First, remember that, most likely your long term disability policy and claim are governed by ERISA, a federal law. And if so, your insurance company has a lot of discretion in this complicated process - including how and why they deny your claim.
But with the right guidance, advice and arguments, you can file a well researched, thorough appeal with persuasive medical evidence, vocational evidence, and the right arguments to get that decision reversed - I am not talking about a letter that says "I hereby appeal your decision" or a form you fill out. I'm talking about the entire start to finish appeal process we customize for every person we work with.
Now, any work can end your disability claim, so you have to be careful. And disability benefit insurance companies will use any kind of work or work-related activity as a basis for denying or terminating your long-term disability benefits - including volunteer work, helping someone else with a business, or any kind of business type activity.
And this sucks because even though you're not fully recovered from your serious injuries or illness and can't go back to working full time, you want to do something.
So if you are getting long term disability benefits and are thinking about going back to work, you should take 3 important steps: 1) review and analyze your long term disability insurance policy - the whole policy, not just a summary or the terms and conditions, etc., 2) make sure your doctor supports this, and 3) don't hide this from the insurance company.
Analyzing Your Long Term Disability Insurance Policy
There are two important distinctions of the periods of time that apply in most long term disability policies, governed by the definitions (under your policy - not dictionary definitions) and these are called “own occupation” and “any occupation”. For the “own occupation” period, that means you qualify for disability benefits under the policy if your injuries or illness prevents you from performing the primary duties of your own job, and usually this lasts for 24 months, but review your policy to make sure. The "any occupation" period means that you cannot do any work because of your injuries or illness - in any field, not just your own.
Proving you cannot work in any occupation usually requires a lot of work to formulate the medical, vocational and other specialty evidence you need to support this and is a critical part of the appeal.
Here are a few other related terms that may be in your policy that you will need to understand:
How does the policy define Total Disability and Partial Disability - what does each term mean?
How does the policy define and deal with what are sometimes called "other Income” offsets, for example, social security disability or workers comp benefits, which reduce your disability benefits if you get these?
Does your policy have requirements or Incentives to work or participate in vocational rehabilitation or re-training programs?
Talking with Your Doctor About Your Activities and What You Can Physically Do After an Injury or Illness
When you feel like you are ready to try to return to work, your doctor should be involved in your decision. It's important that you meet with your doctor and he or she understand the physical requirements of your work and examine you before you try to go back to work.
Your doctor should be able to document any restrictions and limitations you have from the injuries or illness, including how much you can lift or carry, how long you can stand, how long you can sit, and how long you can work overall during a day or week. Have your doctor write a report on note in your chart that details all of the restrictions, limitations, time limits, etc. that apply and then release you for a light duty or trial to return to work to see if you can do it.
You want this because you can't know going in to it whether you can return to work, full time in the same capacity - you may or may not be able to do it. If the doctor just says you can work, with nothing more, it's going to be harder to prove you can't work if you try to go back but can't consistently do the job.
Document Everything with the Insurance Company
Let your disability insurance company know you are going to attempt a trial of going back to work and give them the medical support for the modified duty, restrictions, limits on the amount of time you can work, etc. that you and your doctor formulated.
Once you're earning any income, of course you want to report this and the insurance company should reduce (offset) your long term disability benefits to account for the money you are making now.
And follow up with your doctor - if there are things that you cannot do at work because of your injuries or illness, if you can't work as long, if your job duties have changed and are more physical than you expected - those are all examples of wat you want to pay attention to and document.
And if you've received a denial letter, call us at (202) 393 - 3320. We'll review that for you (free of charge) and give you our thoughts on your next steps. And remember, the appeal you file to that denial letter is absolutely critical to your ERISA long term disability claim - it is probably the only evidence a federal judge will use to decide your case if you have to file a lawsuit, and you only get one shot at it.