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.
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.
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.
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.
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.
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:
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.
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.