Be ready with proof that you are disabled to make sure your long term disability benefits aren't denied.

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Long term disability benefits can be denied if you don't submit proof of your ongoing disability.

If you're on long term disability due to a serious injury or medical condition - a stroke, a heart condition, early onset dementia, or any condition that keeps you from working - you already know your disability benefits company is trying to deny or limit your benefits.  It doesn't matter whether your disability policy is with Hartford, Mutual of Omaha, Prudential, Reliance, or any of the others.

It doesn't matter that you have a legitimate injury or medical condition that prevents you from working.

With long term disability benefits, you need to remember two key points:

  • your insurance policy controls, and it was written by the insurance company and for the insurance company; and,
  • your claims representative works for the insurance company and it is his or her job to limit disability benefits

And that's all legal (for a quick education on this, read the last 10 or so ERISA long term disability decisions in the U.S. District Court in Washington, D.C).

So what can you do about keeping your long term disability benefits or getting them re-instated?

Every long term disability insurance policy requires proof of your ongoing disability.

Practice tip - Get a copy of your long term disability insurance policy from your Plan Administrator, or your HR Department at work if long term disability insurance is provided as an employee benefit.  If you have your own personal long term disability policy (which is smart) you should have a copy.

Work with your doctors to document your ongoing disability.

Typically, long term disability claims specialists or adjusters have review deadlines or triggers, so they review disability claims regularly.  They usually require yo uto provide proof of your ongoing disability within 45 days of when they request it.  So they may call you or send you an email asking for this.

How do you make sure you have the documentation that you are still disabled?

  • Make sure your doctors understand all of the definitions in your policy - do you have to be unable to work in your own occupation? (and how is that defined - is it your actual job, or a similar job classification), do you have to be unable to perform the material duties of your job? (and what are they) or do you have to be unable to work in any occupation?
  • Is part of your disability due to a mental health condition (those are often limited to 24 months) or have you developed depression due to the physical injuries or illness you have
  • Does the doctor have a basis for saying you cannot work - does he or she understand your job and current physical limitations, is there testing or objective evidence (Functional Capacity Evaluations, MRI scans, X-rays) that support his or her opinion?
  • Do you see the doctor regularly enough for him or her to assess your ability to work?

You want to get all of this information in your doctor's reports so you can send it to the long term disability claims specialist.

Even if you are legitimately disabled and do everything right, the insurance company may still deny or terminate your long term disability benefits.

The insurance company decision to deny or terminate benefits has more to do with the legal standard of review written into the insurance policy than anything else.  So unfortunately, lots of deserving, legitimately injured people get denied long term disability benefits they deserve and paid for or got as part of their benefits package at work.

If you get a letter denying or ending your benefits, call us so we can review it for you.  You only have 180 days to file an appeal (the appeal is your response to the decision to deny benefits - please note, this is not some form you fill out, it is 25-30 pages of legal and medical analysis and a whole lot of new supporting medical and vocational evidence.  And you need to do it right. You can't come back later and add evidence you missed.) As of this writing, with coronavirus that deadline has been extended, but it does you absolutely no good to wait.

Call us today at (202) 393 - 3320 and we're happy to talk you through the process of long term disability.

 

 

Frank R. Kearney, Attorney-at-Law
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Experienced DC Workers' Comp, Long Term Disability & Accident Lawyer