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What Happens if You Have a Relapse After Returning to Work on Long-Term Disability?

What Happens if You Have a Relapse After Returning to Work on Long-Term Disability?

Returning to work after receiving long-term disability (LTD) benefits is often a positive step forward. It can signify progress in managing your condition and regaining stability. However, for many individuals, the transition back to work is not without challenges. One of those challenges may involve experiencing a relapse—when your condition worsens, or symptoms resurface—after resuming employment. If you find yourself in this situation, understanding your rights and options is vital to ensure continued financial security.

Returning to Work After Long-Term Disability

When you return to work after receiving LTD benefits, most insurance policies offer programs designed to ease you back into your role. These may include work accommodations, reduced hours, or a “return-to-work incentive.” The aim is to gradually integrate you back into the workforce while safeguarding your health.

However, returning to work doesn’t mean your LTD benefits are automatically gone forever. Many group disability insurance policies have a built-in feature referred to as a “recurrence clause” or “relapse provision.” This clause typically allows you to resume benefits without restarting the claims process if your condition deteriorates again within a set timeframe—usually six months to a year after you resume work. It’s critical to review your policy for the specifics of this provision before returning to work.

What Is a Relapse, and How Does It Impact Your Benefits?

A relapse generally means the recurrence of a disability, illness, or injury that initially qualified you for LTD benefits. For example, if you returned to work following treatment for a chronic pain condition but the pain becomes debilitating again, this would likely be classified as a relapse under most insurance policies.

Whether and how a relapse impacts your ability to claim continuing benefits depends on your policy details. If a relapse occurs within the timeframe noted in the recurrence clause, you may be able to reinstate your benefits without filing a completely new claim. However, if the relapse happens beyond that window, you might need to start the process from the beginning, including meeting any waiting periods and resubmitting medical evidence.

Additionally, be aware that insurers may scrutinize your condition closely in the event of a relapse. They could argue you’re still capable of working or that the relapse isn’t severe enough to justify benefits. Working with an experienced attorney in such situations is critical to presenting a strong case.

Practical Steps to Take If You Experience a Relapse

If you experience a relapse, it’s essential to act quickly and strategically to protect your rights:

  1. Notify Your Employer and Insurer – Inform your employer and LTD insurer as soon as possible. Delaying notification could complicate your ability to claim benefits.
  2. Seek Medical Documentation – Consult your healthcare provider immediately to document how your condition has worsened. Medical records are the foundation of any relapse benefits claim.
  3. Review Your Insurance Policy – Carefully read your LTD policy to understand how recurrence clauses, waiting periods, and disability definitions apply to your situation.
  4. Contact a Lawyer – Relapses can present complex legal and procedural challenges. A skilled attorney can review your policy, gather evidence, and advocate on your behalf if the insurer resists reinstating benefits.
  5. Consider Accommodations – If continuing to work part-time with adjustments is feasible, explore your rights to accommodations under the Americans with Disabilities Act (ADA) or similar laws.

Know Your Rights and Protections

Relapses after returning to work are more common than many people think, and having the right plan in place can make all the difference. Your LTD insurer is obligated to follow the specific terms of your policy, but navigating these terms can be difficult without professional assistance. If you encounter resistance or confusion regarding your benefits, a dedicated legal team like Bartolic Law can step in to help secure the support you need.  

You don’t have to face a relapse alone—understanding your rights and acting swiftly can ensure that you receive the benefits you deserve.

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