By Peter Casciano, Esq.
Once a Long Term Disability (LTD) claimant has been approved and starts receiving benefits, many people believe this is the time to breathe a sigh of relief. While it is true that getting into pay status is a significant win, there are many tactics that insurance companies employ to attempt to terminate those benefits. I have blogged about many of those tactics before, but I wanted to address one specific issue because it comes up so frequently in my practice.
Long Term Disability Claimants
After a claimant is placed into pay status, they are commonly sent review or update forms by the carriers for completion. Typically those forms are duplicative, repetitive and drafted in such a way to encourage claimants to provide unhelpful information. For example, many forms ask people with problems sitting for an extended period of time whether, during a typical work day, they can sit for:
- 0 – 2.5 hours
- 2.5 – 5.5 hours
- more than 5.5 hours
By checking that middle box, claimants can significantly weaken their claim, even if all they can really sit for is 3 hours per work day. By providing claimants with a broad range, the insurance companies encourage claimants to provide detrimental evidence, even when they do not mean to. When in doubt, just write accurate information into the form and don’t worry about the specific answer choices provided by the carrier.
The Problems With LTD Claimants & Vacations
The issue, however, that I have run into several times in recent months is whether the claimant has gone on vacation. One might think, “Who cares, I am disabled, but I am still allowed a vacation, aren’t I?” The answer of course is yes, but it is important to understand what the carrier is getting at. They want to know if you traveled to your vacation, and if so, if you traveled by plane.
Plane travel is riskier than car travel for LTD annuitants for several reasons. First, you have an itinerary for your flight than cannot be altered. If you fly from Washington, DC to St. Louis, then you sat on a plan for a non-modifiable number of hours. However, if you drove you can stop, rest, visit a friend, walk around, etc. If your own forms, or forms completed by the physicians, have indicated that you cannot sit for more than 3 hours at a time, you must be very careful about travel plans. The carriers will read those forms as if, under any circumstances, it is impossible for you to sit for any period of time longer than what is indicated. Annuitants will not receive the benefit of the doubt, where a fair reviewer might say, “Well she just gutted it out for an extra hour and was hurting even worse afterwards.”
Second, air travel is simply uncomfortable. We all know it, from the child kicking the back of our seat, to the tray table resting on our knees, to the gentleman in front of you who seems to be able to recline his seat back further than anyone else. The insurance companies, and their reviewing doctors, will use this against claimants to conclude that if they can endure that, they can endure work like conditions.
Lastly, where you are flying can also be used against claimants. A simple two hour drive to the shore is not likely to raise any eyebrows, whereas a two hour flight to Miami Beach may trigger a heightened review consisting of examinations by the carrier’s doctors and the like. A careful annuitant must consider how their vacation looks to the reviewing official. While there is no articulated standard, the power rests in the hands of the insurance companies and we must do what we can to not raise any red flags.
Long Term Disability Lawyer in Maryland
Looking for a long term disability lawyer in Maryland, the District of Columbia, or Northern Virginia? Andalman & Flynn concentrates on ERISA law, focusing on protecting the rights of our clients as they seek LTD benefits. Our attorneys provide a compassionate service, working to give each client the best chance at success.
Contact us today for help obtaining long term disability insurance benefits.
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