Long Term Disability – What the Insurers Hope You Don’t Know

Long Term Disability - What the Insurers Hope You Don't KnowWhen I went on disability, I was unaware the insurer could terminate my benefits without any notice. Here are some helpful tips that I wish someone had told me when I was diagnosed with cancer and went on disability.

  1. Document, document, document! When you see your doctor, have your doctor send a letter to the insurer for their file. Anything that you “report” to your case handler in conversation can be edited, or even omitted from your file. Though the conversations are usually recorded, the insurers do not transcribe them, and to get the transcribed messages you have to go through lawyers to have them subpoenaed.
  2. As the 2-year mark approaches from the date of your disability (usually from the date the Short-Term began), beware that insurers may begin private surveillance on you. They will hire private investigators to follow you and video tape you. They can send the video to your doctor, or to other doctors of their choice to interpret whether you meet the definition of “disabled.”
  3. Once you have been on Long Term Disability for two years, the standard for “disabled” changes and it is far easier for the insurer to deny your benefits. The standard of review changes and you must be unable to do “Any occupation” versus your previous occupation.
  4. When your benefit is terminated, there is a period of time during which you can appeal. If you appeal, seek legal representation. The reason is that lawyers will know what kind of documents need to be in the file. It is extremely important to fill the insurance company’s file with as much information as possible because this will be your last chance.
  5. If you lose the appeal, and then you file a claim in federal court, the judge will only look to the insurance company’s file. They will not look to any other evidence. So, it is extremely important that the insurer’s file speaks for itself.
  6. The insurer can terminate your benefit at any time that it sees fit. They do not have any obligation to tell you that your case will be under review. Once they render their decision, the benefit ceases immediately whether or not you are immediately made aware of the decision.

This article was not intended to sway anyone from purchasing long term disability. In fact, I recommend to anyone to purchase additional LTD coverage if they have the option at work. One never knows if or when he will be sick or unable to work.

If you are on disability, or have recently been hurt or diagnosed and you will be going on disability, hopefully you are now armed with information the insurance companies wish you did not know.

References:
1. www.disabilityhappens.com
2. www.consumeraffairs.com