First and foremost, it’s important to read the insurance company’s letter very carefully. They may have terminated your benefits for any number of reasons. If your benefits were terminated because a form is missing or some information was not provided, contact the insurance company immediately and try to get the paperwork to them as soon as possible.
If your benefits are being terminated because the insurance company does not believe you are disabled, speak to your doctor and ask if he or she believes you meet the Own Occupation or Any Occupation test which applies to you. The Own Occupation entails determining if you are not able to do your specific employment at the time of the accident. The Any Occupation seeks to determine if you are disabled from doing any type of employment as a result of the accident. If your doctor believes you are disabled according to the appropriate test, have them write a letter to the insurance company confirming their opinion.
Sometimes the insurance company will terminate benefits even if your doctor believes you are still disabled. In this case you may need to take legal action to reinstate your LTD benefits.
Internal Appeal or lawsuit?
If you meet the requirements of the LTD policy and your doctor has confirmed that you are disabled – but the insurance company still refuses your claim – you have two remaining courses of action:
1. Internal appeal
Most insurance companies provide an appeals process for denied claims. They will review your file again (including any new information that you may have submitted) and come back to you with a decision, usually after 60 or 90 days. There may be two or more levels of appeal. In most cases, internal appeals are not mandatory.
2. Suing for your benefits
If the internal appeal is unsuccessful (or if you decided to sue right away) you can begin a lawsuit to obtain your benefits. At this point in the process, suing is your last possible course of action.
CLG Injury Law offers a free consultation where you can discuss your case with a lawyer and receive information on what to do if your benefits were terminated. The consultation is confidential and there is no obligation. Contact Us today at 1-800-606-2529.