Your Long Term Disability claim was approved! You’re relieved. You can now take a deep breath knowing that you and your family can financially survive this tough time in your life. But your sense of security diminishes as you read the remainder of the insurance company’s approval letter. Your insurer is requesting that you complete an updated Claimant Statement and that your treating doctor complete a new Attending Physician’s Statement. You’re confused – you just submitted these same completed forms about one month ago as part of your disability claim. Your medical condition and symptoms have not changed in one month. Why does the insurance company need updated forms so quickly after approval of your LTD claim?
This, unfortunately, is not an uncommon situation. Insurers are always looking for a reason to deny or terminate your disability benefits. As a result, your disability insurance company can, and will, review and re-review your long term disability claim as often as it desires (e.g., every month, every three months, every six months, once per year, or anything in between). It can be overwhelming and intimidating to receive frequent requests for updated information, especially when you are trying to deal with your health conditions. It is also disconcerting to know that your insurer can terminate your disability benefits at any time.
The disability attorneys at Hiller, PC can help reduce your stress level and help you avoid the unexpected pitfalls that can result in terminated benefits. Below are some of the ways we can monitor your LTD claim and assist in maintaining your disability benefits without interruption:
1. We Deal with the Insurance Company’s Communications, Correspondence, and Requests.
Insurance companies know us and will be less likely to harass you. Plus, it is our experience that disability clients are less stressed when they received a telephone call or email from their attorney’s office as opposed to receiving correspondence from their disability insurance carrier. As a result, the first letter that we send to your insurance company will advise them of our representation, and demand that all correspondence, requests, etc. be sent to our office. In other words, we will ensure that your insurer does not contact you directly. We will, of course, keep you apprised of the status of your disability insurance claim, and provide timely responses to any requests from your insurance company.
2. We Assist in Completing Your Disability Update Forms.
Your insurance company will periodically request that you and your doctor(s) complete update forms; it’s generally inevitable regardless of the severity of your disability. We will assist you in crafting accurate and comprehensive responses to the insurer’s questions, with an eye towards avoiding red flags that could trigger a more detailed review of your disability claim.
We will also work with your treating doctors to obtain their completed Attending Physician’s Statement. Prior to submission, we will make sure that the responses prepared by your physician, who likely is not accustomed to completing such paper work, are thorough and accurately reflect your symptoms, restrictions, and limitations.
3. We Gather Updated Medical Records and Other Information Requested by Your Insurance Company.
In addition to the disability update forms, your insurer will also request updated medical records and other information from your doctors. We will work with your doctors’ offices to obtain any documentation requested by your insurance company. As with the updated forms, we will review the medical records prior to submission to make sure that there are no errors, and that no information is missing that could delay the processing of your disability benefits.
In addition, we are proactive in monitoring your long term disability claim. We have decades of experience dealing with insurance companies, and likely know whether the correspondence/requests from your insurer are boilerplate and innocuous, or whether they contain a hidden meaning. We read between the lines. If we suspect that your insurance company is trying to trick you – for example, by deliberately not requesting all relevant information or requesting irrelevant materials, etc. – we will obtain the documentation necessary to keep your LTD benefits in approved status. This may involve, among other things, updated objective testing (e.g., an MRI or functional capacity evaluation) or a narrative report from your doctor.
4. We Attend “IMEs” with You.
Most long term disability policies allow the insurer to require that you submit to an “independent” medical examination (IME) with a doctor of the insurer’s choice. Because most doctors selected to perform IMEs tend to have an institutional bias towards those that employ them (e.g., the insurance companies), we will prepare you for the IME and send a representative from our office to accompany you during the examination. Our representative will observe the examination and take notes to ensure the integrity of the process.
5. We Attend Follow-Up Interviews with the Insurance Company.
Your insurance company may request either a telephonic or in-person interview as part of its effort to obtain updated information regarding the status of your medical conditions and disability. We will thoroughly prepare you, and attend the interview with you. Whether the interview is in-person or over the telephone, we will make arrangements to ensure that it is held in our conference room.
6. We Submit Documentation in Support of a Change In Definition of Disability.
Under many disability insurance policies, the definition of “disability” changes over time from an inability to perform the duties of your own occupation to an inability to perform the duties of any occupation. Depending on the terms of your policy, this change in definition can occur after 12, 24, 60, or 120 months – with 24 months being the most common. As the date upon which the change in definition approaches, your insurance company will increase the scrutiny of your disability claim. Your insurer may insist you that find an alternative, less physically or mentally demanding job that you can perform given your restrictions and limitations.
Knowing that this is a critical period in your disability claim, we proactively obtain updated documentation to support your long term disability claim. For example:
– we will obtain your updated medical records and objective test results;
– we may obtain narrative reports from your treating doctors;
– we may recommend that you go for updated testing, such as a functional capacity evaluation or neuropsychological testing (depending, of course, upon the nature of your medical conditions and disability); and
– we may suggest that you obtain a vocational analysis to explain why you lack the capacity, education, training, and experience to work in an alternate occupation.
As with any request for updated information, our goal with the change in definition is to provide your insurance company with indisputable evidence of your disability such that it has no choice but to continue your benefits.
Contact an Attorney for Help with the Maintenance of Your Long Term Disability Insurance Claim
Just because your Long Term Disability benefits were approved does not mean that they will continue indefinitely. Your insurance company will periodically conduct investigations and request information in an attempt to find a reason to terminate your claim. Having a knowledgeable New York disability lawyer assist you in navigating your ongoing long term disability claim can be invaluable. Contact the NY disability insurance lawyers at Hiller, PC at (212) 319-4000 today.