Common Reasons LTD Benefits Are Terminated After Review

Receiving a letter stating your long-term disability (LTD) benefits are ending is a shock. You rely on these payments to survive, and suddenly, the financial rug is pulled out from under you. Insurance companies routinely review open claims, not just to update files, but often to find reasons to stop payments. Understanding why this happens is the first step to fighting back.

Here are the most common strategies insurers use to justify terminating benefits:

• Adverse Independent Medical Exam (IME) Opinions: A hired doctor disagrees with your treating physician.
• Surveillance Tactics: Video or social media evidence is used out of context.
• Misinterpreted Medical Improvements: Your doctor’s notes are twisted to suggest you are “cured.”
• Policy Definition Changes: The shift from “own occupation” to “any occupation.”

The “Independent” Medical Exam (IME)

One of the most frequent reasons for termination is a report from an Independent Medical Exam (IME). The insurer hires a doctor to evaluate you, usually for less than an hour. Despite having no long-term history with your condition, this doctor may conclude you are fit to return to work.

Insurers often prioritize the opinion of their paid consultant over the doctor who has treated you for years. If the IME report says you can work, the insurance company treats this as “new evidence” sufficient to close your claim.

Surveillance and Social Media

Insurance companies often hire investigators to conduct surveillance. They look for any activity that contradicts your claim of disability.

• Video Surveillance: You might be filmed carrying groceries or walking to the mailbox. The insurer uses this brief snapshot to argue you are physically capable of working a full-time job.
• Social Media: Photos of you attending a family gathering or smiling at a dinner can be used to argue that you are not suffering from depression or pain.

“Improvement” in Medical Notes

Insurers scrutinize your medical records for keywords like “improved,” “stable,” or “feeling better.” A doctor might write that your pain has improved from a 9 to a 7, or that a new medication is helping.

While this is good news for your health, insurers often weaponize it. They may argue that “improvement” equals “recovery.” They ignore the fact that managing symptoms is very different from regaining the stamina and cognitive function required for full-time employment.

The 24-Month Policy Shift

Most LTD policies contain a critical clause that changes the definition of disability after 24 months.

• First 24 Months (Own Occupation): You receive benefits if you cannot perform your specific job.
• After 24 Months (Any Occupation): You only receive benefits if you cannot perform any job that fits your education and experience.

At the two-year mark, insurers often terminate benefits by claiming you can work in a simpler, sedentary role, even if it pays significantly less than your previous career.

Your Success Is Our Priority

At Bartolic Law, we know how to dismantle biased IME reports, contextualize surveillance footage, and prove that you still meet the definition of disability. We are your trusted legal partner in navigating these complex appeals.

Contact us today for a consultation and let us fight to restore the benefits you deserve.