Your long-term disability claim was approved, and the checks are coming. Then a letter arrives asking for updated medical records, a new activity questionnaire, or a phone interview. Should you be worried?
You should take it seriously. Approval is not permanent. Insurance companies review approved claims to decide whether you still meet the policy’s definition of disability, and a review can end in a termination. A review does not mean your benefits will stop. But how you respond often decides whether they do.
Here are five common reasons an approved claim gets a closer look. These are common triggers, not a ranking: some reviews are simply routine checks the insurer does on a schedule.
1. Your policy changes from “own occupation” to “any occupation”
Many policies pay at first if you cannot do your own occupation. After a set period, often 24 months, the definition changes, and you must show you cannot do any occupation that fits your education, training, and experience, sometimes with an earnings requirement.
Example: you were approved because severe back problems kept you from working as a nurse. At 24 months, the insurer decides you can do a sedentary office job and stops paying.
Your condition did not change. The definition did. The insurer still has to apply your policy’s actual words, including any requirements about your education, experience, and earnings. More: Own occupation vs. any occupation and How insurers use vocational experts.
2. Your medical records suggest you have improved
Insurers regularly request updated records, and ordinary phrases in them can raise questions:
- your doctor writes that you are “doing well,”
- your condition is described as “stable,”
- your medications have been reduced,
- your doctor notes improvement after surgery or treatment, or
- the records stop discussing your functional limits.
Example: you receive benefits for chronic back pain. Your doctor notes that your pain has improved with treatment. The insurer reads that as evidence you can return to work.
Improvement does not mean you can sustain full-time work. “Better than last month” and “able to work 40 hours a week” are very different things. Make sure your records keep describing the limits you still have. More: Why your doctor must describe limitations, not just diagnoses.
3. You reach a policy limitation or maximum benefit period
Some policies limit how long benefits are paid for certain conditions:
- mental health conditions such as depression and anxiety,
- some conditions based mainly on self-reported symptoms,
- disabilities related to alcohol or substance use, and
- other conditions the policy names.
Many group policies limit certain mental health claims to 24 months. Example: you receive benefits for severe depression. At 24 months, the insurer reviews the claim and applies the mental health limitation.
If another condition independently keeps you from working, it may support continued benefits, depending on the policy language. More: The 24-month mental health limitation.
4. The insurer gets surveillance or social media evidence
Insurers sometimes hire investigators or review public social media, looking for activity that seems inconsistent with what you have reported: travel or recreation photos, video of you lifting or doing yard work, posts about hobbies.
Example: you receive benefits for chronic pain and limited mobility. An investigator records you carrying groceries and doing yard work. The insurer argues you have more capacity than you reported.
An occasional activity does not mean you can do a job eight hours a day, five days a week. But inconsistencies between what you report and what is observed can do serious damage. Describe your activities accurately and in context. More: Can they cut me off because I drive, shop, or travel?
5. You return to work, report earnings, or get other disability benefits
Insurers often review a claim when they learn about new income or activity:
- returning to part-time or full-time work,
- starting a business or doing self-employment,
- reporting earnings that may affect eligibility,
- being approved for Social Security disability, or
- reaching a policy milestone involving other benefits.
Example: you begin working 15 hours a week while receiving benefits. Even if the earnings are modest, the insurer may review whether you are still disabled under the policy.
Some policies allow limited work or pay partial benefits, so read the reporting requirements before you start. And a Social Security approval is not a reason to cut you off. It can be evidence that you are still disabled. The insurer may review your file to calculate the offset, but that is a different thing. More: Approved for SSDI: what happens to my LTD claim?
How to respond to a review
- Answer every request on time, and keep copies of everything you send.
- Keep your treatment regular, and make sure your doctors understand your work-related limits.
- Describe your limits the same way every time, on forms, in phone interviews, and to your doctors.
- Watch the calendar. If your policy’s definition is about to change, prepare before the review, not after the termination letter.
- Call a lawyer if the review includes an independent medical exam, a vocational assessment, or a request for a recorded interview.
Got a review letter from your LTD insurer? Call 770-351-0801 or request a free case evaluation. We will help you respond before it becomes a termination.
Related: What to expect at an independent medical exam · Mistakes that sink LTD claims · Should I take a buyout offer?