Many former employees in Chicago receive long-term disability insurance from their former employer’s group plan or insurance policy. Often, once you start receiving long-term disability benefits under an “any occupation” or “gainful occupation” definition of disability, you continue receiving those benefits until the end of the eligibility period under the policy (commonly Social Security Normal Retirement Age). But sometimes insurers attempt to terminate those benefits after years of paying the individual. If this happens, here are a few helpful things to consider.
Sometimes your condition improves, or your doctors give different opinions than they did before. Compare what your doctors state about your ability to work now to what they said before. If there is no change to their opinions, and no documented improvement in your condition, then the insurer’s process will be critical.
If the insurer terminated your benefits, consider what the insurer deemed important in approving your benefits and what process it followed. For instance, if it deemed your doctors’ unwavering opinions credible before, did they require additional proof before? Did the insurer require an FCE or IME to approve your benefits before? What tests did it communicate were necessary to approve your claim before?
The last step is comparing the insurer’s prior process to result in approval to the current process resulting in termination. Most often, if an insurer terminated benefits years into paying you, and your condition has not improved, the insurer’s process changed. Compare its current process to the prior process. This will show the insurer already determined a reasonable review process, and its current process likely failed to live up to the insurer’s own demonstrated standard.
A good example of this reasoning occurred recently in Skinder v. Federal Express Long Term Disability Plan, No. 5:19-cv-153, 2021 WL 1377982 (W.D.N.C. Apr. 11, 2021). Aetna found Skinder totally disabled from any work since 2004, and then terminated her benefits in 2018. In the first review, Aetna determined an FCE was necessary to demonstrate disability. But when Aetna terminated her benefits 14 years later, it relied upon paper medical reviews. When Skinder sued under ERISA § 502(a), the court agreed Aetna abused its discretion because there appeared to be no improvement to Skinder’s condition, her doctors consistently opined she was disabled, but Aetna’s process changed.
If an insurance company terminated your long-term disability benefits after years of paying them, talk to an experienced ERISA long-term disability attorney immediately.