New York Life recently acquired Cigna to become one of the biggest long term disability insurance carriers in the country, and unfortunately, this merger has only expanded some of the more frustrating parts of Cigna’s claims handling process and culture. It can be easy to become complacent after you’ve begun to receive benefits, but these benefits can be short-lived if you don’t take some proactive steps to preserve your entitlement to disability benefits. Your answers to the following three questions can put you in a better position to protect your long term disability benefits.
How Long Have You Been on Claim?
If you have a group or ERISA long term disability insurance policy, after you’ve been on claim for about 24 months you’ll need to deal with a shifting definition of disability. Initially, claimants can receive long term disability benefits if they’re unable to perform their own occupation. But after two years of benefits, claimants will continue to receive benefits only if they’re unable to perform any occupation. It’s important for claimants to be prepared for this shift.
Claimants who stop attending medical appointments after they’ve been approved for disability could find that their benefits are short-lived. As you approach the 24-month mark, New York Life may look back through the last six to 12 months of medical records and, if it doesn’t see a strong medical foundation for your long term disability claim, terminate your benefits. Dell & Schaefer can help push back against these rubber-stamp denials and force the insurance company to defend its decision.
What Do Your Medical Records Show?
It’s important to remember that your medical records are the foundation of your entire long term disability claim. These records must be complete and comprehensive, showing the specifics of your physical condition and the limitations your condition imposes. Although doctors don’t like to deal with paperwork, it can be risky to allow your physician to pass your long term disability insurance claim forms on to their medical assistant or receptionist to complete – once your claim form has been submitted, it’s very tough to go back and change or correct any misinformation. Your doctor should know that their failure to fill out the claim form or your medical records in a certain way could lead to the denial of your claim.
At each visit, you’ll want to correct information in your record that may have changed since your last visit. It’s also important to remember that, in many cases, you’ve learned to cope with chronic pain – fight the urge to tell your doctor you’re “feeling better” when this really means you’re dealing with pain at a level 5 instead of a level 7 that day.
Are Your Claimant Statements Complete and Truthful?
Once you’re on claim, you’ll be asked to fill out a claimant’s statement regularly – anywhere from once a month to a few times a year. This statement poses some general questions, and it can be tough to strike the balance between over-answering the questions and giving vague statements that don’t provide enough information. It’s also crucial to avoid over-representing the symptoms and limitations you’re experiencing or under-representing the amount of physical activity you’re able to do. If New York Life isn’t satisfied with your responses to the claimant’s statement (or if you’re observed doing something you previously said you couldn’t do), you may receive a request for an in-person interview or have your benefits terminated outright.
Trying to navigate the long term disability insurance benefits process by yourself can put you at a disadvantage, especially when you’re dealing with an insurance company as large as New York Life. The legal team at Dell & Schaefer has helped thousands of claimants secure and maintain their disability benefits, and we can help you too. Give us a call today to schedule a convenient time to discuss your claim with one of our experienced long term disability insurance attorneys.