What to Do if Your Disability Claim is Denied or Terminated

“You’re Disability Benefits Have Been Terminated.”

            Working with insurance companies to maintain disability benefits is difficult. Even after your benefit claim is approved, which is a feat in itself, the insurance company usually has the right to request that: (1) your physician submits documentation of your progress and your expected return to work; (2) you provide updated medical records from all of your doctors; (3) you submit to an examination with one of the insurer’s own physicians; or (4) that you answer lengthy questionnaires about your activities, medical condition and financial records.

We set out below some ideas of what you should do if the insurance company for your employer-provided disability benefit plan sends you a letter letting you know your disability benefits are being terminated.  But, importantly, there are attorneys (like us at the Law Office of Katherine MacKinnon) that specialize in helping people when they receive the dreaded, “your benefits are being terminated” letter.

What Should I Do Now?

  1. Read the letter carefully. Read the letter the insurer sends to you explaining why it is denying or terminating benefits. What are the insurer’s reasons for denying the benefits? What does the letter say the procedure is for appealing that decision?
  1. Make note of any due dates. A letter explaining that a company is denying or terminating benefits must outline the process which you must follow to appeal the decision. The letter should also tell you the date by which any action must be taken – be careful not to wait until the last minute to either contact an attorney for help, or begin working on an appeal yourself. The appeal is often a big undertaking.
  1. Is the insurance company asking for something? While carefully reading the letter, notice if the company is asking for any information that was not submitted. Are benefits being terminated or just suspended for failing to have a doctor submit a form? Is paperwork missing? Maybe there is something simple the company is simply missing or asking you to complete that would fix the whole problem.
  1. Write to the insurance company, and request copies of all your plan documents and a copy of your claim file. The company is required by federal regulations to provide you with “reasonable access to, and copies of, all documents, records, and other information relevant to the claimant’s claim for benefits.” 29 C.F.R. §2560.503-1(h)(2)(iii). Since there is a time limit on when an appeal can be submitted or a claim can be brought in court, it is important to write and ask for these documents right away.
  1. Administrative appeal. In some circumstances a person can put together their own appeal, and in some circumstances it is best to consult an attorney. An appeal is often your best and last opportunity to furnish the insurer with all relevant information regarding your disability benefit entitlement. The insurer needs and wants the information so that it can make an informed decision about whether you are entitled to benefits. Helpful information might include: all your medical records from each provider; a statement explaining your disability and how it affects your ability to work; letters from your doctors, coworkers, family members, or friends talking about your disability and inability to work; a videotape showing your condition and how it impacts you; your employment records showing how you struggled to work; any decisions from the Social Security Administration, other disability insurers, or other entities that considered you to be disabled.

Putting together an administrative appeal is a huge project, involving collection of many pieces of information from multiple sources. If you get confused or frustrated, you can always contact an attorney who specializes in ERISA benefits for help. Good luck!

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