Patients that suffer long-term disabilities may be eligible for long-term disability benefits from their insurer or the at-fault insurance provider. To these people, the benefits are a lifeline. They depend on them to support their lifestyle and ensure there isn’t much difference between their financial situation before and after the accident.
However, there are instances when the insurer may stop the payments without giving an apparent reason. If this sounds like your situation, this post can help you understand why this can happen and what to do about it.
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Long-term disability benefits take quite a chunk of money from insurance every month. As a result, insurers always look out for reasons to build a case to substantiate the termination of your benefits.
There are many reasons why insurance may fail to pay up. But whatever the reason, they should notify you, indicate the reason, and allow you to appeal their decision.
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If you have received a notice of benefit termination, or the insurer fails to pay up, you have a right to challenge their decision.
Often the insurer will build a very strong case when deciding to terminate your benefits. Challenging the case on your own is an impossible task. Your best chance of getting a favorable outcome under such circumstances will be in having a long-term disability attorney involved in your case.
Why an Insurer May Stop Paying Long-Term Insurance Benefits
There are legitimate reasons why insurers can stop paying benefits. But even then, they can only do so following the laid-out procedure. Some common reasons why an insurer may terminate payments include:
Elapsed Payment Time Limits
Different policies have different time limits for paying benefits for some classes of disabilities. For example, most companies have a time limit of two years for nervous and psychological impairments, addictions, and certain kinds of chronic pains benefits. Some conditions that may have a two-year benefit payment limit include:
- Depression
- Chronic fatigue syndrome
- Post-traumatic stress disorder
- Anxiety
- Alcohol or drug addiction
- Arthritis
- Carpal tunnel syndrome
- Back pain
If your termination results from the expiration of your policy requirements, there may be nothing much you can do about it.
Failure to Invoke Your SSDI Benefits
If you receive your disability benefits under the worker compensation plan, you may be required to apply for Social Security Disability Insurance (SSDI). SSDI benefits allow a person with long-term disabilities to get some relief from the program.
If you qualify for the SSID benefit, the insurance company will only need to offset the balance after deducting the SSID benefit from your deserved benefits. If your benefits stopped for failing to apply for SSDI, a lawyer could help you establish if your insurance has an SSDI requirement and, if so, work with the insurer to resolve the matter.
Discontinuing Treatment
Settling for long-term benefits isn’t the end of the insurers’ battle. They always keep a keen eye on beneficiaries looking for an opportunity to discontinue payment of benefits.
One such reason is discontinuing treatment. To sustain your long-term disability benefits, you must continually submit your treatment records to the insurer; a failure to submit the records will lead to benefit discontinuation.
Also, the insurance company will use experts to review your medical records and history to establish if you are still disabled. If the experts deem your condition not fitting a disabled status, the insurer can seek to terminate or reduce your benefits.
Other circumstances that would lead to your disqualification for long-term disability benefits include engaging in an activity that casts doubts about your disability status. If your benefits are discontinued under such circumstances, and you feel the actions were unjustified, a lawyer can help you fight for what you deserve.
