Q: Can I reinstate stopped long-term disability benefits after 24 months due to medical disagreement?
I was receiving long-term disability insurance through my former employer for 24 months, but the benefits stopped. The company, Lincoln Financial, claims that independent studies suggest there are other occupations I can perform, but my doctors and neurosurgeon disagree, stating I need lumbar surgery. I don’t have a copy of the policy to check the terms regarding disability. Is it possible to have my benefits reinstated?
A:
Yes, it is possible. It sounds like your policy is most likely governed by a federal law called "ERISA." It will depend on the language of the policy, but most long-term disability policies pay benefits for 24 months while you are disabled and unable to work in your own occupation. After 24 months, you have to prove that you're incapable of working in any other occupation. Typically, the insurance company looks for other occupations that would earn you a percentage of your pre-disability earnings (usually, but not always, 60%). In other words, if they think there are alternative occupations that you could work, which would earn you at least 60% of your previous earnings, then they're going to deny the claim.
It sounds like that's what happened in your case. Those type of denials happen frequently and after 24 months that is commonly when an insurance company denies benefits.
At this point, the next step is to file an appeal. You should check the denial letter for the instructions on how to file an appeal, but usually you have 180 days to appeal. Do not appeal until you have all the evidence in support of your appeal (but also do not wait longer than the appeal deadline - if you miss the deadline, your claim will be waived). You will need strong medical support, doctor support, vocational support, and legal arguments in your appeal to explain why the denial should be overturned.
I highly recommend speaking with an attorney at this point, especially someone who specializes in ERISA long-term disability claims. ERISA has a number of very specific rules that apply to these types of cases and it's important to have legal advice on how to navigate the appeals process. I'm always happy to talk if you have questions. My contact information should be on my bio.
Hope this helps!
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