What Happens if Your Long-Term Disability Payments are Stopped Suddenly?

Opening your mailbox to find a termination letter from your insurance company is terrifying. You rely on those monthly checks to pay for your mortgage, groceries, and medical care. When your long-term disability payments stop without warning, it feels like the floor dropped out. You likely feel panic and anger. You wonder how the insurance company can simply decide you are no longer disabled. However, you have rights and a path forward to fight this decision.

Why Choose Capitan Law, PLLC for Your Disability Claim?

When your financial future is on the line, you need a legal team that understands the details of disability law. At Capitan Law, PLLC, we focus almost exclusively on long-term, short-term, and individual disability insurance claims. We do not split our focus between different areas of law. Instead, we focus on getting disabled individuals the benefits they deserve.

Super Lawyers in Philadelphia recognized Joe Capitan, a partner at our firm, as a “Rising Star” from 2012 through 2021. Super Lawyers gives this honor to only 2.5 percent of attorneys. Our legal team has experience going toe-to-toe with billion-dollar insurance giants like Cigna, MetLife, and Prudential. We handle cases on a contingency fee basis. This means there is no money up front. Additionally, you pay no fees unless we recover benefits for you. While we are based in Philadelphia, we represent our clients nationwide. We bring local knowledge to a national stage.

Common Reasons Why Long-Term Disability Payments Stopped

Insurance companies are for-profit businesses. They look for any reason to stop paying benefits. There are several common milestones and policy provisions that they use to justify a termination. Understanding these triggers can help you prepare for the challenges ahead.

The 24-Month Transition: Most policies change the definition of “disabled” after two years.

Mental Health Caps: Many plans limit payments for mental health conditions to 24 months.

Maximum Benefit Age: Your policy may have a set end date, such as age 65.

The Shift from “Own Occupation” to “Any Occupation”

One of the most common reasons benefits stop is the shift from the “own occupation” standard to the “any occupation” standard. For the first 24 months of a claim, the policy usually considers you disabled if you cannot perform the duties of your specific job. However, after that period, the standard often changes. The insurance company will now claim you are only disabled if you cannot perform any occupation. They look at jobs for which you are suited by education, training, or experience. They often use vocational experts to identify low-stress, sedentary jobs they claim you can do. Often, these jobs are not actually available to you.

Mental Health and Substance Abuse Policy Limits

Many long-term disability policies contain a “mental and nervous” limitation. This provision typically caps benefit payments at 24 months. Mental health conditions like anxiety, depression, or PTSD cause or contribute to these disabilities. Insurers may try to reclassify a physical ailment as a mental health issue to trigger this cap. For example, you might have chronic pain that causes depression. The insurer might argue that the depression is the primary cause of your disability. This allows them to stop your payments after two years.

How Insurance Companies Justify Cutting Off Your Benefits

Insurers use a variety of tactics to build a case against you. They often rely on medical professionals who have never met you. These doctors overrule the opinions of your treating physicians.

Independent Medical Examinations (IMEs): Doctors hired and paid for by the insurance company perform these exams.

Paper Reviews: Non-examining physicians review your medical records. They claim there is no “objective evidence” of your limitations.

Claims of Medical Improvement: The insurer may seize on a single positive note in your records to claim you have recovered.

Surveillance and Social Media Monitoring

Insurance companies frequently use private investigators to conduct surveillance on claimants. They may film you doing everyday tasks like grocery shopping or taking out the trash. Then, they use that footage to argue you are not as limited as you claim. They also monitor social media accounts. An insurance adjuster can twist a photo of you smiling at a family dinner. They might suggest that you are capable of returning to a high-stress work environment.

Lack of Regular Medical Treatment or Evidence

To keep receiving benefits, you must show that you are under the regular care of a physician. If you miss appointments or stop treatment, the insurance company will use this as an excuse. They might claim you are not following medical advice. They require “objective medical evidence,” such as MRI results or blood tests. Furthermore, they will often ignore “subjective” reports of pain or fatigue.

Immediate Steps to Take After Your Benefits Are Terminated

If you receive a termination notice, you must act quickly. The first step is to request your complete administrative claim file from the insurance company. This file contains all the evidence they used to make their decision. It includes internal notes and consultant reports. You should also carefully review the termination letter. This helps you understand the specific reasons they cited for stopping your benefits.

Gather updated medical records. Ask your doctors to provide detailed statements regarding your specific functional limitations. It is also wise to avoid speaking directly with insurance adjusters. Their goal is to get you to say something that undermines your claim. Instead, let our law firm handle all communications.

The Importance of the ERISA Appeal Process

ERISA, a federal law, governs most group disability policies provided by employers. This law sets very strict rules for how you can challenge a benefit termination. You typically have at least 180 days from the receipt of the denial notice to file a formal administrative appeal.

This appeal is the most important stage of your case. Under ERISA, the administrative appeal is usually your last chance to add new evidence to the record. If the insurance company denies your appeal and you eventually file a lawsuit, the judge will generally only look at the evidence you submitted during the appeal. You cannot simply “save” evidence for court. You must include it in your appeal package.

Frequently Asked Questions About Stopped LTD Payments

Can I sue the insurance company if my payments stop?

Under ERISA, you generally cannot file a lawsuit until you have “exhausted” the administrative appeal process. This means you must complete the plan’s internal appeal process before filing a lawsuit in federal court. If they deny that appeal, then you have the right to take them to federal court.

How long do I have to appeal a termination of benefits?

You usually have at least 180 days from the date you receive the termination letter. Missing this deadline typically results in the forfeiture of the right to further administrative review or legal action. It is important to start the process as soon as possible. This ensures you have time to gather all necessary medical evidence.

Do I need a lawyer to get my benefits back?

While you can file an appeal on your own, the process is challenging. It is designed to favor the insurance company. Our attorneys help “frame” your claim by highlighting the strongest evidence. We also address the insurer’s specific arguments. We handle the “review and respond” exchanges that often occur during the appeal process to protect your rights.

Contact Capitan Law, PLLC Today for a Free Consultation

If your long-term disability payments stopped, do not wait to seek help. The clock is already ticking on your right to appeal. At Capitan Law, PLLC, we are ready to help you handle this stressful time. We will fight for the benefits you were promised.

Contact Capitan Law, PLLC today for a free, confidential case review. You can also read our client testimonials to see how we have helped others in your situation. We work on a contingency basis. Therefore, you owe us nothing unless we successfully recover your benefits. Let us take the burden of the insurance company off your shoulders. This allows you to focus on your health.

Related Posts

• Why Insurance Companies Deny Long-Term Disability Claims After 24 Months
• Understanding ERISA Appeals: How Evidence Improves Your Chances
• How to Avoid Long-Term Disability Claim Mistakes and Denials
• Disability Surveillance: Insurance Company Video Tactics to Deny Claims
• Can You Collect Long-Term Disability and Social Security at the Same Time?