At Hawks Quindel, S.C., our long-term disability attorneys help workers challenge the termination of LTD benefits they were already receiving. If your insurer suddenly stops your monthly payments, the termination does not necessarily mean your claim is over. You may have the right to appeal and seek reinstatement of your benefits.
A termination can be particularly disruptive when you have spent years or decades in the workforce and have come to depend on disability benefits because you can no longer work. The appeal deadline can also arrive quickly. Our attorneys can review the termination letter, policy, claim file, and evidence to determine why benefits stopped and what needs to happen next.
Securing Disability Benefits Rightfully Owed to Wisconsin Workers
Why Would Long-Term Disability Benefits Suddenly Stop?
Approval of an LTD claim does not necessarily mean benefits will continue indefinitely. Insurers periodically reevaluate claims and may terminate payments when they conclude that a claimant no longer meets the policy's terms.
Common reasons include:
- Any-occupation transition: The policy changes from evaluating your ability to perform your own occupation to considering whether you can perform another occupation.
- Medical review or IME: An insurer relies on a file review, independent medical examination (IME), or another medical opinion to conclude that you can return to work.
- Surveillance or investigation: Surveillance, social media, or other information is used to question your reported limitations.
- “No longer disabled” finding: The insurer argues that updated medical records show improvement or no longer establish disabling restrictions.
- Policy limitation: Benefits reach a contractual limit, including limitations imposed by some policies on certain mental-health or substance-use conditions.
Your termination letter should explain the reason your benefits stopped. Identifying exactly what changed between the decision to approve your claim and the later decision to terminate it is an important starting point for an appeal.
Did Your Benefits Stop After 24 Months?
One of the most important points in many LTD claims occurs when the policy changes its definition of disability.
An own-occupation definition generally considers whether your medical condition prevents you from performing the material duties of your occupation. Some policies later switch to an any-occupation definition that considers whether you can perform another occupation satisfying the policy's requirements.
That transition frequently occurs after 24 months, although the controlling policy determines the actual timing and standard. A worker can therefore remain medically impaired and unable to return to a longtime career yet lose LTD benefits because the insurer contends that other work is possible.
For someone who has spent many years in a physically demanding, skilled, or specialized occupation, that conclusion may require careful examination. An appeal can involve not only medical restrictions but also education, training, work experience, transferable skills, occupational demands, earnings requirements, and the precise language of the policy.
How Is an LTD Termination Different From an Initial Denial?
An initial denial means the insurer decided that the claimant did not establish entitlement to LTD benefits in the first place. Termination occurs after the insurer has approved the claim and paid benefits for a period. That history can matter.
When challenging a termination, our attorneys can examine what evidence originally supported approval, what has changed since then, and what new evidence the insurer relied upon to stop payments. If your condition and limitations have not materially improved, the insurer's reason for reaching a different conclusion deserves close attention.
The procedural path after termination can nevertheless resemble that following an initial denial. If your plan is governed by the Employee Retirement Income Security Act (ERISA), you may need to complete an administrative appeal before pursuing litigation.
Our Long-Term Disability denial & appeals lawyers can explain that process and the importance of developing the administrative record in greater detail.
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Hawks and Quindel are an amazing law firm to deal with. It’s a scary time and everyone there puts you at rest that they have your best interest at heart. They never make you feel like you are bothering them and they kept me in the loop with answers before...
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I can’t praise Aaron Halstead and Connor Clegg enough for their work on my legal matter. I especially appreciated their thoroughness, patience, and insight. They were always responsive to my questions. They helped me navigate a challenging workplace issue and obtain a good outcome. I would and do recommend them.
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During this very difficult time, the staff at Hawks and Quindel kept me reassured and informed every step of the way. I had the pleasure of working with Attorneys Jessa Victor and Brook Tylka. Jessa, Brook, Matt, and Hadley, thank you for all of your hard work, professionalism and compassion!...
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From our first phone call with Donnie Malchow, we knew we'd found the right person to help us. I had filed for disability and been denied. He was willing to walk beside us and thoroughly explain the entire process (lasted over a year and a half) and expectations (gave us...
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Attorney Halstead and his team went above and beyond to not only win my case, but because of certain circumstances I had going on, they did everything they could to help and rush the settlement through. They were always quick at responding to emails and phone calls with questions I...
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Many thanks from my family to all of you at the firm!!! Hawks Quindel, S.C. is the only place I would consider for LTD, disability, SSDI, ERISA, EEOC, DRoW legal help!! Jessa Victor and her team got me all the answers and results when I didn't think it was possible!!!...
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How Long Do You Have to Appeal an LTD Termination?
Do not assume you have unlimited time because the insurer previously approved your claim.
For disability plans governed by ERISA, federal claims procedures generally give a claimant at least 180 days after receiving an adverse benefit determination to appeal. The U.S. Department of Labor advises claimants to review their Summary Plan Description and claims procedure because a plan may provide a longer period.
The termination notice should explain the applicable appeal procedure and deadline. An appeal should not be treated as a short letter telling the insurer you disagree. The Department of Labor advises claimants to submit the information and evidence they want the plan to consider before the appeal period expires. Claimants can also request relevant claim documents and information without charge.
Contacting our attorneys early provides more time to determine why benefits stopped and develop evidence addressing the insurer's reasoning.
What Does It Take to Get LTD Benefits Reinstated?
There is no single document that automatically restores LTD benefits. The appeal needs to address the insurer's stated reason for terminating the claim.
If the insurer claims that your health has improved, additional medical documentation may be needed to explain your ongoing functional restrictions. If an IME or medical review drove the termination, the appeal may need to address the conclusions in that report. If the insurer says you can perform another occupation, medical evidence may need to be supplemented with occupational or vocational evidence.
Depending on the claim, our attorneys may develop:
- Updated medical records and opinions explaining continuing functional limitations.
- Evidence concerning the physical or cognitive demands of work.
- Occupational or vocational evidence addressing other jobs the insurer claims you can perform.
- Responses to medical reviews, IMEs, surveillance, or investigative evidence.
For ERISA-governed claims, this evidence can also become important if the appeal is unsuccessful and litigation follows.
Can You Recover Benefits for the Months Payments Were Stopped?
If the termination is successfully overturned, reinstatement may include LTD benefits that should have been paid during the period payments were stopped, subject to the terms of the policy and circumstances of the claim.
The calculation is not always as simple as multiplying the monthly LTD benefit by the number of missed months. Many policies contain provisions allowing certain other income to reduce the LTD benefit. Those provisions are commonly called offsets.
Social Security Disability Insurance, workers' compensation, retirement income, or other benefits may affect the LTD payment when the policy identifies them as deductible income. The specific policy language controls which sources are included and how an offset is calculated.
For that reason, reinstatement and the calculation of past-due benefits need to be considered together.
Can SSDI, Workers' Comp, or Retirement Benefits Cause LTD Payments to Change?
Receiving another benefit does not necessarily mean you are no longer disabled under your LTD policy. Instead, another source of income may change the amount the LTD insurer owes.
An LTD policy may offset Social Security disability insurance (SSDI), workers' compensation, retirement income, or other benefits, depending on its terms. Separately, the Social Security Administration explains that private disability insurance does not reduce SSDI, although workers' compensation and certain public disability benefits can reduce SSDI payments in qualifying circumstances.
If your LTD payments changed or stopped after another benefit was awarded, the insurer's explanation and calculations should be reviewed. The issue may be an offset or asserted overpayment rather than a finding that you are no longer disabled.
What If an IME or Surveillance Led to the Termination?
Insurers may use an independent medical examination, medical file review, surveillance, or other investigative evidence when reevaluating an existing claim.
Surveillance might show a claimant driving, shopping, doing household activities, or attending an appointment. The significance of an isolated activity depends on the circumstances, including the policy's definition of disability, occupational demands, reported restrictions, and broader medical evidence.
Likewise, an insurer's medical examiner or reviewing physician may reach conclusions that differ from those of treating providers. When an IME or investigation contributes to a termination, the evidence and the conclusions drawn from it should be examined as part of the appeal.
Our LTD IMEs & Insurer Investigations resource provides more information about how these reviews can affect disability claims.
How Can Hawks Quindel, S.C. Help After Your LTD Benefits Stop?
Our role is not simply to resend the same medical records and ask the insurer to reconsider. Depending on the claim, our long-term disability attorneys can review the policy and termination letter, obtain the claim file, determine what evidence the insurer relied on, identify any gaps or disputed issues, and develop medical, occupational, or vocational evidence to address the reason benefits stopped.
We can then prepare the administrative appeal. If benefits remain denied after the required administrative process, we can evaluate the available legal options and pursue litigation when appropriate.
Hawks Quindel, S.C., has represented Wisconsin workers and individuals for more than 60 years. Because our attorneys also handle Social Security Disability and workers' compensation matters, we can identify issues that arise when multiple benefit systems overlap.
Frequently Asked Questions About Terminated LTD Benefits
Can an insurer stop LTD benefits after approving my claim?
Yes. An insurer can reevaluate continued eligibility under the policy. Benefits may stop due to a medical review, an IME, an investigation, a change in the disability definition, or a policy limitation. You may have the right to appeal the termination.
Why did my LTD benefits stop after 24 months?
Some policies change from an own-occupation definition to an any-occupation definition after a specified period, often 24 months. Other policies impose limits on benefits for certain conditions. Your termination letter and policy should identify the reason your payments stopped.
Can LTD benefits be reinstated after termination?
Yes. A successful appeal can result in reinstatement when the evidence establishes continued entitlement under the policy. Benefits that went unpaid during the termination period may also be recoverable, subject to policy terms and applicable offsets.
Should I contact an attorney before appealing?
Consider seeking legal advice before submitting an appeal, particularly if the plan is governed by ERISA. For ERISA disability claims, the administrative appeal is an important opportunity to submit evidence supporting the claim, and claimants generally have at least 180 days to appeal an adverse benefit determination.
Talk to a Long-Term Disability Attorney at Hawks Quindel, S.C. to Learn More
If you depended on LTD benefits and the payments suddenly stopped, the termination letter begins an important stage of your claim—it does not necessarily end it. Understanding why the insurer changed its position is the first step toward determining how to challenge that decision and seek reinstatement.
The attorneys at Hawks Quindel, S.C. can review your termination letter, policy, and claim history and explain your options. Contact us to learn whether your matter qualifies for a free case screening.
Call our Madison office at 608-257-0040 or our Milwaukee office at 414-271-8650, or fill out our confidential contact form today.