What situations trigger a termination of long-term disability benefits? Below, we discuss some red flags that make insurance companies take notice. Being aware of these red flags can help you avoid losing the benefits that are so important to you and your family. To learn more about what you can do to help you protect your ongoing benefits, contact CJ Henry Law Firm, PLLC today.
It’s all about the details. Little things can cause the insurance company to question the validity of your claim. For example, if you report to the insurance company that you never go shopping alone and your doctor reports that occasionally you shop alone, that’s a red flag. Coordinate the information you submit with physicians or others who contribute reports to avoid inconsistencies in your file.
Consult with your doctor about including an estimated return to work date. If your condition is unpredictable or your symptoms change still leave you unable to work discuss specifying a return to work date with your doctor. He or she needs to understand that projecting a return to work date could jeopardize your long-term disability benefits.
If your medical file includes any indication of medical improvement, it could cause the insurance company to reconsider your long-term disability benefits. For example, medication may have reduced the severity of memory loss, but you may still experience debilitating back pain. Under these conditions, it is vitally important that you continue to receive your benefits.
It’s time to have a talk with your doctor. He or she needs to understand the impact their comments will have on your ability to receive long-term disability benefits. Answer any questions he or she has about your activity level, and also make sure to clear up any miscommunication.
If your doctor’s report mentions dissatisfaction with your work, the insurance company may assume you filed a claim for disability benefits so you no longer have to work. For example, if your anxiety level increases while you were at work, the doctor needs to explain that increased anxiety is part of your disease and not connected to any workplace differences.
If your doctor recommends a treatment plan, be sure you follow it to the letter. The insurance company is more likely to terminate your long-term disability benefits if they believe you are avoiding treatment because you don’t want to go back to work.
This is another circumstance when talking with your doctor is crucial to maintaining your disability benefits. Doctors are busy. He or she may inadvertently fail to include a major aspect of your diagnosis or a major symptom. Be sure you communicate your symptoms both clearly and thoroughly.
If your doctor reported symptoms conducive to a diagnosis related to mental illness rather than a physical illness, your insurance company may cancel your disability insurance. For example, if mental illness is caused by your physical disability, your doctor should detail how mental illness contributes to your physical impairment. Benefits for mental illness may be treated differently under your policy. Avoid this situation by consulting with your doctor.
It is possible that your doctor checked a box which indicates your disability is less severe than it really is. If your physician indicates you can function at 35 percent of your pre-disability rate instead of 5 percent of your pre-disability rate, the insurance company may terminate your benefits.
Information from your doctor is very influential in your insurance company’s benefit decisions. If your doctor reports that your disability has improved because of a new or more aggressive treatment, or you experienced a remission, your insurance company may terminate your coverage because they do not understand the full scope of your disability.
If you were approved for disability benefits based on decreased mobility, but your file indicates you take daily walks, this is a red flag. The insurance company may terminate your long-term disability benefits because your file and disability are inconsistent.
There are other reasons the insurance company may red-flag your file, but careful documentation and clear communication with your medical professional may prevent termination of your benefits.