Suffering a work injury that causes a permanent disability is a traumatic and life-changing experience, so finding out that your long term permanent disability benefits have been cancelled can come as a second shock. Unfortunately, there are many different reasons why insurance companies cut off these monthly payments. To maintain your benefits for as long as you need them, it is important to be aware of what can happen.
Be sure to know the details of the insurance plan or policy you have. Requirements and claims are different for various plans. Many policies for disabilities arising from mental, nervous, or psychological impairments have a limitation of 24 months. This includes disabilities, such as depression, anxiety, chronic fatigue syndrome, and post-traumatic stress disorder (PTSD).
Other disabilities that often have 24-month limits are chronic pain conditions, such as carpal tunnel syndrome, arthritis, and back pain. Disabilities linked to drug and alcohol abuse also are typically limited to 24 months. Additionally, after 24 months, some policies have a shift in the definition of what it means to be disabled. While initially your benefits were granted because of an inability to perform your occupation due to injury, the new definition says that to continue benefits you must be unable to perform any occupation at all. There is also an age limit for benefits, which is generally the normal Social Security retirement age of 66 or 67.
One of the most common reasons for termination of long term disability benefits is failure to continue regular medical treatment. Insurance companies consider a lack of treatment as a sign that your condition has improved and therefore, you do not need disability benefits. Even if there is no medical treatment that can help your condition, your policy may still require annual certification from your doctor that you are still disabled and proof that you attend regular medical examinations.
Some insurers use surveillance to check the validity of a disability. An investigator hired by the insurance company could track you for several days to monitor your activity to see if it is consistent with your claimed injury. If they decide by observing you that your medical condition has improved, your long term disability benefits could be terminated.
Your options will depend on the type of plan you have, you may be required to file one or two appeals with the insurance company before you can file a lawsuit to have your benefits reinstated. This is the case for most disability coverage offered through employer plans. If you are a government or church employee or have an individual policy, you may not be required to file an appeal. If your disability benefits have been terminated or denied, contact a qualified long term disability lawyer for clarification about the appeals process.
If your long term disability was cancelled, the Pittsburgh long term disability lawyers at AlpernSchubert P.C. can help. We have over 75 years of combined experience fighting for injured workers. Call us at 800-243-6095 today to schedule a free consultation or contact us online. From our offices in Pittsburgh, we represent clients throughout western Pennsylvania, including those in Washington County, Allegheny County, and Lawrence County.