Individuals who see their claims for long-term disability insurance (LTD) benefits approved often feel overwhelming relief. Often, however, this approval is just one step in your long-term disability journey. Particularly if you have not documented maximum medical improvement (MMI), adjusting LTD benefits for medical changes is common. The medical condition impact on long-term disability will depend on the terms of your policy, but often a policy that includes offset provisions for part-time work will make LTD payment adjustments due to health status when medical updates suggest improvement in the direction of a return to work. When insurance companies are adjusting long-term disability benefits, medical conditions’ uncertain recovery timelines may not always be taken into account. Make it a priority to keep thorough records of your symptoms and your progress so that you are prepared to advocate for yourself if your benefits are cut unfairly.
LTD Payment Adjustments Due to Health Status
The exact wording will depend on the terms of the policy, but most long-term disability insurance policies will contain provisions requiring an individual receiving benefits to report any change in his or her medical condition that enables the person to return to work. How long you may have to make the report will be defined by the terms of the policy, but insurance companies obviously have considerable incentive to make sure that there is no significant gap between the day an individual receiving benefits becomes able to work and the day his or her benefit payments end. Failure to provide the medical updates required under the terms of the policy can lead not just to termination of benefits, but to back pay obligations.
If your long-term disability insurance company is adjusting LTD benefits for medical changes that they believe allow you to return to work, this will usually mean that your benefits are terminated or at least reduced. If the company determines that you have been receiving LTD benefit payments during a period when you were actually capable of working, or during a period when you otherwise did not meet the policy’s requirements for benefit eligibility, the company can require you to pay back all of the benefit “overpayments” that you received during that period. As stressful as submitting information that you know jeopardizes your income may be, attempting to delay a medical condition impact on long-term disability benefits also poses risks.
Adjusting Long-Term Disability Benefits: Medical Conditions and Recovery
Navigating LTD payment adjustments due to health status can often be a frustrating experience for individuals receiving benefits, for a handful of reasons. For the most part, these underlying causes of frustration relate to the practical challenges presented by the often uncertain, and frequently non-linear, nature of a medical condition impact on long-term disability when “long-term disability” is understood as the condition of being disabled for an extended period, not just the insurance policy intended to provide income replacement during that period.
Sense of Imbalance
First, the obligation to provide notice of medical improvement is stipulated in the terms of most LTD policies so that insurance providers can make LTD payment adjustments due to health status when an individual makes measurable steps toward recovery. Most people receiving LTD payments are easily able to understand the logic behind this requirement. The frustration centers on the fact that these requirements, adjusting LTD benefit for medical changes by promptly reducing or eliminating benefit payments when a recipient’s medical condition improves, tend not to be balanced by any comparable assurance that the individual’s benefits will be increased or reinstated if their condition takes a turn for the worse, a common scenario that in medical contexts is called regressing – the opposite of progressing toward recovery.
Two Steps Forward, One Step Back
Second, this perceived imbalance can be even more stressful because medical recovery is very often not linear. Even in conditions that are highly susceptible to improvement, and offer optimistic long-term prognoses, the recovery process itself is often an experience of “two steps forward, one step back.” An individual will make substantial progress for weeks or months, only to suffer a substantial setback and partial regression, and have to regain the ground they have lost. When insurance companies are adjusting long-term disability benefits, medical conditions’ tendency to improve in slow stages, along uncertain timelines, are often left out of account. Adjusting LTD benefits for medical changes on the assumption that someone who has reached a given level of recovery will be able to maintain that level indefinitely can pose significant problems for someone who experiences a partial regression and worsening of symptoms.
Potential for Negative Impacts on Personal Health
Third, because the termination of benefits in response to partial recovery can be so abrupt, people dealing with challenging medical conditions may fear that attempting a return to work too soon may jeopardize the very recovery on which the removal of their benefit payments is based. LTD payment adjustments due to health status are usually a one-way process from the insurance company’s perspective. Benefits are automatically reduced or ended, depending on the degree of recovery and the terms of the policy, in response to medical improvement. At the same time, most disability insurance providers require substantial renewal paperwork from the disabled person in case of regression. If an individual’s medical condition is worsened by over-exertion as they attempt to return to work, then not all policies provide an efficient means for renewing benefits.
Variability in Symptoms
Fourth, individuals suffering from conditions whose symptoms vary significantly from day to day are often able, and eager, to do meaningful work on their “good” days that will enable them to contribute to their household’s finances and help them hone their employable skills. However, many times these sporadic expansions in personal capacity are short-lived, and too irregular and infrequent to make maintaining employment on a full-time basis a realistic option. Because this variability can also make it difficult for someone to know whether they are experiencing a genuine, sustainable improvement in their medical condition vs. an unusually long string of days with reduced symptoms, one medical condition impact on long-term disability in these situations can be that individuals may struggle to determine when they have a medical update that should be reported.
Finding Work After Disability
Fifth, the ability to work logically needs to come before looking for a job. If benefit payments are terminated as soon as an LTD recipient shows signs of a stable recovery, but before there is a job offer in place, the individual can easily be left with no source of income, potentially while still in a tenuous medical condition.
Adjusting Long-Term Disability Benefits: Medical Conditions, Future Employment, and the Search for Financial Stability
People living on long-term disability benefits, even those receiving payments through relatively robust policies, are in many cases already managing difficult financial situations. Although many people who apply for LTD benefits do so as part of a transition from short-term disability insurance (STD), the generally stricter requirements and slower approval process involved in qualifying for long-term disability benefits can often lead to a significant gap between the time STD benefits end and when LTD benefits are approved.
Particularly in combination with the substantial medical expenses many people filing disability insurance claims must also shoulder, this gap can often make deep inroads on an individual’s personal savings. LTD benefits themselves typically pay only a percentage of the individual’s lost income, which makes it extremely difficult to replenish savings accounts depleted during that gap. All of these factors can lead to a situation in which someone who loses LTD benefits without having another form of income in place is likely to be in a deeply precarious situation, experiencing extreme financial stress.
LTD Payment Adjustments Due to Health Status: Options for Skills Training
Some long-term disability insurance policies offer incentives for vocational training or higher education opportunities. These options can be helpful if a person receiving LTD benefit payments is likely to make a partial recovery that might enable him or her to work a full-time job at some point, but not to return to work in the career they left. If the partial recovery scenario looks likely to you and your medical team, then checking your policy terms and investigating possible career options that would make sense for your altered abilities may be helpful.
Medical Condition Impact on Long-Term Disability: Progressive Conditions and Temporary Recovery
Even though most LTD payment adjustments due to health status are intended to save the insurance company money by eliminating benefit payments to individuals who are able to return to work, many long-term disability policies include specific provisions for dealing with the variable nature of particular medical conditions. Usually, these provisions would apply to an individual’s ability to engage in part-time work. The two types of conditions that are most likely to be affected by these policy terms are:
- Conditions characterized by intermittent periods of recovery or remission
- Progressive conditions
Within policies that include tailored provisions to allow for a changing medical condition impact on long-term disability benefits, the adjustments for progressive conditions and temporary recoveries tend to be similar, but they follow opposite directions.
LTD payment adjustments due to health status for a temporary recovery that allows the individual to engage in part-time work will reduce benefits during their recovery or remission, and may allow for benefits to be increased again when symptoms worsen. The increase may require greater paperwork than the reduction, but sometimes healthcare professionals can play an important role in establishing the variable nature of a medical condition. Adjusting LTD benefits for medical changes in response to progressive conditions follows a more straightforward, though also more tragic, trajectory: The assumption here is that an individual who has been diagnosed with a condition that is known to be degenerative will need to withdraw gradually from the workplace, and disability benefits will need to increase slowly as the person’s working ability and income diminish over time.
Changing Medical Condition: Impact on Long-Term Disability
Most long-term disability insurance companies will make LTD payment adjustments due to health status improvements as soon as they receive medical updates suggesting a benefit recipient may be able to work. Whether these adjustments are reductions or eliminations will depend on the terms of the policy and the nature of the medical improvement. Adjusting LTD benefits for medical changes that further limit an individual’s ability to work, usually after they have been working part-time, may not be as automatic, but many plans do include provisions for this type of medical condition impact on long-term disability eligibility. In adjusting long-term disability benefits, medical conditions whose symptoms are variable not just day-to-day, but month-to-month, can often pose the greatest challenges. The documentation requirements needed to make upward adjustments after benefits have been revised downward can often be substantial, so you may wish to review the terms of your policy with a disability attorney to be sure you are complying with all of the specifications made by the insurance company.
Protecting Your Benefits as Your Health Changes
Adjusting LTD benefits in response to changing medical conditions can be one of the most stressful parts of living with a disability, but you do not have to navigate it alone. Careful documentation of your medical updates, a clear understanding of your policy terms, and professional guidance can help protect your rights and ensure that your benefits reflect your true needs. If you are facing an adjustment to your long-term disability benefits and want to better understand your options, consider reaching out to an experienced LTD benefits attorney for advice tailored to your unique situation.
