Congratulations—your long-term disability appeal was approved! The good news is that you will likely be receiving a check from your disability insurance carrier for the total amount of past due disability benefits and begin receiving monthly benefit on an ongoing basis. The bad news is that there is still significant “leg work” to be done to ensure your claim remains approved.
Indeed, although the insurer has approved your LTD appeal, they may still deny your claim again in the future. In order to give yourself the best chance of making sure your LTD claim remains in approved status, here are a few things to keep in mind:
1. Continue Receiving Regular Medical Treatment.
Most plans include require that you remain under the “regular care of a treating physician” to continue receiving LTD benefits. This means that you are consistently attending scheduled medical appointments and following prescribed treatments with a licensed healthcare provider who is directly involved in the ongoing management and evaluation of our disability. This includes receiving regular assessments, updates to treatment plans, and any necessary medical interventions to manage the condition. The treating physician should take careful medical notes to document these interactions and provide detailed reports that demonstrate your continuous and active medical care. This ongoing medical relationship ensures that your health status is regularly monitored and that any changes in your condition are promptly addressed, thereby supporting the legitimacy of your claim for disability benefits.
2. Keep Your Insurer Up to Date Regarding Your Medical Appointments.
Keeping your insurer up to date with your current list of treating providers is crucial for the seamless management of your disability insurance claim. Regular updates ensure that the insurer has access to accurate and comprehensive medical information, enabling them to properly evaluate the validity and ongoing nature of your disability. This transparency facilitates timely communication between the insurer and healthcare providers, ensuring that all necessary medical records, treatment updates, and professional opinions are available to support your claim. Moreover, it helps prevent delays in the processing of benefits, as the insurer can promptly verify continued treatment and the necessity of ongoing support. Ultimately, maintaining current information with your insurer reinforces the credibility of your claim and aids in receiving uninterrupted benefits.
3. Be Mindful of Any Change to Your Plan’s Definition of Disability.
Most LTD plans include a change in the definition of disability after a claimant has received benefits for 24 months. Usually, the definition will change from whether to you perform the material duties of your “own occupation” to whether you can perform the material duties of “any occupation.” The latter is a more challenging standard to prove. Accordingly, staying informed about such changes allows you to understand the criteria you must meet and prepare accordingly, such as obtaining the necessary medical documentation or pursuing vocational assessments.
4. Consider Whether Your Claim is Subject to a Limited Pay Period.
Some plans impose restrictions on the duration of benefits for specific conditions, such as mental health disorders, chronic pain, or certain musculoskeletal issues, often limiting payments to just 24 months. Awareness of these limitations enables you to plan ahead, including by exploring alternative income sources or adjusting your budget. It also underscores the importance of ensuring your disability carrier has accurately classified your condition. Indeed, you may be eligible for extended benefits if you have other coexisting disabling conditions. Ultimately, understanding these limitations helps you prepare for potential changes in your financial support, ensuring you are not caught off guard and can maintain stability in your life and care.
5. Be Responsive to Requests for Updated Information.
Once your LTD claim is approved, it’s common that your carrier will request periodic updates from you regarding any changes or improvements to your condition. Promptly responding to such requests is essential to maintaining the continuity and accuracy of your benefits. Timely submissions of required documents—such as medical records, treatment updates, or details about your activities of daily living—demonstrate your commitment to complying with the plan’s terms and facilitate the insurer’s ability to assess and verify your ongoing eligibility. Contrarily, delays in responding can lead to interruptions in benefit payments, additional scrutiny of your claim, or even denial of benefits. Moreover, prompt communication helps to build a cooperative relationship with the insurer, potentially leading to smoother claim processing and quicker resolutions of any issues that arise. Staying responsive ensures that your claim remains active and that you receive the financial support you depend on without unnecessary disruptions.
6. Pursue Other Benefits for Which You May Be Eligible.
Applying for other sources of income, such as Social Security Disability Insurance (SSDI) benefits, when requested by your long-term disability insurance carrier is crucial for maximizing your financial support and adhering to the terms of your policy. Insurance carriers often require you to seek these additional benefits to offset their own liability, potentially reducing the amount they need to pay out. If you fail to apply, the insurer may estimate your potential SSDI benefits and deduct that amount from your long-term disability payments, regardless of whether you are actually receiving those benefits. This can significantly reduce your monthly income, causing financial strain. Proactively applying for SSDI and other applicable benefits ensures that you receive all available financial assistance and prevents unnecessary reductions in your long-term disability benefits, thereby maintaining your overall financial stability.
7. Your Insurer Could Deny Your Claim Again.
Even if a long-term disability insurance carrier approves your appeal for benefits, this does not guarantee that your claim will remain approved indefinitely. The insurer retains the right to reassess your eligibility periodically and may deny your claim again in the future if it determines that you no longer meet the plan’s definition of disability or other eligibility criteria. Factors such as improvements in your medical condition, non-compliance with treatment plans, or insufficient medical documentation can prompt a re-evaluation. Therefore, it is essential to continuously meet all policy requirements, maintain regular medical consultations, and provide timely and accurate information to the insurer. This ongoing diligence is crucial to sustaining your benefits and avoiding potential disruptions in your financial support.
In Conclusion…
Taking a proactive approach to managing your long-term disability claim is essential to ensure continuous and reliable access to the benefits you depend on. Proactive management helps prevent misunderstandings, delays, or denials that can jeopardize your financial stability. Our firm can provide invaluable assistance throughout this process, offering expert guidance, thorough documentation, and effective communication with your insurer. By helping you navigate the complexities of your claim, addressing any issues that arise, and advocating on your behalf to secure and maintain the benefits you are entitled to, we ensure your peace of mind and financial security.
If you’d like to speak with one of our experienced long term disability insurance attorneys, please contact us at 608-257-0040.
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