Why Did I Stop Receiving My Long Term Disability Payments?
If you are receiving Long Term Disability payments, there may be instances when your payments are withheld, reduced, or stopped completely. When this happens, you may be asking yourself not only why, but also whether your insurance company is allowed to do this.
If you have questions or need advice about what to do after you’ve been denied, contact a long term disability attorney at Fields Law Firm. We can review your claim policy and help you understand why your disability benefits were denied, and what your legal options are.
Reasons Your Disability Benefits May Be Withheld
A Long Term Disability insurance company can withhold your benefits if you do not adhere to the terms and guidelines of the plan. This usually involves failing to provide information to the insurance company on a timely basis or not performing something that the policy instructed you to do.
Other times, benefits may be reduced or offset due to other income you receive or are expected to receive, such as income from a pension, retirement account, or Social Security Disability payments. Benefits may also be stopped completely if you fail to provide necessary information to the insurance company or if the insurance company claims you are no longer disabled from working.
Client Success Story
A woman had worked for a large nationwide bank as a loan documentation specialist, a sedentary position that was clerical in nature. However, she was forced to stop working as a result of her severe anxiety. She had applied for and been granted short-term disability benefits from the insurance company. But just three months later, the payments stopped without warning. The insurance company claimed to have had her medical records “peer reviewed” by a physician who had never even met the woman, and even had the audacity to call the severity of her conditions into question.
The woman wanted to appeal the insurance company’s decision, but needed professional expertise. She went straight to Fields Law, and our qualified experts analyzed her case and got to work writing her appeal. Our attorneys argued that the insurer had erred in relying on the opinions of the independent doctor and ignored substantial medical evidence in our client’s claim. Further, we highlighted the records which best demonstrated the severity of our client’s condition. Faced with our arguments, the insurance company returned a decision within a month overturning their previous denial and reinstated our client’s benefits.
Types of Long Term Disability Insurance Plans
Long Term Disability insurance plans typically work in one of two ways. The first is where your actual employer funds, administers, and sponsors its own disability plan. The second, which is typically known as a Group Policy, is where the insurance company, on behalf of your employer, funds and administers the plan. The majority of individuals with Long Term Disability coverage usually have Group Policies. With both plans, the employer and insurance company can set its own rules, guidelines, and eligibility requirements.
The major difference between these two types of plans however, is that Group plans are covered under the Employment Retirement Income Security Act (ERISA), while non-group plans are covered under state law. Under ERISA, insurance companies must adhere to certain rules and procedures in administering the plan. Therefore, if your disability benefits are being withheld, reduced, or stopped, you may have some legal safeguards and protections under ERISA.
Disability Insurance Companies Must Abide By The Rules
Under ERISA, whether your benefits are withheld, reduced, or stopped, your insurance company must inform you before doing so. The insurance company must also provide specific reasoning for its actions as set forth by your disability policy. The insurance company must also give you an option to appeal the denial of benefits and provide more information. If you do not have a Long Term Disability plan covered under ERISA, your local state law may also have some similar protections and safeguards to assist you.
If you feel that you benefits are being wrongfully withheld, reduced, or have stopped completely, you must act quickly to ensure your chances of getting your benefits back. Contact an experienced Long Term Disability attorney at the Fields Law Firm today to discuss what options you have and what legal actions you can take against your insurance company.