Filing for and maintaining your long term disability insurance benefits can be a confusing and complicated process. Wherever you are in the process, there is a lot to consider.
With so much at stake, it is essential to handle your disability claim correctly to avoid delays, obstacles, and benefit denials. Careful strategic planning is key.
At Riemer Hess, we’ve been helping individuals win and maintain their disability benefits for over 25 years. Our NYC ERISA long term disability attorneys are well-versed in all aspects of long term disability claims. Below you will find important information regarding the best strategies to filing, appealing, and protecting your long term disability claim.
Become Informed Before Starting Your Disability Leave
The decision to stop working and file for disability benefits is one of the most difficult you'll have to make.
Having a plan before exiting your career can help prepare you for the disability claims process and increase your claim’s chances of approval. At Riemer Hess, we have successfully guided scores of clients through the process of leaving work to filing for disability. Below we’ll answer common questions about how to plan your work exit.
What is ERISA and long term disability?
First, let’s explain: What is ERISA? What is long term disability?
Disability benefits can come from different sources. Social Security Disability benefits are provided by the government to people with disabilities. When we refer to long term disability in this article, we refer to long term disability insurance from private companies.
Long term disability insurance is typically received in two ways:
- insurance provided by your employer as part of your benefits package; or
- individual insurance plans you purchase for yourself.
You may also have multiple LTD policies, of either or both types.
Long term disability (“LTD”) insurance through your employer, also known as a group plan, is generally treated as an employee benefit. Because of this, employer-provided LTD plans are regulated under the federal Employee Retirement Income Security Act of 1974 (ERISA). These policies are subject to the provisions of ERISA.
How do I plan before going on disability?
Before anything else, review your ERISA long term disability (“LTD”) insurance policy. Your policy is key to planning a successful transition to disability. See the next section for more on understanding your disability insurance policy.
Once you have familiarized yourself with your LTD policy, obtain copies of your medical records from your treating doctors. Your insurance company will require medical evidence of your disability before approving you for benefits. Your doctors' support is essential to your disability claim. Not only will their records be necessary, but you may need them to provide supportive letters to your insurance company and/or employer.
With your insurance policy and medical records in hand, you can better evaluate whether you have the appropriate evidence to support a disability claim. For example, after reviewing your records, you may see you should increase your frequency of treatment or communicate symptoms not recorded in your treatment notes.
What do I need to know about my policy before going on disability?
Understanding your long term disability insurance policy is critical to planning your claim. Your policy contains the terms you must meet to qualify for disability benefits. This includes the definition of disability, the occupational standard, and the elimination period, among other requirements.
Your policy's definition of disability will determine what standard you must meet to qualify as "disabled." An "own occupation" definition means you only must prove you cannot perform the duties of the occupation you were in when you became disabled. An "any occupation" definition means you must prove you cannot perform any occupation reasonable for your education, training, and experience. Your policy's definition of disability will determine the framework for your disability claim.
Our guide to disability insurance policies provides useful information on understanding the terms of your policy.
Can I file a long term disability claim if I get fired or laid off?
If you are fired or terminated before taking disability leave, your opportunity to file a long term disability claim may be in jeopardy if your coverage is provided through your employer ("group" coverage).
Understandably, many people with serious medical conditions are hesitant to leave their careers for long term disability. Many people attempt to continue work past the point of being able to successfully execute their job duties. It may be difficult to gauge your condition’s impact on your performance, or you may struggle with the uncertainty of the long term disability process. However, attempting to continue work when your performance declines due to your health issues can backfire.
Filing a long term disability claim if you've been terminated from your job is possible, but it will be an uphill battle if you have group coverage. Your long term disability insurance company may deny your claim by arguing you are no longer covered by your policy as of your last date of employment. Most policies have provisions stating they are only active as long as you are working for your employer.
For you to have an eligible disability claim with group coverage, you must generally demonstrate to your insurance company that you became disabled before your last date of work. This means providing medical evidence of your disabling condition that predates your last day on the job. We recommend our clients in this predicament obtain a written statement from their treating doctor stating the history, progression, and extent of their disability. Further, if you have evidence from your employer of your declining performance (such as a poor annual review), this can potentially substantiate your disability claim.
Other factors may complicate your right to file for group LTD benefits. For example, if you have signed a severance agreement, you may have waived your right to file a claim.
We always recommend consulting with an experienced ERISA attorney rather than filing a claim on your own. An experienced attorney will be able to review your circumstances and determine the best strategy to filing a successful disability claim.
Can I be fired while on leave for disability?
People on disability leave are granted certain job protections. The federal Family and Medical Leave Act (FMLA) provides up to 12 weeks of unpaid, job-protected medical leave per year. However, not all employers are subject to FMLA. Your company must have a minimum of 50 employees, and you must have worked for a certain amount of time and hours to qualify. Other exemptions may apply.
Your state might provide additional job protections above and beyond FMLA. Always check to see what your state might offer.
Many states in the U.S. have at-will employment, meaning an employer can legally terminate an employee for any non-discriminatory reason. People with disabilities are classified as a protected class. You potentially would have a wrongful termination case if your employer terminated your employment while you were on disability.
This area of law is very specific and dependent on many individual factors. If you have been fired while on disability leave, or fear you will be, we strongly recommend that you speak to an attorney who can explain your rights and options.
Strategies To File A Long Term Disability Claim
Filing for long term disability is not an easy decision. The uncertainty of leaving your career and financial insecurity can be overwhelming – not to mention the confusing and intimidating paperwork involved with filing your long term disability claim.
One mistake on your application could jeopardize your disability benefits. Getting your initial claim application right will save you time and money.
How do I get my disability claim application approved?
Your long term disability insurance application creates the groundwork for your disability claim. Getting your disability benefits approved necessitates meeting the requirements of your insurer.At Riemer Hess, we’ve honed a successful strategy for getting our clients’ disability claims approved. Below we’ll outline a few important strategies when filing a long term disability claim.
- Always meet the deadlines. Your long term disability insurance policy will lay out the deadlines you must meet in order to qualify for benefits.
The first form to submit will be your Notice of Claim. Your Notice of Claim alerts your insurance company of your intent to file a claim for LTD benefits. Usually, the Notice of Claim should be filed within 20 to 30 days from your date of disability.
After your Notice of Claim is submitted, your insurance company will provide you with Proof of Claim forms. Your Proof of Claim form is a questionnaire requesting information about yourself, your medical condition, and your employer. These forms must be completed and submitted to your insurance company within a certain period after your Elimination Period ends. Typically the Elimination Period is 90 or 180 days, depending on the policy.
- Create a strong narrative. It may seem obvious to you why you should be granted disability insurance benefits. However, your insurance company will seek reasons to deny you benefits. Medical evidence alone does not always tell the whole story. You do not have to restrain yourself to the limited space the disability application gives you. If you want to expand on the ways your disability restricts you from performing your job duties, you can make a note on the application to “see attached supplemental statement”, and then attach your longer answers written out to the back of the forms.
It is essential to convey all of the duties your job entails, as well as the limitations and effects of your medical condition. Make sure to outline the physical aspects of your job (standing, walking, etc.) and the cognitive demands. Additionally, elaborate on the efforts you have made to recover and how your condition affects your life outside of work. This is your chance to explain to your side of the story to your insurance company.
- Submit all supporting evidence. Your insurance company’s internal administrative processes are your only chance to submit all evidence substantiating your disability. This also includes the internal appeal process should your claim be denied or terminated. If you neglect to submit any evidence during the internal administrative process, you likely will not be able to submit it during a litigation. Consider all evidence related to your claim (medical, vocational, personal/witness statements, etc.).
Click the links below to explore more in-depth strategies for filing an LTD claim.
How do I demonstrate my work restrictions to my insurance company?
In order to receive disability benefits, your insurance company will require you prove that:
- You suffer from a disabling medical condition; and
- Due to this condition, you cannot fulfill your essential work duties.
Not only must you provide your insurance company with medical evidence of your disability, you must also explain why your condition limits you from working.
Your insurance company evaluates your occupation in a number of ways. First, they will categorize your occupation in one of the following categories: sedentary, light, medium, or heavy. Your occupation’s category depends on how physically demanding your duties are.
Your functional limitations (i.e. inability to perform your work) can be exertional or non-exertional. Exertional limitations include sitting, standing, walking, etc. Non-exertional limitations range from manipulative (problems using your hands/fingers), mental (issues with concentration, focus, etc.), postural (inability to stoop/bend/etc.), and more.
It’s important to understand how your insurance company will categorize your occupation. For example, if you are a senior level accountant, your job would likely be considered sedentary. You will need to provide proof that your medical condition impacts your ability to perform your job. If your medical evidence only shows you cannot walk long distances or lift heavy objects, your insurance company could deny your claim. Your evidence must show you have non-exertional limitations.
Check out our Vocational Evidence section below for more on how you can prove your work restrictions and limitations to your insurance company with evidence.
What if the insurance company wants to interview me?
When filing an LTD claim, your insurance company may want to interview you. Don’t be too alarmed if this happens – it is not necessarily a red flag. In fact, approximately half of our clients face an interview request during the claims process.
However, you do want to be prepared for any interview. Your insurance company will either request a “field” interview (conducted in-person) or a phone interview. Common subjects for these interviews include a timeline of your disability, your symptoms, why you left work, and plans for the future.
You should always be truthful during these interviews. However, be careful in how you answer their questions. Insurance companies may ask broad questions. Do not be afraid to provide full context or elaborate if needed.
For example, one common question from insurance companies is: “How do you spend a typical day?” This is a trap if you have variable symptoms. If your symptoms fluctuate, you can explain to your interviewer that there are no "typical" days -- you have good and bad days.
Having an experienced ERISA attorney is very helpful in this situation. They will help prepare you for questioning, monitor the interview, and object to any inappropriate questioning.
Why do long term disability claims get rejected?
Knowing why long term disability claims get rejected is just as important as knowing why they get approved. By understanding typical justifications your insurance company uses to deny benefits, you can avoid making common mistakes.
Common reasons insurance companies deny long term disability claims include:
- Missed deadlines. If you miss the deadline to file, your insurance company can use that as justification for denying your benefits. This is why it is vital to understand the deadlines involved with your claim. Filing a late claim may leave you with little recourse in the event of a denial.
- Lack of evidence. Your insurance company won’t just take you at your word. Your claim must be supported by medical documentation of your disability. Below we further discuss the types of medical evidence you may submit to your insurance company.
- Lack of appropriate treatment. Your insurance company requires you receive appropriate treatment for your condition to qualify for benefits. If you neglect to treat with your doctor regularly, they may deny your claim. This can be frustrating for those who have a poor prognosis for improvement and no treatment options. Regardless of your chances for improvement, you should maintain a regular treatment schedule with your providers.
- Exaggerated claims. Always be honest about how your disability impacts your capacity for work. It is possible your insurance company will investigate you during the claims review process. This could mean surveillance or monitoring your social media. If you tell your insurance company that you cannot drive, and they then catch you behind the wheel, they could deny your claim outright.
Your insurance company will look for reasons to deny your claim. Don’t give them an easy one. We always recommend consulting an ERISA attorney to help you navigate the minefield of the disability claims process.
How can an attorney help file my disability claim?
Experienced disability attorneys understand the claims process. They can gather the correct paperwork, ensure all deadlines are met, and communicate with your insurance company on your behalf.
At Riemer Hess, we create a personalized strategy for every client. Our strategy takes into account all of your needs and concerns. From exiting work to filing your claim, our attorneys are at your side every step of the way to answer questions and provide guidance. Our goal is delivering you a successful outcome with as stress-free a process as possible.
While every client is unique, we do have broader strategies we implement for all our cases.
- We act as gatekeepers with your insurer. We immediately inform your insurance company that we represent you. All future communications must be handled through us. By controlling the flow of information, we can ensure they will not catch you off-guard with questions or requests. We also are able to track precisely what information is being received and sent.
- We provide comprehensive information concerning your disability. Insurance application forms leave little room to explain your health issues. At Riemer Hess, we always expand on the insurance company’s questions with supplemental statements. We prepare applications with answers addressing all of their questions in full. This gives your claim more leverage than your insurance company intends.
- We create a strong narrative. Your insurance company must be convinced of your disability and that it prevents you from working. A brief doctor’s note will not be enough. Our expert attorneys at Riemer Hess understand what your insurance company is looking for. We will itemize your unique job duties and symptoms, and then provide your insurance company with an analysis of how your condition impairs your ability to work. We always go above and beyond to ensure your insurance company does not misinterpret your condition.
- We coordinate with your doctors. Doctors are busy individuals. We understand what documentation is needed from them. We also coordinate to make sure their paperwork is received on time. If the paperwork has errors or information is missing, we will work with your doctor’s office to ensure it is accurate and complete.
- We prepare you for every event. Whether you are exiting from work or your insurance company requests an interview, we will guide you. An attorney’s advice is invaluable, as missteps during these times can derail a disability claim. We set out a strategy for every step of the process. This way you can feel confident and prepared at every stage.
Strategies To Prove A Long Term Disability Claim
Your long term disability insurance company will require proof of your restrictions and limitations in order to approve benefits. There are multiple types of evidence that can prove your disability status. The types of evidence includes:
Objective medical evidence
Subjective medical evidence
It is essential to incorporate as much supportive evidence you can with your long term disability claim. The more evidence you submit to your insurance company, the better chance your claim will be approved.
Below we will outline how to obtain different kinds of evidence for your long term disability claim.
How important is medical evidence for my disability claim?
The most vital aspect of your disability claim is medical evidence that substantiates your restrictions and limitations. Medical evidence can come in many forms, such as office visit notes, testing results, diagnostic films, and opinion letters from your treating doctors. Any objective medical records that show indisputable proof of your disabled condition will hold the most weight with your insurer.
The three key types of medical evidence are:
- Objective medical evidence. Objective medical evidence is any evidence that is quantifiable and able to be independently verified. This includes imaging reports (MRIs, X-rays, etc.), blood lab results, and other diagnostic testing. Objective evidence will hold the most weight with your insurance company.
- Subjective medical evidence. Subjective medical evidence cannot be impartially authenticated. This can include self-reported symptoms. For example, pain is a subjective symptom. However, subjective symptoms can be supported by objective evidence. If you report frequent headaches, and a CAT scan reveal a brain tumor, your subjective self-reported symptom is highly substantiated. Still, insurance companies are reluctant to award benefits based on subjective evidence alone.
- Medical opinions. Your treating providers can provide medical opinions to your insurance company. Their opinions hold weight when supported by their examinations, clinical findings, and observations of you in person. Your doctor can tell your insurance company they believe you are disabled based on your treatment history.
While objective medical evidence will be most important to your insurance company, subjective evidence and medical opinions can still help your disability claim. This is especially true when the subjective evidence and medical opinions are substantiated by objective findings.
You can help develop a range of medical evidence to support your disability claim. Ways you can help increase your medical evidence includes:
- Treating with your providers regularly. You may not be experiencing a change in your condition. Still, you should continue to treat with your doctors on a regular schedule.
- Reporting all of your symptoms. You may assume your doctor will understand your symptoms without explaining. For purposes of documentation, make sure to relay all symptoms. This includes both physical and cognitive.
- Undergoing any appropriate testing. Evaluation reports and testing results can help substantiate your diagnosis and symptoms. If your doctor has not recommended you for testing, ask if you have options.
How can I help prove my condition beyond regular medical records?
We often recommend our clients keep a contemporaneous diary of all symptoms. We refer to this as a "Bad Day Diary."
Your diary should include:
- All symptoms experienced that day
- The severity of your symptoms on a scale of 1-10
- The duration of your symptoms
- How many breaks were required throughout the day and their duration
Be as specific as possible. Details make your accounting of your symptoms more credible. Documenting numbers (pain scale, length of symptom duration, etc.) also allows a bigger picture to be drawn of how your disability impacts your day-to-day life.
How does a Neuropsychological Evaluation help my long term disability claim?
If your disability involves cognitive impairment or mental illness, consider a neurological examination.
A neuropsychological evaluation will measure your cognitive deficits in an objective manner. The conducting neuropsychologist will then analyze the results of the testing and provide a detailed evaluation report with their findings. They will also render an opinion on whether your cognitive dysfunction prevents you from performing work duties.
Your medical records may not contain detailed information regarding your cognitive function. A neuropsychological evaluation offers a much more comprehensive assessment of your cognitive abilities. If the findings are supportive of cognitive dysfunction, this will be strong evidence for your disability insurance company to consider.
How can a Vestibular Evaluation help my disability claim?
A vestibular evaluation is a good option if you suffer from symptoms such as:
- Balance issues
These symptoms are difficult to assess objectively. A vestibular evaluation will quantitatively measure the severity of your vestibular symptoms. A vestibular evaluation consists of a series of tests, ranging from Electro/Video-Nystagmography to Auditory Brainstem Response Test to CT/MRI scans. The specific testing involved will depend on your vestibular specialist.
The objective of a vestibular function evaluation is to detect abnormalities in the inner ear. If abnormalities are found, you will have an objective cause for your symptoms. Your insurance company will take your symptoms of dizziness, vertigo, and imbalance more seriously.
Can a Functional Capacity Evaluation help my disability claim?
A Functional Capacity Evaluation (“FCE”) should be considered if your disability involves physical limitations.
An FCE gauges your physical function across the spectrum. The assessment is conducted by a trained medical professional, such as an occupational therapist. An FCE involves a series of tests, as well as observations from the specialist conducting the FCE. The evaluation can be done in one day, or across two days. We generally recommend our clients opt for a two-day FCE to obtain a more comprehensive evaluation report.
Some of the physical functions tested in an FCE include:
- Physical strength
- Ability to sit/stand
- Ability to lift/carry
- Ability to perform fine manipulations (such as hand gripping)
An FCE report will provide objective data, findings, and test results that underline your physical limitations. This gives your insurance company strong evidence of your work limitations and restrictions.
How do I prove I cannot work?
It is necessary to show your insurer proof that you are unable to fulfill the duties of your occupation. Beyond medical evidence that proves your restrictions and limitations, you can also obtain vocational evidence that explains what functionality your job role requires. Vocational evidence can be used to give your insurer a clear idea of your occupation and everything it entails.
Do I have to prove I can't work my own occupation or any job at all?
Your disability insurance policy will lay out the definition of disability you must meet to receive benefits. Typically there are three types of occupational standards:
- Own occupation. An “own occupation” standard means you must prove you are unable to work in your own occupation.
- Any occupation. An “any occupation” standard means you must demonstrate you are unable to work in any occupation reasonable for your education, training, and experience.
- Hybrids. A hybrid standard usually means at first you must meet the “own occupation” standard, and after a set amount of time, show you meet the “any occupation” standard to continue receiving benefits.
Review your policy carefully to see which occupational standard you must satisfy. This will shape your strategy for filing your disability claim.
Can a Vocational Assessment help my long term disability claim?
Your disability insurance company may not have a comprehensive understanding of your occupational duties. A vocational assessment is a great way to provide evidence of what tasks your job role entails.
Vocational assessments are conducted by vocational experts. The vocational expert provides a detailed analysis of your occupation. They will take into account how your disability interferes with your ability to perform your job duties.
Remember, your disability claim relies on:
- medical evidence demonstrating your disability; and
- proving you are unable to work due to your disability.
Your insurance company may accept your evidence of your condition. However, they may argue that your symptoms do not prevent you from working. Offering an expert opinion from a vocational specialist can help counter that argument considerably.
What job limitations do I need to show my insurance company?
There are two types of limitations to take into consideration for your disability claim.
- “Exertional” limitations are limitations that affect your ability to meet the strength demands of a job (such as sitting, standing, walking, etc.).
- “Non-exertional” limitations are limitations that do not impact your ability to perform the exertional demands of an occupation. A limitation may still be considered non-exertional if your condition is physical in nature (i.e., arthritis in your hands makes it difficult for you to type).
The insurance company considers these limitations to identify work activities that you can still perform. Identifying all of your limitations will make your claim stronger.
Strategies To Protect Ongoing Disability Benefits
Many claimants make the mistake of assuming that once they’ve been approved for long term disability benefits, they no longer need to be concerned. However, insurance companies will require ongoing proof of your disabled condition to continue benefit payments.
What do I need to maintain my disability benefits?
Your insurance company will require ongoing evidence of your disability to continue paying benefits. These update requests can be as frequent as every month. Should you fail to provide sufficient proof of your medical condition, your insurance company may terminate your benefits.
You can take steps to ensure your benefits continue uninterrupted. Below are some of the strategies Riemer Hess uses to protect our clients’ benefits.
- Get ahead of the curve. We urge our clients to treat with their providers regularly. We also gather medical records ahead of time. That way when the insurance company sends a request, much of the necessary documentation is already obtained.
- Cooperate with the insurer. While we stand firm against shady insurer tactics, we also develop good working relationships with claims representatives. We make it clear that our clients are disabled and have no reason to withhold information. Representatives are less likely to cancel the benefits for a claimant whose attorneys are cooperative and helpful.
- Review your doctor’s documentation before submitting it to your insurer. Doctors are busy people – it is easy for them to check a wrong box on a form or omit an important piece of information about your condition. Always review your doctor’s statements before submitting them to your insurance company. Otherwise your insurance company could use a small mistake as justification for cutting off your benefits.
What will cause my insurance company to terminate disability benefits?
If you fail to continue meeting your insurance company’s standards, they may terminate your benefits. You must demonstrate your condition continues to prevent you from working.
When your insurance company requests updated information, they will look for certain red flags. These include:
- Signs of medical improvement. If your medical records note improvement in your limitations and restrictions, this may cause issues.
- Failure to report other income. Your insurance company will question any employment opportunities you take, even if they are outside of your regular occupation.
- Contradictions in your claim. For example, if you mention playing recreational sports while also claiming to have limited mobility, your insurance company will have questions.
You should always be honest with your insurance company in your submitted updates. However, you should also provide any context for alleged medical improvement or inconsistencies with your claim. Your insurance company will never give you the benefit of the doubt. At the end of the day, insurance representatives are searching for reasons to deny paying benefits.
How do my doctors affect my ongoing disability benefits?
Your doctor’s support is essential to your claim’s ongoing approval. If your medical records do not reflect your continued disability, your insurance company may use that as a basis to terminate benefits.
Here are examples of “red flags” for insurance companies from your doctors:
- Lack of disability evidence in medical records. Doctors do not make treatment notes for the benefits of insurance companies. They may omit symptoms you are experiencing from their records. This happens for various reasons – for example, those symptoms may not be your primary complaint at that appointment.
- Your doctor estimates a “return to work” date. Many insurer forms ask your doctors to estimate a date you can return to work. The wording can be deceptive. Your doctor may think they have to give an exact date. However, if your doctor does put a date, your insurance company may take this as a cutoff date for your benefits.
- Your doctor omits restrictions and limitations. If your doctor skips a question or neglects to check a box indicating your work restrictions, your insurance company may conclude the doctor does not believe you are disabled.
Doctors are busy individuals. They did not go to medical school to fill out insurance paperwork. You can head off some of these red flags by reviewing all paperwork your doctor completes for your insurance company before submitting it. You can also make sure to communicate every symptom you are experiencing at every appointment. This helps ensure all of your symptoms are recorded in your treatment notes.
Why does my long term disability insurer want to me file for Social Security Disability benefits?
Most ERISA long term disability insurance policies require claimants file for Social Security Disability. If you file for SSDI and become approved, your LTD insurance company will deduct that amount from your insurance benefit. This is called an "offset." Your insurance company prefers you be approved for SSDI so they can lower what they pay out of pocket.
Should I be worried about surveillance?
Long term disability insurance companies regularly spy on their claimants. Your insurance company wants proof you are lying about your inability for work. Should your insurance company surveil you performing activities contradictory to your stated limitations, they may use this as reasoning to terminate your benefits.
Surveillance can come in different forms, including:
- Background checks. Your insurance company may run a background check that includes information on your properties, assets (cars, etc.), businesses in your name, and more. Background checks are often run as a precursor to in-person surveillance.
- Video and photographic surveillance. Your insurance company may hire a private investigator to video you outside of your home and follow you throughout your daily activities. Oftentimes this surveillance will happen around the time they schedule you for an independent medical examination because they know you will need to leave home for the appointment.
- Internet and social media research. Running a check on your internet presence is an easy way for your insurance company to dig up information. Your insurance company may search popular social media platforms for information on your activities.
It may seem shocking, but long term disability insurance companies pay millions a year for investigators to spy on their claimants. Always be vigilant of your public activities, both in real life and online.
Will my disability insurer monitor my social media?
Long term disability insurance companies routinely monitor their claimants’ social media. This includes:
- Google searches
- Personal blogs or websites
Internet research is an easy way to dig up potentially damaging information on a claimant. Always be aware of what you post publicly on the internet – and what others post about you. It is all too easy for your insurance company to take an innocent post or picture out of context. If they can use your social media as grounds to terminate benefits, they will.
What happens to my disability benefit if I start working again?
You may wish to return to work, either in your own occupation or another.
Always consider how your employment will affect your insurance benefits. Your wages must be reported to your insurance company. In turn, your insurance company will reduce your benefit by any earned income. Your insurance company could potentially terminate your disability claim, depending on your new occupation and the terms of your policy.
We always recommend consulting with an attorney if you are receiving disability income and wish to pursue new employment.
What are my options if my insurance company cancels my disability benefits?
Termination of disability benefits can be devastating. But benefit cancellation isn’t the end of the road. Options exist to reestablish your benefits.
Typically your course of action to reinstate benefits is filing an appeal through your insurance company’s internal administrative process. Your denial letter should include instructions on the appeals process. This includes the deadline to file your appeal. In most cases, your policy dictates you must go through your insurance company’s internal appeals process first. Should you be denied again, you may then file a lawsuit.
If your appeal is approved, you will be paid back benefits to the date of termination.
Check out the section below where we discuss strategies for filing an appeal with your insurance company.
How can an attorney protect my disability benefits?
We always recommend you consult with a disability attorney. Experienced ERISA attorneys can help monitor your disability claim and prevent benefit termination.
At Riemer Hess, we regularly assist our clients with fielding requests from their insurance companies. This includes:
- Submitting continuing medical evidence
- Navigating interviews with representatives
- Preparing clients for independent medical examinations
- Responding to reports from biased insurance company doctors
We understand what evidence your insurance company seeks to continue paying benefits.
Strategies To Appeal A Long Term Disability Denial
If your long term disability claim is denied, or your approved claim is later terminated, you have options to reinstate your benefits. Your insurance company will allow you to appeal through their internal administrative process.
You may be tempted to rush your appeal submission with hopes of getting your benefits back quickly. However, that can backfire. Taking the time to prepare and file your appeal with as much substantive evidence as possible gives you a better chance at overturning the claim denial. Keep in mind that if your appeal is denied, your only recourse may be expensive and drawn-out litigation.
Below we’ll answer common questions and discuss strategies for preparing and filing a long term disability insurance appeal.
Is there a deadline for my disability insurance appeal?
ERISA provides that your insurance company must allow you a minimum of 180 days to file your appeal. The 180-day countdown starts from the date of your denial letter. If you have an individually purchased insurance plan, check your policy. The deadline may differ.
Meeting this deadline is crucial. Should you submit your appeal late, your insurance company may deny it outright.
How do I win my long term disability appeal?
There is no one way to win an LTD appeal. However, at Riemer Hess we have developed tried-and-true strategies we use with every client.
- Meet your deadlines. Your denial letter should outline the appeal deadline. As discussed above, it is essential to submit your appeal on time. If you need more time to prepare your appeal, you may request your insurance company extend the deadline. Always do this in writing. Your insurance company is not required to grant an extension, but many times they will agree.
- Request your claim file. Many claimants are unaware they have a right to the insurance company’s claim file. Your claim file includes many important documents, such as all correspondence, medical records reviewed by your insurance company, internal notes on your claim, and any reports from your insurance company’s doctors. Immediately request a copy of your claim file when you receive a denial letter. Your claim file offers insight to why your insurance company denied your claim. You can use this when drafting your appeal.
- Submit more evidence. If your submitted medical records were insufficient for your insurance company, obtain more evidence. This could be a doctor’s opinion letter, additional medical/functional testing, a vocational report, an affidavit, etc. More evidence of your functional restrictions and limitations will strengthen your appeal.
- Continue treatment. We always advise our clients to continue treatment with their providers during the appeals process. Your insurance company may contact your doctors. If they learn you have stopped treatment, they may assume your condition is improved or you are non-compliant. Continued treatment also means you can submit updated medical records from the time between your denial and filing your appeal.
How long will it take for an insurance company to make a decision on my appeal?
Your insurance company will make a decision on your appeal within 45 days. It is possible your insurance company may ask for an extension to render a decision. This only happens if they send a letter citing special circumstances (for example, waiting for a reviewing doctor's report).
An extension allows your insurance company another 45 days. At most you would have 90 days from submitting your appeal to hearing a decision.
What additional evidence can help my appeal?
Your appeal is your last chance to introduce new evidence to support your disability claim. The specific evidence you should obtain depends on the nature of your disability. However, there are a variety of evidence options available to you.
- Additional medical testing. Seeking medical evaluations whose findings support your disability claim can be very helpful. Additional testing provides your insurance company more irrefutable evidence of your limitations.
- Vocational evidence. Enlisting a vocational expert to conduct an analysis on your occupation and work duties can help your appeal. A vocational report offers proof to your insurance company of the requirements of your work.
- Medical records. Any medical records not previously submitted to your insurance company can be included in your appeal.
- Witness statements and affidavits. Statements from family, friends, and/or former co-workers explaining the impact of your disability on your work and life can help. Additionally, a personal affidavit from yourself can also help persuade your insurance company.
How can an attorney help win my long term disability appeal?
Getting your appeal right is critical. Your appeal is likely your last option before litigation. Suing your insurance company will be a drawn-out and costly process. You can avoid the expense and frustration by filing a successful appeal.
At Riemer Hess, our attorneys know what it takes to file a successful appeal. Our approach involves obtaining as much evidence as possible to rebut your insurance company’s reasons for denial. We address all of your insurance company’s arguments and submit a thorough, comprehensive appeal that proves you are unable to work.
If you fail to submit evidence at the appeal stage, you may not be able to introduce it should litigation become necessary. An experienced disability insurance attorney will understand how best to convince your insurance company to overturn their decision.
If you’ve thinking of applying for long term disability benefits, need to appeal a denial or termination, or need assistance maintaining ongoing benefits, you should consult with a qualified long term disability attorney. An experienced ERISA long term disability attorney can help increase your chances of claim approval.
Our New York long term disability lawyers can assist you. Call Riemer Hess LLC at (212) 297-0700 or click the button below for a consultation on your disability case.