After being approved for long-term disability benefits, or LTD benefits, you may think you’re all set. However, you will remain subject to periodic eligibility reviews for the duration of your claim. To ensure that your LTD benefits continue without interruption, you need to understand when these reviews typically occur and how to handle them. If a review reveals that there’s insufficient evidence to support your disability, your benefits may be denied. Contact a Long Term Disability Lawyer in St Louis to help you with your disability claim.
When Do LTD Reviews Happen?
Finding the time to receive regular care for your disability and to get the rest you need is difficult enough. Having to respond to requests for documents and other evidence during periodic LTD reviews is even trickier. Still, the insurance company or administrator can and will request ongoing evidence concerning your disability, including work and income documents, Social Security documents, medical records, independent medical tests and functional capacity tests.
Unless your LTD policy states otherwise, there is probably no schedule in place concerning when eligibility reviews occur. Similarly, there usually isn’t a set period of time that must elapse between such reviews. How long, how often and when these reviews take place are most likely left to the discretion of your plan’s or claim’s administrators.
With that being said, eligibility reviews most commonly occur when changes are made to the test for eligibility that’s outlined in your policy. During the first 24 months of your claim, you typically must prove that you are disabled from working your usual occupation. After 24 months have passed, you must prove that you are disabled from working any occupation. Most policies require eligibility reviews in the months leading up to the 24-month deadline, and they can happen as early as six to nine months beforehand. Check your policy for information regarding these potential time-based changes.
How to Tell If Your LTD Claim Is Up for Review
Typically, no formal notice of an impending review is required for LTD benefits. Oftentimes, insurance companies will notify you that your benefits are currently under review, and they usually request documents and other information at that time.
Be on the lookout for clues suggesting an eligibility review is imminent. They may include being asked to fill out an Activities of Daily Living or Disability Questionnaire form; receiving calls from claims analysts asking you to provide oral updates about your work history, medical condition, activity level and so on; being required to attend an independent medical evaluation or functional capacity evaluation or requesting you or your physicians to provide updated medical records.
What to Do If You Are Subject to an LTD Benefits Review
Keep the following points in mind to reduce the risk of your LTD benefits being denied as the result of a review:
- Don’t be obstructive – Do not try to evade claims analysts or be difficult.
- Comply with requests in a timely manner – If asked for medical records and other documents, provide them promptly. If your disability makes it difficult, contact the administrator to explain or request additional time. Always keep copies of the records you provide along with proof that you sent them.
- Follow up with medical providers – Don’t assume medical providers are providing requested documents. Always contact them to make sure. If they won’t comply, gather what’s needed and submit it yourself.
- Comply with requests for FCEs and IMEs – While you should comply with requests for FCEs and IMEs, get your doctor’s okay before doing so. If you’re not given the go-ahead, contact your insurance company and provide them with a statement from your doctor. If you are given the go-ahead, request copies of your IME and FCE reports.
Hire a Long Term Disability Lawyer in St. Louis
Reduce the risk of losing your LTD benefits by hiring a long term disability lawyer in St Louis. Call David Hicks at 888-588-0001 now.