Individuals whose long-term disability insurance (LTD) benefits are terminated can feel shocked, especially if the LTD benefits have been their sole source of income. Sometimes the disabled person has reason to expect that benefits may be terminated in the near future. Often, however, the termination comes as a complete shock. In either case, it is normal to have questions and wonder about your next steps post-LTD termination. In many ways, the process for appealing a termination may not be that different from what to do after a long-term disability denial. Depending on how your initial claim was processed, you may have some relevant experience already. In either case, it is important to review your insurance company’s guidelines and procedures to determine your choice of actions if LTD benefits are terminated.
Review the Termination Letter
Your actions if LTD benefits are terminated will normally need to begin with a careful review of the termination letter from the insurance company. This letter will typically tell you:
- The date of your last LTD benefit payment
- The reason for the termination of your LTD benefits
In many cases the letter will also state the timeline you have for filing an appeal. Take careful note and comply with their requirements, but also consider getting started as soon as possible.
Get a Copy of Your File
Your insurance company has terminated your LTD benefits based on the information available to them, so one of your first actions if LTD benefits are terminated unexpectedly should be to request a complete copy of all records the insurance company has in your name. There are some federal guidelines that impose requirements on employer-sponsored LTD plans, but for the most part insurance regulations are set at the state level. State-level regulation means that the LTD provider may be subject to slightly different requirements as far as the timeline for responding to your request, so you may want to look up your state’s Department of Insurance (or comparable agency) to get a sense of what you should watch for in your next steps post-LTD termination.
Your insurance policy itself will also likely include information about minimum and maximum timelines for their various procedures, including responses to your requests. Many people on long-term disability insurance will already know that any obligations the insurance company assumes in the policy will generally override any state regulations for what to do after long-term disability denials. Even though state regulations set the minimum standard, companies have the option to set policies more favorable to consumers when outlining their own actions if LTD benefits are terminated. Many insurance companies operate across multiple states with different regulations, so they may sometimes set their policies across the board to comply with the regulations of the most demanding state in order to streamline their processes. For your own peace of mind, it may be worth verifying the rules that apply in your own situation.
Review Your Options for Appeal
The scheduled end date for your benefits listed in the termination letter will have obvious practical implications for your personal financial planning. However, the reason the insurance company gives for termination is likely to be much more valuable information as you are evaluating your next steps post-LTD termination.
Factors Influencing Appeal Actions if LTD Benefits Are Terminated
In general terms, your options for appeal will be shaped by these three factors:
- The reason or reasons for termination of benefits, as identified in the termination letter from the insurance company
- The information the insurance company has on file for your case
- How the information in your file led the insurance company to terminate your benefits
Your next steps post-LTD termination will likely be based on determining what information in your file the insurance company is using as a reason for terminating your benefits. Your appeal will need to provide new information that corrects a mistaken impression or updates your record to meet a requirement.
Common Reasons for Termination of Long-Term Disability Benefits
The specific grounds for termination will always depend on the individual case. They will also depend, to some extent, on the terms of the policy, since the policy terms are generally where possible reasons for termination are established. Insurance regulations do vary from state to state, but insurance policies also operate primarily as a form of contract. This contractual basis means that, like any other contract, their terms need to list not only the mutual obligations of the parties, but also the conditions under which either side is released from one or more of their obligations.
Some of the more common reasons for termination of long-term disability benefits in LTD policies include:
- The insured has failed to maintain his or her recommended treatment.
- The insured is no longer disabled.
- The insured has failed to pay premiums.
- The insured missed a required deadline, such as for submitting a renewal packet or updated medical documentation.
- The coverage period has ended.
Depending on the policy, there may be other miscellaneous compliance reasons for termination, such as neglecting to notify the LTD provider of a change in Social Security Disability Insurance (SSDI) approval, or other payments that might affect the LTD company’s financial obligations.
Gather Documentation
Almost always, the primary tools you will need to take action if LTD benefits are terminated will be various forms of medical documentation. In most cases, the documentation requirements will be similar to those you followed in order to file your original long-term disability claim, or those that may have become familiar if you had to learn what to do after long-term disability denial.
Common examples of medical evidence you may need to submit in support of your appeal include:
- An updated attending physician statement (APS)
- The results from a new comprehensive medical examination
- Results from recent medical tests and scans
- Supporting statements from professionals other than your regular physician who can attest to your disability, such as case workers or therapists
- Records, such as providers’ notes and your own receipts, from appointments you made and kept in compliance with your doctor’s recommended course of treatment
- Receipts for medical expenses, other than office visits, associated with your disability, such as prescriptions or the purchase of assistive devices
The combination of items that may be useful in supporting your case will depend, again, on the information your insurance company already has and the reason the company has given for terminating your benefits.
Submit Your Documents
Once you have collected the information that would be needed in order to complete missing or outdated information from your file, or to comply with your insurer’s requirements for documentation of continuing disability, it is important to be sure that you comply with all of the company’s requirements regarding the format and timeline for submitting your evidence. Many insurance companies maintain online portals for submitting documentation related to claims, but do not hesitate to contact company staff directly to confirm that your information has been received, and that the company has all of the documentation you have submitted to address the cause of your benefits termination. You may also want to request an updated copy of your file so that you can verify for yourself that the information is current.
Next Steps Post-LTD Termination: While You Wait
Generally, when appealing the termination of LTD benefits, the steps are similar to those taken after an initial long-term disability denial. However, some insurance providers use different procedures for handling these two types of appeals, and the timelines for review and processing may also vary.
Depending on the length of notice you had prior to benefits termination, you may find yourself struggling financially as you await a decision. Familiarize yourself with additional options for short-term financial assistance in your area. Many local and regional utility systems, and some providers of services such as phone or internet, offer temporary hardship relief that may enable you to defer some bill payments, or pay in installments that can make it easier to avoid losing access to critical services during a difficult time. Your next steps post-LTD termination, once you have submitted your appeal, will depend in large part on the insurance company’s response, so you may have a little while to wait.
Final Thoughts On Your LTD Termination of Benefits
Navigating the termination of long-term disability benefits can feel overwhelming, especially when the decision comes without warning. By staying organized, reviewing your policy carefully, gathering thorough documentation, and following each procedural step closely, you can give yourself the strongest chance of a successful appeal. Remember that you are not alone in this process. Consider reaching out to an experienced advocate or legal professional if you need help clarifying your options or presenting your case effectively. Taking action quickly and thoughtfully can help protect your rights and provide greater peace of mind as you work toward restoring your benefits.
