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Why Do I Have to Continue to See My Doctor If There Is No Treatment For My Condition?

If your employer offered you long-term disability (LTD) coverage as part of a group benefits package, or if you purchased an individual disability insurance policy on your own, you may be eligible to continue receiving a percentage of your salary if you become unable to work due to “sickness” or injury.

First, you must establish that you meet all the eligibility criteria under the LTD Policy. If your claim is approved, it is important to pay attention to the following types of provisions and terms under the Policy to continue receiving your benefits:

  • The definition(s) of disabled/disability
  • Limitations for specific conditions
  • Requirement to be under the regular care of a doctor
  • Events that trigger termination of coverage

How Do I Continue to Prove That I'm Disabled?

Insurance companies are not in the business of paying disability benefits until and unless they are absolutely convinced that the claimant meets each and every requirement under the LTD Policy. Continuing to receive “regular care of a doctor” is a very common requirement in almost all policies, as claimants bear the burden of establishing that their disability is ongoing to keep receiving benefits.

Although some people have their claims approved and then stop going to their doctors as often or altogether, doing so will likely lead to eventual and inevitable termination of your benefits.

Even if you are told that there is no further treatment for your condition(s), or that you have reached maximum medical improvement (MMI), you still need to have a doctor who can say they are familiar with your current condition(s) to be able to complete forms and certify your continuing disability.

Failure to continue, or explore new, treatment may be grounds for the insurance company to terminate your benefits and close your claim, forcing you to appeal their decision and fight for your benefits (again).

Help from a Lawyer with Expertise in ERISA and Disability Insurance

Filing a claim for benefits (or an appeal if your claim is denied/terminated) can be a complicated and overwhelming process. That is why we strongly recommend speaking with an experienced long-term disability attorney who can help you with:

  • Submitting your disability insurance claim;
  • Making sure the insurance company meets their deadlines;
  • Appealing a denial or termination of your long-term disability benefits;
  • Managing your ongoing claim;
  • Negotiating a lump-sum settlement; or
  • Filing a lawsuit against your disability insurance company if, for example, they deny your appeal.

Call for a free consultation with a disability attorney. No fees or costs until you get paid.