You worked for an employer for several years and then became ill or injured. You were placed on short-term disability, and then unfortunately, your condition was serious enough that you applied for and received long-term disability (“LTD”) benefits. Despite your desire to get back to work, and taking every possible step to recover and feel well, you are still not able to return to your previous job.

If you have not looked closely at your LTD policy, you might assume that you will continue to receive those benefits. Surely, you legitimately cannot do your previous job, and this is what those benefits are for. Do not be shocked if, as you approach the point where you have been receiving LTD benefits for two years, you receive a letter from the benefits provider telling you that your benefits will be terminated on the second anniversary of the start of your LTD claim.

How can your long-term disability benefits be terminated if you are still unnable to return to work?

It may seem unfair, but most LTD policies contain a provision where benefits will only continue to be payable past the two-year mark if you are unable to perform the essential duties of any occupation for which you are suited by training, education, and experience. In other words, just because you are unable to perform the duties of your own occupation, the insurance company believes that you are able to perform the duties of some other occupation and are therefore disentitled to continue receiving LTD benefits.

What should you do if you are unnable to return to work and your long-term disability benefits are terminated?

The letter that you receive telling you that your benefits will be terminated on a certain date will likely advise you that you can appeal the decision within a certain number of days following the termination of your benefits. It may be that the benefits provider simply does not have enough information bout your current state of health. If your doctor supports your claim that you still cannot perform the duties of any occupation for which you are suited, then you should immediately provide the benefits provider with the information from your doctor and see if they will reconsider their decision. If they do not do so and advise you that your benefits will be discontinued, then it makes sense for you to contact a lawyer.

It is not unusual for LTD providers to make this decision, and quite often the wording of the specific policy on which they are relying can be challenged. The policy wording may be unclear, or they may be denying your claim for reasons that are not permitted according to the wording of their own policy. They may be making their decision on a questionable review of your medical records. It may very well be that their determination of what you are capable of doing is simply not reasonable and is open to challenge.

What can a lawyer do for me?

A lawyer will review your medical file, along with the wording of your LTD policy and give you an opinion as to whether there is a viable claim. If there is, then it is likely that the lawyer would start a lawsuit on your behalf. In the event your matter went to court and to a trial, a judge could order the LTD provider to put you back “on claim”, meaning that your monthly benefits should be continued and can order a payment of arrears, meaning any payments that the provider should have made prior to the court’s determination.

In many cases, there is a reasonable prospect of coming to a resolution that involves a payment by the LTD provider of a lump-sum representing payment for some period of time into the future, as well as payments in arrears. The advantage to this approach is that you are no longer subject to further medical assessments or examinations required by the LTD provider to prove your ongoing disability. You may be able to obtain a settlement that lets you be free of the insurance company and move on with your life.

Bonn Law can help determine the best way forward with your long-term disabiltiy benefits claim.

Of course, every case is different, and most LTD policies have different wording, although they share many common features. In order to properly assess the merit of your claim, it will be necessary for a lawyer to review your medical records, along with the documentation from your LTD provider before providing you with an opinion as to the likelihood of a successful case.

If you find yourself in this unfortunate situation, the lawyers at Bonn Law would be happy to assist you.