You have experienced an accident or medical condition that has caused you to be unable to continue working. Thankfully, because you had disability coverage, you were able to submit a claim for disability benefits and were approved, and you have been collecting disability benefits. Although the benefits are not as much as your salary was, receiving the benefits alleviates much of the stress that accompanied your unfortunate situation. While things could be better, you still breathe a sigh of relief that you carried disability insurance. However, one day you receive a letter from your disability insurer saying that it has determined that you no longer meet the policy definition of total or partial disability, and you will therefore not receive any further disability benefits. You panic because you know that you will not be able to survive without the disability benefits. This type of scenario can be incredibly stressful. And it is common.
If you receive, or plan on receiving, disability benefits, it is crucial to be prepared for your disability insurance company to terminate your disability benefits after you begin receiving them. Because paying your disability benefits are a significant cost to your insurer, it has a vested interest in finding a way to discontinue paying them to you. Thus, it is reasonable to believe that your insurer is always looking for a justification for terminating your benefits, even if the reason is improper. They do this by conducting ongoing surveillance of you, reviewing your medical records to look for inconsistencies and or lack of support for your disability, conducting so called “independent” medical examinations with biased medical personnel or by waiting for a change in definition of disability under your policy to assert you no longer qualify for disability benefits.
If you have been notified that your benefits have been terminated or are going to be terminated, it is vital for you to take certain steps to protect your benefits.
What to Do if Your Disability Benefits Have Been or Are Going to Be Terminated
First, you should do carefully read the insurance company’s reason for terminating your benefits so you can understand exactly what that reason is. If you do not understand why your benefits have been or are being terminated, you will have an extremely difficult time presenting an effective appeal to your insurance company. If you have read the insurance company’s rationale and do not understand it, you should immediately consult with an experienced disability insurance attorney. The knowledgeable and experienced disability insurance attorneys at McKennon Law Group PC will provide a free consultation regarding the termination of your benefits.
Second, review the policy language to see whether it supports the insurance company’s basis for termination. It may be that your benefit period under the policy has expired and you are no longer entitled to benefits. On the other hand, it may be that the insurance company has concocted an illegitimate reason that is not supported by the policy. Without reviewing your policy, you may not understand whether the insurance company’s determination was proper.
Third, you should review the medical and other evidence supporting your disability claim. If you submitted sufficient evidence and the insurance company approved your claim, then it reversed itself without presenting new evidence or pointing out what in the existing evidence changed to prompt its determination, it is likely that the insurance company’s decision was improper. Once you have been determined to be disabled under either an “own occupation” standard (under which you are considered disabled if you are unable to perform the duties of your own occupation) or an “any occupation” standard (under which you are considered disabled if you are unable to perform any occupation for which you are suited by education, training or experience), the insurance company may not then determine that you are no longer disabled under that same standard without presenting evidence that your condition has improved. Therefore, it is important to understand the evidence supporting your claim and how the insurance company interprets that evidence.
It may be a matter of your insurer expecting to see ongoing evidence of your disability, in which case it will request additional information from you. This is entirely normal and expected unless you have an undisputed permanent disability condition. If you fail to provide that information or provide insufficient information, the insurance company may be able to properly terminate your benefits under the policy. However, if you have provided sufficient information and your insurer still terminates your benefits, there is a good chance that the insurance company acted improperly. In such a case, you should seek experienced disability insurance lawyers to assist you. The award-winning team of attorneys at McKennon Law Group PC can help you avoid having your benefits terminated, or help you recover your benefits if they have been terminated. Reach out to McKennon Law Group immediately for a free consultation.
If the insurance company has enlisted a physician to certify that you are not disabled, you may need to get your treating physician or physicians to provide additional certification supporting your position that you are disabled. Not only that, but it will also likely be necessary to present evidence that calls into question the opinions of the insurance company’s physicians or nurses.
If you are receiving ongoing disability benefits, it is important to understand the very real possibility that your insurance company will terminate them at some point. When this happens, the best thing you can do is immediately contact the expert disability insurance lawyers at McKennon Law Group PC who specialize in all types of disability insurance issues.