Disability Insurance Claim Terminated Before Cleared By Doctors

Once you begin collecting disability insurance benefits, your claim will be reviewed periodically by the insurance company to determine if you should continue receiving payments. The insurance company doctors will independently review the information, and based on that review, benefits may be terminated.  A termination of the disability claim could be decided before you are cleared by your own doctors.

Appeal the Termination

If your personal doctor has not cleared your medical condition that led to disability then you can appeal the insurance company’s termination decision. The initial appeal should be filed using the insurance company’s internal appeals process. You can do handle this step yourself though it is advisable to consult with an attorney.

Preparing for the appeal requires accumulating additional documentation that proves you are still disabled and entitled to your benefits.

• Directly address the provision stated by the insurance company that gives them the right to terminate your benefits
• Directly address each reason the insurance gives for ending benefits
• Follow the insurance company appeals process rules paying close attention to the deadlines for submitting your appeal

If you disability insurance is through an employer then you have specific rights under the federal Employee Retirement Income Security Act (ERISA). But in any disability insurance case, you have a right to expect the company to act in good faith and to rely on unbiased physician opinions.

Collect Additional Documentation

In most states you can request a copy of your claim file. Based on the insurance letter and the claim file, the documentation you should accumulate may include the following.

• Letters from personal physicians that dispute the insurance company claims you are no longer disabled
• Documentation addressing each reason for termination given by the insurance company that proves the reason is invalid
• Proof of your doctor’s expertise in the area of specialization to validate his or her opinion
• Letters from an employer saying you are not released by your doctor to work due to your disability
• Description of medications you are taking that make it impossible or dangerous to work

Proving your benefits should continue may be difficult. If the insurance company denies your appeal then you should consult with an attorney. Though you can file a complaint with your state insurance agency, it is not always able to assist with disability terminations that fall within the ERISA federal law.

Get Legal Advice

Due to the difficulty and complexity of proving disability claims, you should get legal advice at the time your benefits are ended.  The attorney can negotiate with the insurance company or file litigation to protect your rights if necessary.