance lawyer. An attorney can provide you with an honest assessment of your claim, suggest ways you can strengthen your appeal, and help you navigate the complex process of filing an administrative appeal or a lawsuit.
Bryant Legal Group: Chicago’s Respected Disability Insurance Team
At Bryant Legal Group, we’ve earned a reputation for our practical, client-focused approach to disability insurance law. Whether you’re considering applying for LTD benefits or the insurance company terminated your monthly payments, our team can help you build a plan and educate you about your legal options. We assist people in Chicago and throughout Illinois with their disability insurance claims and appeals.
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