How to Protect Your Disability Benefits | 5 Things You Need to Know

An approved disability claim does not guarantee that you will receive disability benefits indefinitely. You need to protect your disability benefits. The insurance company may still terminate your disability benefits at any time after you won your claim.  Knowing why  disability benefits get terminated will help you understand how to protect your future benefits.

Keep current with your ongoing medical treatment

Even after your claim is approved, the insurance company will periodically request additional medical proof of your ongoing disability.  This is true regardless of whether your condition is expected to get better or worse.

If you stop receiving treatment, you will experience difficulty responding to the insurance company’s requests for updated medical documentation.  Failure to provide updated documentation will certainly put your benefits at risk.

If the insurance company is not satisfied that you have a continuous disability, it will do one of two things:

• The insurance company will simply terminate your benefits. Termination may necessitate a costly, risky, and time-consuming appeal with no guarantee of benefit reinstatement.  Without continuous treatment, your chances of winning an appeal may be lower.

• The insurance company may require you to be examined by one of their “independent” medical examiners. Unfortunately, these examinations often lead to termination, as discussed further below.

Thus, one of the easiest things that you can do to avoid benefit termination is to remain in continuous treatment following approval.  Continuous treatment will help provide clear documentation of your ongoing disability.

Avoid Independent Medical Examinations

At any point, the insurance company may require you to submit to an “independent” medical examination, commonly known as an “IME.”  Unfortunately, the IME physicians are anything but “independent.”

The insurance companies hire IME physicians to perform hundreds to thousands of examinations every year.  The examinations are brief, cursory, and often incomplete.  Many times, the independent medical examiner will not even review all of your medical records, thus leaving him/her wholly unfamiliar with your conditions and medical history.  Unsurprisingly, the IME reports are usually unfavorable and often lead to benefit termination.

To avoid having to undergo an IME, you should remain in continuous treatment to document your ongoing disability, as discussed above.

Know your policy’s definition of “disabled”

Your policy may contain a clause that changes the applicable definition of “disability” after a certain period of time.  The change often leads to termination when the definition becomes more stringent.

For example, for the first two years of disability, your policy may only require that you are “unable to perform the material and substantial duties of your own occupation.”  Then, after two years, your policy may require that you are “unable to perform any occupation.”  The second standard is often much more difficult to satisfy.

You should consult with an experienced long term disability attorney to interpret your particular policy’s definition of “disability.”  Your attorney may recommend obtaining a statement from your doctor that identifies the work limitations that prevent you from sustaining any employment.

Be cautious an investigator could be watching

At any point, the insurance company may launch an investigation of your claim in an effort to terminate your benefits.  The insurance company will typically hire a third-party investigator to gather damaging evidence against you.

The investigations usually involve:

• Video and photography surveillance: The investigator will secretly tape or photograph you for hours on end, usually over the course of several days.  The insurance company will review the surveillance and look for activities that contradict your allegations of disability.

• Internet and social media searches: The investigator will conduct internet searches to find your name, address, and any other personal information he/she can find.  The investigator will also conduct social media searches to read your posts and view your photographs.  The insurance company will review the results to judge whether you remain disabled.

• Licensing searches: The investigator may check whether you have recently renewed any licenses needed to work.  For example, a state bar license to practice law, a commercial driver’s license, a license to practice medicine, or a real estate sales license. If the insurance company discovers that you renewed a license to work, it may find that you are no longer disabled because you are seemingly taking steps to go back to work.

• Financial searches: The investigator may search to see whether you have filed income taxes, taken out business loans, or have any other questionable sources of income.  The insurance company will look for anything that suggests you are working.

While you cannot avoid an investigation, you should conduct your activities with the knowledge that you may be investigated at any time.  You should be particularly cautious about what you put on the internet.

Get your doctor to thoroughly document your disability

The insurance company may erroneously find that your medical condition improved to the point where you can return to work.  This may happen even if your condition is degenerative or progressive, such as multiple sclerosis or ALS.

After you begin receiving benefits, the insurance company will constantly be looking to your medical records for signs of improvement.  If your doctor does not document your ongoing medical issues well enough, your benefits may be in jeopardy.

Therefore, it is important to let your doctor know that you are receiving disability and that the insurance company will eventually review your doctor’s records.  Knowing this, your doctor may take extra steps to document your ongoing disability more clearly.