Many people in Louisiana and across the country rely upon long-term disability (LTD) benefit payments to replace income lost due to a disability. Some people had long-term disability insurance as a job benefit and some bought individual policies. No matter how people get long-term disability insurance, in most cases, a for-profit insurance company will be administering the claim. Insurance companies have the right to request ongoing proof of disability, but some insurance company requests can indicate the termination of long-term disability benefits could be imminent.

When an LTD insurance company focuses on a particular aspect of a disability and drills down on particular functional limitations, this is a reason for concern. The insurance company is often trying to get someone, whether a treating provider or the claimant themselves, to admit to certain capabilities. For example, the insurance company may ask whether a person can perform a job sitting down all day. If the policy definition of disability only requires the insurance company to show the ability to perform sedentary work to terminate benefits, a statement that the insured can work sitting down all day could damage the claim.

Another major trouble spot is an LTD insurer request for an independent medical examination (IME). Many long-term disability policies require an insured to participate in an IME if the insurance company requests one. These doctors are rarely truly independent. While they may not work for the insurance company, they are paid by the insurance company. Insurance companies work off a roster of favorable doctors, and many doctors make a good living on medical exams. In all fairness, sometimes these doctors give insureds a fair hearing, but they tend to be wary of reports that could cost future work.

Finally, a change in claims analyst and a new skeptical tone can be an indication that a claim has been flagged for possible termination of benefits. Insureds should trust their gut and common sense when they feel like the insurance company is turning on them. A skeptical and aggressive tone is an indication the insured needs to be cautious about communications with the insurance company. Also, a continuing benefits review from an insurance company is an indication to talk to doctors about functional limitations and perhaps talk to a lawyer about what to expect. If benefits are terminated, it is important to speak to a lawyer as soon as possible to handle an appeal.