When you receive long term disability (LTD) benefits, it’s important to understand that your insurance company may periodically review your claim to ensure you continue to qualify for benefits. These reviews or audits can be stressful, but with proper preparation, you can navigate the process smoothly and maintain your benefits. In this detailed guide, we’ll explore the steps you can take to prepare for a long term disability insurance review or audit.
Understanding Long Term Disability Insurance Reviews
Insurance companies conduct periodic reviews to verify the ongoing validity of your disability claim. These reviews typically involve evaluating your current medical condition, treatment progress, and ability to work. The frequency and depth of these reviews can vary depending on your policy, the nature of your disability, and the insurer’s protocols.
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Steps to Prepare for an LTD Insurance Review
- Maintain Comprehensive Medical Records
- Regular Medical Visits: Continue seeing your healthcare providers as recommended. Regular visits help ensure that your medical records are up-to-date and reflect the current status of your condition.
- Detailed Documentation: Keep thorough records of all medical appointments, treatments, and medications. Ensure that your medical records include detailed notes on your symptoms, treatment plans, and any changes in your condition.
- Specialist Reports: Obtain reports from specialists who can provide detailed evaluations of your condition. Specialist opinions can add credibility to your claim, especially if they are experts in the specific area of your disability.
- Communicate with Your Healthcare Providers
- Inform Your Doctors: Make sure your healthcare providers know that you are receiving LTD benefits and may undergo periodic reviews. This awareness can help them prepare accurate and comprehensive reports.
- Discuss Your Limitations: Regularly discuss how your condition affects your ability to perform daily activities and work-related tasks. Ensure that these limitations are clearly documented in your medical records.
- Keep Detailed Personal Records
- Symptom Diary: Maintain a daily diary of your symptoms, treatments, and their impact on your daily life. Note any variations in your condition and how they affect your ability to function.
- Activity Log: Record your daily activities, including any modifications or assistance you require. This log can help demonstrate the extent of your disability and the limitations you face.
- Review Your Insurance Policy
- Understand Your Policy: Familiarize yourself with the terms and conditions of your LTD policy. Know the specific criteria for continuing to receive benefits and any definitions of disability used by your insurer.
- Policy Changes: Stay informed about any changes to your policy or new requirements introduced by your insurance company.
- Prepare for Communication with the Insurer
- Respond Promptly: Answer any requests from your insurance company for additional information or documentation as quickly as possible. Timely responses can prevent delays in the review process.
- Provide Accurate Information: Ensure that all information you provide is accurate and complete. Inconsistencies or inaccuracies can raise red flags and jeopardize your claim.
- Written Communication: Whenever possible, communicate with your insurer in writing. Written communication provides a record of your interactions and can be referred to if there are any disputes.
- Seek Legal Assistance
- Consult an Attorney: If you’re unsure about the review process or feel overwhelmed, consider consulting a long term disability attorney. An experienced attorney can guide you through the review, help you gather necessary documentation, and represent your interests if there are disputes.
- Legal Representation: Having an attorney can be particularly beneficial if your insurer requests an independent medical examination (IME) or if your benefits are threatened with termination.
Examples of Common Review Requests
During a review, your insurer may request various types of information. Here are some common requests and tips for handling them:
- Updated Medical Records: Provide recent medical records from all your healthcare providers. Ensure these records are comprehensive and up-to-date.
- Functional Capacity Evaluations (FCE): If requested, participate in FCEs to assess your physical and mental capabilities. Follow your attorney’s advice on how to prepare for these evaluations.
- Independent Medical Examinations (IME): Attend any IMEs scheduled by your insurer. Document your experience and share the results with your healthcare providers for review.
- Questionnaires or Forms: Complete any forms or questionnaires sent by your insurer promptly and accurately. Double-check your responses to ensure consistency with your medical records.
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Maintaining Your Benefits
By staying organized and proactive, you can better manage the review process and maintain your LTD benefits. Here are a few additional tips to keep in mind:
- Regular Updates: Keep your insurer informed of any significant changes in your condition or treatment.
- Documentation: Always keep copies of any correspondence or documentation you send to your insurer.
- Support Network: Lean on your support network, including family, friends, and legal advisors, for assistance during the review process.
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