Q: Do I have legal grounds to appeal an LTD discontinuation/denial? If yes, how?
I am currently receiving workers comp benefits from my company in New York and not working for 1 year now. Three months ago an Independent Medical Exam determined that I'm 25% disabled. My company accepted the claim but recently reduced my benefit amount by 75% and can't offer me light duty work.
One month ago, my LTD insurance plan at my company reviewed my disability status and decided that I no longer meet the Disabled definition under the plan and identified (through vocational assessment) that a gainful occupation (which meet my earning requirement) existed around my home and, therefore, I’m no longer eligible to receive LTD benefits.
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A: It's not an "appeal" what you need to do is notify the insurance company that you disagree with their determination and if necessary start a declaratory judgment action seeking the insurance coverage. I would recommend hiring an attorney, doesn't have to be me, but some attorney who knows how to navigate this stuff. Please feel free to privately email to discuss more details about your case.
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