DATE POSTED 23. 04. 2011, By

Need to Continue Doctor Visits or Course of Treatment Under Disability Plans

Employees, executives and managers in Chicago and the Midwest receiving disability benefits from their employer’s short-term or long-term disability insurance plan often express frustration with one common string attached to those benefits. They complain about how frequently they need to continue to see their doctor when clearly nothing is improving. This begs the question: why would a plan require somebody with a chronic disabling condition to so frequently visit the doctor, when it appears clear the condition is not improving. The reason is often two-fold. First, the plan might make that a condition of you receiving benefits. Second, the claims administrator will pounce on the first hint in the doctor’s description of restrictions and limitations to terminate your benefits. There are several things you can do to protect yourself, though.

If you are commencing short-term disability, and expect it to run into a claim for long-term disability, or are receiving long-term disability and expect to need the benefits for quite some time, it would be wise to have somebody thoroughly review the terms of your plan and guide you through the process. Get on a recurring schedule of physician office visits rather than just going upon notice from the administrator that an updated report is necessary. Try to find a doctor that will be sympathetic to your condition, rather than trying to rid himself or herself of any paperwork associated with a disability claim.

You should not assume the administrator knows what it takes to do your job. The administrator will usually hire a vocational expert or vocational rehabilitation counselor, who will not investigate the demands of your job, but will take the title of your job, and look up the description of that job in the Department of Labor’s Dictionary of Occupational Titles. This most often affects persons with high-stress positions in management roles. It is a good idea to gather information early in the process, perhaps from friendly co-workers, that describes what the duties of your job were.

A good ERISA lawyer can work with you through the process, rather than just once your benefits have been terminated, to minimize the risk of your benefits will be terminated, or get them reinstated as quickly as possible.

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