Posted on Friday, January 30th, 2026 at 8:00 am

Many people receiving long-term disability benefits eventually face a common challenge. They receive a letter from their insurance company claiming they have improved and are ready to work. Often, these claims come without solid medical evidence. This pressure can lead to a forced return-to-work situation. You may feel you must choose between your health and your financial security. Understanding your rights and how insurance companies operate helps you protect your benefits.

Why Choose Capitan Law, PLLC for Your Disability Claim

When you face a large insurance company, you need a legal team that understands their tactics. Capitan Law, PLLC exclusively handles long-term disability and other disability insurance claims. This focus allows us to provide the knowledge needed to challenge wrongful benefit terminations.

Our firm has a record of success. Joe Capitan earned the Pennsylvania Rising Star title from Super Lawyers for eight consecutive years, from 2012 to 2019. He also earned recognition as a Super Lawyer in 2021 and 2024. Our associate attorney, Greg Scott, brings years of experience in disability law and non-profit advocacy.

We have represented clients against major insurers like Cigna, Unum, Prudential, Hartford, MetLife, and many others. We work on a contingency fee basis. This means you pay no money up front and no fees unless we recover benefits for you. From our Philadelphia office, we represent disabled claimants nationwide with dedication.

Understanding Claims of Improvement Without Evidence

Insurance companies often use the phrase “improvement without evidence” to justify stopping payments. They may claim that your medical records show you are getting better. This happens even when your treating physician disagrees. This tactic is common in cases involving chronic pain, fatigue, or mental health disorders.

Insurers often hire medical reviewers to look at your file. These doctors may never meet you. Yet, they issue opinions that contradict your doctor’s findings. They focus on small details in your records to suggest you can work. They often ignore the overall reality of your condition.

How Insurance Companies Downplay Your Condition

Insurance companies use several methods to minimize your disability:

Selective Record Review: They may highlight one good day while ignoring weeks of documented struggle.

Reliance on IMEs: They may require an Independent Medical Exam (IME) with a doctor they pay. This doctor often provides a report favorable to the insurer.

Ignoring Subjective Standards: They often dismiss symptoms like pain or exhaustion because tests cannot measure them.

The Own Occupation vs. Any Occupation Transition

Most long-term disability policies have a critical turning point, usually at the 24-month mark. During the first two years, you are typically disabled if you cannot perform your own occupation. After this period, the definition changes to any occupation.

This transition is a major point of concern for your claim. The insurance company puts your file under a microscope during the months leading up to this change. They try to prove that you can perform some other type of work. They look at your education and experience to find other jobs. Handling this occupational transition requires careful preparation and strong vocational evidence.

Your Legal Rights Against Forced Return to Work

You have specific rights under federal laws like ERISA. If your insurer terminates your benefits or pressures you to return to work, you have the right to appeal. ERISA regulations give claimants at least 180 days to file a formal administrative appeal after a denial. This is often your only chance to add new evidence to the record.

Strong medical documentation is your best defense. Your treating physician should provide detailed certifications of your limitations. Simply having a diagnosis is rarely enough. You must show how that diagnosis prevents you from working.

Evidence Needed to Prevent Termination

To protect your claim, you should gather:

Detailed, up-to-date medical records from all providers.

Functional Capacity Evaluations (FCEs) measure what you can and cannot do.

Statements from your doctors addressing your work limitations.

Vocational expert reports that when the insurer claims you can do other jobs.

Common Reasons Insurers Terminate Benefits

Insurance companies look for reasons to stop paying a claim. Some common justifications include:

Insufficient Medical Evidence: Claiming your records do not prove you are disabled.

Missed Appointments: Using a single missed doctor’s visit as a reason for denial.

Conflicting Diagnoses: Highlighting minor differences in opinions between doctors.

Social Media Surveillance: Misinterpreting a photo as proof that you are no longer disabled.

Missed Deadlines: Terminating a claim because paperwork arrived late.

What to Do If Your Insurer Pressures You to Return to Work

If you receive a letter questioning your disability status, do not ignore it. Document every phone call and save every piece of mail. Before you agree to return to work, consult with an experienced disability attorney.

Gathering comprehensive evidence immediately is important. You must show that your condition has not improved enough to allow work. Filing a well-supported appeal within the required timeframe helps keep your benefits flowing.

Frequently Asked Questions

Can an insurance company force me to return to work if I am on disability?

No, an insurance company cannot physically force you to go to a job. However, they can stop your benefit payments if they decide you are no longer disabled. If you cannot work but they stop your pay, it can feel like a forced return.

What happens if I disagree with my insurer’s medical evaluation?

You have the right to challenge their findings through the appeals process. You can submit your own medical evidence and expert opinions to counter the insurer’s doctors.

How long do I have to appeal a disability benefit termination?

Under most ERISA-governed policies, you have 180 days from the date of the denial letter to file an appeal. It is critical to meet this deadline. Missing it usually means you lose your right to sue the insurer later.

What if my condition is subjective, like chronic pain or mental health issues?

These claims are more difficult but can be successful. Success depends on consistent medical treatment and detailed records of your daily limitations. Strong support from your treating physicians is also key.

Can I work part-time while on disability?

This depends on your specific policy. Some policies allow for partial disability benefits. Others consider any work as proof that you are no longer disabled. Always check with a lawyer before attempting to work.

What should I do if I receive a proof-of-loss request from my insurer?

You must respond promptly and accurately. Providing incomplete information can give the insurer an excuse to deny your claim. Having an attorney review your response helps avoid common pitfalls.

How Capitan Law, PLLC Can Help You

Capitan Law, PLLC provides claim management. We handle everything from the initial application to federal court litigation. Our team knows how to gather the right evidence and organize your medical records.

We negotiate directly with insurance companies. We also evaluate lump-sum settlement offers to help you get a fair deal. Because we work on a contingency basis, you do not have to worry about upfront costs.

Do Not Let Your Insurer Terminate Your Benefits

If your disability insurance company pressures you to return to work, you do not have to fight alone. Capitan Law, PLLC has challenged these denials for many clients.

Call (267) 419-7888 today for a free, confidential consultation. We will review your case and help you pursue the benefits you deserve.

Can Insurance Companies Force You to Return to Work While on Disability?