Even though your long-term disability claim has been approved, your benefits can be terminated by the insurer for a wide variety of reasons. It’s important to understand the conditions under which your monthly benefits can be terminated so you can protect your right to your benefits for as long as you are disabled.
Disability Definition Transitions from “Own Occupation” to “Any Occupation”
There is a common clause in group LTD policies that changes the definition of disability from “own occupation” — or an inability to perform the duties of your regular occupation — to “any occupation,” which means an inability to become able to perform any occupation. Courts have upheld that this means you are not considered disabled and your benefits can be terminated if you are medically able to perform almost any job that exists, even if the pay is greatly reduced and it is not even related to your field.
Time Limit for Conditions with Subjective Complaints
Most group policies also have a two-year time limit for claims that involve any disability arising from a nervous, psychological, or mental impairment. This may include depression, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder, or anxiety. Most insurance companies will only continue with benefits if you are confined to inpatient treatment or institutionalized after the limit expires.
There are sometimes exceptions to this limit, such as for organic mental disorders like dementia or mental illnesses like schizophrenia, but this is certainly not always the case.
There is also usually a two-year limit for benefits for chronic pain disorders like chronic back pain and arthritis as well as any condition that is primarily diagnosed due to a subjective complaint that can’t be objectified. This may include soft tissue disorders and fibromyaglia. In some cases, insurance companies make an exception when there is objective evidence showing traumatic spinal cord necrosis or spinal tumors, for example.
Failure to Apply for SSDI
Most policies require that you apply for Social Security Disability Insurance (SSDI) benefits. This is because the insurance company can reduce your LTD benefit payments by the amount you receive from SSDI.
Failure to Continue Treatment
You are also likely obligated to submit regular updates proving your disability through continued treatments. You may need to attend medical examinations or show evidence of re-certification.
Many people have their LTD benefits terminated because they have shown medical improvement and the insurance company no longer considers them disabled, even if they are still unable to work. The insurance company must show substantial evidence of medical improvement related to your ability to work.
Video Surveillance Evidence
LTD insurance companies often hire private investigators to produce video surveillance on claimants. If you are videoed doing anything against doctor recommendations or even performing simple actions like basic yard work or taking groceries in from your car, the insurance company may try to use it as evidence that your condition has improved to discontinue benefits.
Maximum Age for Benefits
The majority of LTD policies end when the claimant reaches retirement age or upon their death. If you are over 60 when approved for benefits, your benefits may continue past 65-67, but not for long.
Return to Work
Your benefits can also be terminated if you work while receiving monthly LTD benefits. While some policies let you work and continue benefits as long as you can only earn a wage that is substantially less than your pre-disability wages, this is not common and the maximum amount you can earn will be set in the policy.
Contact an LTD Attorney in Philadelphia
If your LTD benefits have been terminated, it’s important to understand your rights. An experienced long term disability lawyer can help you review your policy and reason for termination to determine if you have a claim against your insurance company. Contact Edelstein, Martin & Nelson for a free consultation with a Philadelphia disability lawyer to discuss your case.
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