Many people assume that they can relax once their long term disability (鈥淟TD鈥�) claim is approved. While it鈥檚 true that winning your long term disability claim is a big hurdle, it doesn鈥檛 mean you鈥檙e entirely in the clear. Over time, your LTD insurer will continue to re-review your file and demand proof of your ongoing disability.
LTD insurers use a number of ploys to justify cutting off your benefits after your claim is approved. Below, the NYC long term disability attorneys at Riemer Hess will discuss the five most common tactics used by LTD insurers to terminate long term disability benefits.
The insurer will latch onto anything it can find. For this reason, our legal team always reviews our clients鈥� submissions for any potential red flags. If we find a possible issue in the submission, we proactively request more information to address it 鈥� minimizing the chances of benefit termination.
You can learn more about red flags here, but typical red flags include:
The insurer will look for any inconsistencies in your new evidence. For example, your doctor now reports you can occasionally sit for up to 30 minutes, but you previously told the insurer that you can never sit for more than 15 minutes. If the insurer finds an inconsistency, it may demand more information and be more likely to question the reliability of your other statements.
Insurer forms often ask your treating doctor to estimate a specific date when you will be able to return to work. If your doctor writes down a time that you can return to work in the near future, the insurer will latch onto that date as a 鈥渄eadline鈥� to cut your benefits off by. The insurer will justify the benefit termination by saying your own doctor said your condition has improved enough by that time to work.
Documentation of medical improvement will be noticed by the insurer. The improvement may even be minor or not directly stated. For example, if your doctor stops prescribing medication for your pain, the insurer will assume that your pain improved enough to work. The insurer may jump to this conclusion even if your doctor stopped prescribing the medication for some other reason, such as poor response or intolerable side-effects.
If your doctor suggests that you are malingering and/or exaggerating your symptoms, the insurer will almost certainly use that as justification to terminate your long term disability benefits.
Long term disability insurers want to see that you are still doing everything in your power to improve your health and return to the workforce. For this reason, they want confirmation that you are reasonably compliant with your doctor鈥檚 treatment plan. Most disability insurance plans require you seek 鈥渞egular treatment鈥� to remain in compliance with the policy. If you don鈥檛 seek treatment regularly or fail to follow the recommendations of your doctors, the insurer will try to claim that you are purposely avoiding treatment that might end your disability.
The ongoing support of your treating doctor is critical. If your doctor indicates that you are no longer disabled, that can be extremely difficult to overcome. To keep your benefits ongoing, either that doctor will need to change their mind (perhaps by considering new testing, for example), or you will need to find/have another doctor who continues supporting your disability.
Unsurprisingly, the IME reports are often unfavorable to you, which can easily lead to benefit termination. These IMEs are typically cursory and incomplete. Often, the independent medical examiner will not even bother to review your medical records. They tend to significantly downplay the degree of your disability and supportive medical findings. An unfavorable IME report can be used by the insurer to cut off your disability benefits.
Our team does everything we can to help our clients avoid IMEs. We do so by analyzing the specific circumstances surrounding each client鈥檚 unique claim, while always recommending ongoing treatment with a qualified medical professional. The failure to receive regular treatment will almost always result in an IME request.
Long term disability insurers often will have one of their doctors (or nurses) call your doctor to talk about your condition, treatment, limitations, and return to work possibilities. Allowing an insurance company doctor to speak with your doctor is fraught with risk. We don鈥檛 allow it. Instead, we proactively direct that all doctor-to-doctor communications be in writing. Here is why:
The call is not typically recorded. Rather, the insurer鈥檚 doctor prepares summary notes based on the call. So, there is no clear record or transcript. Often these summary notes contain substantial errors and omissions, while also reflecting the subjective bias of the insurer鈥檚 doctor.
There is ample room for miscommunications and misunderstandings during these calls. Oftentimes the insurer鈥檚 doctor will pose a very broad or confusing question that your doctor does not fully understand. Your doctor also might offer responses while incorrectly assuming that the insurer鈥檚 doctor is familiar with your file.
Your doctor is busy and the insurer rarely schedules ahead. An unscheduled call from the insurer鈥檚 doctor will likely catch your busy doctor off-guard. If that happens, your doctor鈥檚 responses may be rushed or incomplete. Even worse, your doctor may not have time to even pull up your chart, so your doctor might try to respond from memory only 鈥� never a good recipe. The circumstances of a phone call make it too easy for your doctor to mistakenly provide incomplete, inaccurate, or vague assessments of your medical condition.
Your doctor might check the 鈥渙ccasionally鈥� box for sitting, thinking you can sit 5% of the day. However, the long term disability insurer will interpret your doctor鈥檚 response as indicating the ability to sit for 33% of the day.
We actively avoid these traps by requesting supplemental written statements or other forms of clarification from treating doctors. This allows your doctor the opportunity to clearly outline your restrictions and limitations. These supplemental statements often make the difference between benefit continuance and benefit cutoff for our clients.
Long term disability insurers often hire third-party investigators to spy on their claimants and dig up evidence that supports benefit termination. This surveillance is conducted with the hope of 鈥渃atching鈥� you performing activities that are inconsistent with your ongoing disability. If successful, your long term disability insurer will use the surveillance as 鈥減roof鈥� to cut off your long term disability benefits.
Our team aggressively combats surveillance evidence. This evidence is often too cursory or incomplete to draw any reliable conclusions about your ability to work. It is often insufficient to reliably demonstrate an ability to work on a full-time basis. Most of the activities recorded are just daily activities, which are irrelevant to your work demands. However, that won't stop the insurer from trying their best to use surveillance as justification to terminate your disability claim.
Insurers will use a variety of tactics to deny or terminate disability benefits for their claimants. If you recognize any of the above "red flags" from your insurer, you may want to speak to an experienced long term disability attorney.
At Riemer Hess, our New York ERISA attorneys are highly familiar with the tactics used by insurers to cut off disability benefits. We understand the best strategies to keep your disability claim in good standing, and how to proactively avoid common issues that cause insurers to try to terminate benefits.
The attorneys and staff at Riemer Hess know how to keep your disability benefits secure. Contact an attorney at Riemer Hess today at (212) 297-0700 or click the button below to schedule a call with one of our professionals to discuss your long term disability claim.