There’s a huge relief that comes when your initial claim for long-term disability insurance benefits is approved and consistent monthly checks start coming in. No more financial insecurity. No more worrying about being able to afford the life you worked hard to build. Right?
Unfortunately, it doesn’t always play out that way. Long-term disability benefits are expensive. And while your insurance contract may promise that benefits are payable for a certain period—maybe even until retirement age—there are plenty of terms, conditions, exclusions, and exceptions in the fine print. The insurance company has a strong financial incentive to determine you’re no longer eligible for benefits, and they don’t always make the correct call.
If your benefits were unexpectedly terminated, it’s critically important to act quickly, review your legal options, and get in touch with a long-term disability lawyer. You might have a limited window to file a long-term disability appeal, and you’ll want to make sure your claim file has all the medical evidence you need to be successful.
Why Would My Disability Insurance Company Suddenly Terminate My Benefits?
As noted above, insurance companies have a strong financial incentive to terminate benefits as soon as possible. Sometimes, those reasons are valid. Sometimes they are not. Either way, the reasons for benefit termination include:
- You’ve reached the end of your maximum benefit period. Long-term disability insurance plans typically have a set benefit period outlining how long benefits are payable. This could be two years, five years, ten years, until Social Security normal retirement age, or something else. If you’ve reached the end of your benefit period, your monthly payments will stop regardless of whether you’re still disabled.
- Your condition has certain restrictions. Regardless of the benefit period, your policy might provide a shorter window for certain conditions. For example, conditions diagnosed based on self-reported symptoms and lacking “objective medical evidence” (for example, mental health issues or chronic pain) are commonly covered for a maximum of two years.
- Your insurance company no longer believes you are disabled. This can happen for any number of reasons. Some of the most common include a change of your policy’s definition of disability from “own” occupation to “any” occupation; re-evaluation of your medical records by (supposedly) independent medical professionals hired by the insurance company; results from an independent medical examination or field visit; even evidence from insurance company surveillance or your social media posts.
- Failure to comply with policy terms. Your insurance plan may require you to maintain regular medical treatment, periodically submit to independent medical examinations, meet with an insurance agent for a field visit, or comply with other requests for medical records or information. If you do not comply, your benefits may be terminated.
- The insurance company believes you are earning income. Some long-term disability insurance plans prohibit claimants from earning income above a certain level while receiving benefits. This will depend on your specific policy, though.
Key Steps to Successfully Appealing Long-Term Disability Termination
If your benefits are terminated, or are about to be terminated, you’ll need to act quickly. Here is a quick overview of what to expect if you have an ERISA plan.
- Carefully review your termination letter. This letter should contain a clear explanation of the specific reasons they are terminating your benefits, as well as information about how to file a disability insurance benefits appeal.
- Contact a long-term disability lawyer as soon as possible. Most long-term disability insurance plans are governed by ERISA, a federal law that places significant restrictions on the appeals process including detailed Department of Labor regulations. You have a limited time to act—usually just 180 days. Generally, ERISA requires that you must go through at least one round of administrative appeals before you can file a lawsuit. Even if you do take your case to court, keep in mind that you often can’t add new evidence that isn’t already in your LTD claim file for the court’s consideration. In other words, you might have only one shot at gathering all the necessary evidence for a successful appeal. An experienced attorney can help you make the most of your opportunity and meet all relevant deadlines.
- Request a copy of your claim file and begin gathering evidence. Your insurance company should have an extensive record of paperwork, medical records, and other evidence in your long-term disability claim file. If their records are inaccurate or incomplete, you need to know so you can address those gaps. Remember, under ERISA you might only have one chance to add evidence to the record. You need to be absolutely sure you have the information you need and that it addresses the specific reasons for termination laid out in the termination or denial letter you received.
- File the appeal paperwork. The exact steps in the appeals process will vary based on the insurance company and whether your disability insurance is covered by ERISA. That said, your appeal will typically include all the additional medical evidence you’re submitting, as well as an appeal letter that provides specific, detailed arguments (referencing the evidence) for why you believe the termination was in error.
- Wait for a decision. Once you appeal, the insurance company will have a limited amount of time to review the evidence and either uphold or reverse its decision. If your benefits are not reinstated after all your administrative appeals have been exhausted, in most cases, you can then file a lawsuit in federal or state court depending on the law applicable to your coverage.
If your plan is not governed by ERISA, you are not required to go through the administrative appeals process before filing a lawsuit. An experienced long-term disability attorney can help you determine the best course of action.
Download a Copy of Our Free Ebook
If you’d like a more detailed breakdown of the appeals process for a long-term disability denial or termination, we encourage you to download a copy of our free ebook, “How to Appeal a Long-Term Disability Termination.” This quick, easy-to-read guide should provide you a good foundation of information about your legal options and next steps.
Click here to request your free copy.
Benefits Terminated? Call Bryant Legal Group Today
Don’t let preventable mistakes or unfamiliarity with the process keep you from obtaining the disability benefits you need to support yourself and your family.
Bryant Legal Group has earned a strong reputation throughout Illinois for handling long-term disability termination appeals honestly, aggressively, and successfully. To schedule your free consultation with an experienced LTD attorney, call us today at (312) 586-9128 or complete our online form.
The content provided here is for informational purposes only and should not be construed as legal advice on any subject.
