One day your long-term disability benefits are coming in, and the next day they’re not. No warning, no real explanation – just a letter in the mail telling you your coverage has been terminated. If this has happened to you, take a breath. You are not powerless, and this is not necessarily the end of the road. Insurance companies cut off benefits all the time, and in many cases, those decisions can be challenged and reversed. The key is knowing what to do next and moving quickly. Here are five steps to take right now if your LTD benefits have been suddenly cut off, terminated or denied.
1. Read the Termination Letter Carefully – Every Word of It
The first thing you need to do is read that letter from top to bottom, even if the language is confusing and frustrating. The reason your benefits were cut off matters a lot, because it determines exactly how you push back. Insurance companies are required to give you a written explanation for why your benefits were terminated, and that explanation is your starting point. Look for the specific reason they used. Did they say your condition no longer qualifies? Did they claim you missed a deadline or failed to submit paperwork? Did they say a doctor reviewed your file and decided you can work? Write down what they said and when the letter was received, because deadlines for appealing can be very short. If the letter is unclear or full of language you don’t understand, that’s a red flag in itself – and it’s one more reason to get a professional set of eyes on it as soon as possible.
2. Do Not Miss Your Appeal Deadline
This step can make or break everything else, so it needs to be said clearly: you have a limited window of time to appeal the decision, and if you miss it, you may lose your right to fight back entirely. Most LTD policies governed by ERISA, the federal law that covers most employer-sponsored benefits, require you to file an appeal within 180 days of receiving a denial letter. That might sound like a long time, but it goes fast, especially when you’re dealing with a health condition and financial stress at the same time. Other policies may have shorter windows. Do not wait to figure this out. If it’s not set out in the denial letter, pull out your policy documents, look for the appeals section, and find out exactly how much time you have. If you can’t find that information, call the insurance company and ask – and write down the name of the person you spoke with and the date of the call.
3. Start Gathering Your Documentation Right Now
A strong appeal is built on strong evidence, and that means you need to start collecting documents right away. Our first step is to request your entire claim file from the insurance company. This is known as your Administrative Record, or AR. This includes your full insurance policy, every letter you’ve received from the insurance company, your medical records, notes from your treating doctors, and any paperwork you submitted as part of your original claim. If your doctor has been documenting your condition consistently, that documentation should be in there as well. Depending upon what is contained in your AR, and what support the insurance company received to deny your claim, you may need additional medical or vocational support. We make a point of drafting a Questionnaire specific to you and your claim, addressing all of the issues raised in the denial. If the insurance company has done a Transferrable Skills Analysis (TSA), we may need to hire a vocational expert to review that analysis. Many times, the occupation they say you can do 1) you cannot because you don’t have the transferrable skills. Often, a denial will claim our client can do sedentary work but leave out the fact that they do not have computer experience, and 2) the jobs they say you can do may not exist. One client was told they could be a Jewelry Repair expert in northern Minnesota. Our vocational expert confirmed that there were no jobs like that in existence in our client’s area.
Keep copies of everything and organize it all in one place. Insurance companies are known to say they never received documents that were clearly sent – so if you’re submitting anything by mail, send it certified with a return receipt. If you submit anything electronically, save the confirmation. Often clients will tell us that they submitted something numerous times and the insurance company claims they never received it; however, when we get the AR, there are multiple copies of the document.
4. Don’t Just Immediately Send in a Letter Saying “I Appeal”
First, that almost never gets the denial overturned. Most denials include a medical paper review from an insurance doctor stating that the medical information provided does not support disability. Second, that does not provide the insurance company with any additional support to overturn their denial. Third, while it is not their first rodeo, it likely is yours. Not having the AR, the adverse medical report, and the TSA means you are flying blind and do not know what you need to support an appeal.
5. Talk to a Disability Attorney Before You Do Anything Else
Here’s the truth: the appeals process for long-term disability benefits is complicated, and the insurance company has a team of lawyers and claims specialists working against you. You deserve someone in your corner who knows how this system works and how to fight back effectively. A disability attorney can review your termination letter, evaluate your policy, identify the deadlines you’re working against, and help you build the strongest possible appeal. Many disability attorneys offer free consultations. There is no reason to go through this alone, and there is no cost to finding out where you stand. The sooner you reach out, the more options you have.
Your Benefits Were Cut Off – Beedem Law Is Ready to Fight Back
At Beedem Law, we know how devastating it is to have your long-term disability benefits suddenly taken away. You were counting on that income, and you deserve to have your rights protected. Our experienced team of disability and ERISA attorneys has spent decades helping people in the Twin Cities fight back against insurance companies that wrongfully deny or terminate benefits – and we’re ready to help you too. We offer free consultations and free evaluations of your insurance paperwork. Don’t let the insurance company have the last word. Reach out to Beedem Law today and let’s talk about what we can do for you.