When receiving long term disability (LTD) benefits, you need to be aware that your insurance company can terminate – or cut-off – your benefits. If the insurance company decides that you are no longer disabled, they can reduce or terminate your benefits with very little notice. It’s always important to review your policy for reasons your benefits can be terminated. Here we will touch on the most common reasons why benefits are canceled.
Not Applying for Social Security Benefits
Did you know that under most LTD insurance policies the insurance company can require you to apply for social security disability (SSD) benefits? If approved for LTD benefits, you may be required to apply for SSD. The reason is to help offset the payment of benefits by the insurance company. If you are approved for SSD, then the insurance company will only have to pay you the net amount that remains after the Social Security benefit amount is deducted from the gross LTD benefit amount – instead of the entire gross LTD amount before setoffs. This will save the insurance company lots of money. Failure to comply could result in the termination of your benefits.
Your Activities During Surveillance
It is possible that you will be under video surveillance for a short period of time if the claims adjustor handling your LTD claim thinks that you are not truthful about your condition. During this time, the insurance company may hire a private investigator to monitor your activities and take pictures or videos of anything they see that contradicts what you have told the insurance company or the court. They can also monitor your social media accounts. Example: You post a picture of you riding a rollercoaster at the fair, but you claim to have a severe neck injury. Most people with severe neck pain would not be riding a roller-coaster.
Mental Health Conditions
Most LTD policies have a maximum payout of 24 months for mental health conditions. These conditions could include medical conditions like depression (including postpartum), bipolar disorder, PTSD, and anxiety. The insurance company uses the reasoning that these illnesses are hard to prove with medical testing and lab reports. They can be faked or exaggerated. Although these illnesses are serious, you must prove the existence of your illness and the resulting limitations. That is very hard to do.
Chronic Medical Conditions
Some LTD policies have a maximum payout for chronic illnesses like arthritis, back pain, and carpal tunnel syndrome. Conditions associated with lifestyle choices like alcoholism, COPD from tobacco use, or other diseases related to drugs or alcohol use could result in termination of benefits after 24 months or less. Check your policy for possible limitations based on these types of conditions.
Not Continuing Your Treatment Plan
If your condition is severe enough to receive LTD benefits, the claims adjuster will ask you to submit proof that you are continuing treatment. Your treatment plan for your condition may be supplemental to your general healthcare. For example, You may be seeing a primary doctor for overall health, but your treatment plan for your heart condition is with a cardiologist. In this situation, you want to make sure you always see your cardiologist who is required for your treatment plan. If you miss appointments or scheduled procedures, the insurance company will assume your condition is no longer as severe and may terminate benefits.
Most long term disability policies have an age limit. It’s usually retirement age between 62-67 years old. There are some exceptions to this – like if you apply for benefits over the age of 60, your benefits may have a “minimum benefit period” that may extend into the claimant’s initial retirement years. Check your policy for the exact wording on age out dates and restrictions.
Many claims are terminated because the claimant returns to work while receiving LTD benefits. Remember, the reason behind receiving benefits is you are saying you can’t work. Going back to work would most certainly disprove that. If your LTD payout is not enough to pay for your basic living needs and your co-pays, reach out for help. Contact the insurance company and explain your situation, ask your doctor’s offices to work with you on a payment plan, or consult a disability attorney for your options.
There are many reasons why an insurance company may cancel your benefits. Using these situations as a guide can help you extend benefits for a more extended period of time. If you think your benefits have been canceled unfairly, you should look over your policy and consult an attorney.
Although based in Florida, the Ortiz Law Firm represents claimants across the United States. If you’d like to speak to an experienced Long Term Disability Insurance Attorney contact us at (866) 853-4512 to schedule a consultation. We can help you evaluate your claim to determine if you will be able to access Long Term Disability Benefits and how to move forward with the process.