How Much Should I Tell My Long Term Disability Insurance Company When They Ask Me for Updated Information?
- Matthew Maddox
- May 5
- 11 min read
Navigating the complexities of a long term disability insurance claim can be challenging, especially when it comes to communicating with your insurer. Providing updated information about your condition is a critical part of maintaining your claim, but it raises important questions: How much should you share? What kind of information is necessary And how can you protect your privacy in the process?
This article aims to guide you through the intricacies of communicating with your long term disability insurer, ensuring you provide enough information to support your claim while safeguarding your personal details. We’ll explore the types of information to include in updates, the risks of sharing too much, and the consequences of not sharing enough, providing you with the knowledge to manage your interactions with your insurer effectively.
What Type of Information Do Long Term Disability Insurance Companies Typically Request in Updates?
When long term disability insurance companies request updates to verify the continued validity of a claim and the claimant’s eligibility for benefits, they typically ask for specific types of information, including standardized forms. Here is some common information you may be asked to provide:
Current Medical Information: This includes up-to-date medical records, doctor’s notes, test results, and details of any treatment or therapy. Insurance companies often request this information through an Attending Physician Statement, which is a form completed by your doctor detailing your medical condition and treatment.
Medication Updates: Any changes in your medications, such as alterations in dosage or the type of medication, are important. This helps your insurance company understand the current status of your condition.
Employment Status: Updates about any attempts to return to work, changes in your job duties, or income from any sources, including self-employment or volunteer activities. This might be reported directly by you or through a Claimant Questionnaire.
Functional Abilities: Information about your physical and mental capabilities, which can be evaluated through assessments like a functional capacity evaluation. These reports help insurers assess what activities you are capable of performing.
Therapy and Rehabilitation Reports: Details about ongoing rehabilitation or therapy sessions and their effectiveness, including physical therapy, psychological counseling, or other rehabilitative services.
Personal Statements and Symptom Diaries: Insurers may not ask for this directly, but it can be helpful to submit a personal statement or a symptom diary that documents your daily activities and the impact of your condition on your life.
By providing comprehensive and accurate information through these documents and forms, you help the insurance company assess the ongoing nature of your condition and your eligibility for continued benefits.
Why Is It Important to Provide Accurate Updates to My Long Term Disability Insurer?
Providing accurate updates to your long term disability insurer is crucial for several reasons, including:
Ensuring Continuation of Benefits: Accurate updates demonstrate that you still meet the criteria for disability as defined by your insurance policy. This is vital to continue receiving benefits without interruption.
Compliance with Policy Requirements: Most long term disability policies require that you regularly provide accurate information about your medical condition and any changes in your employment status. Failure to comply can be seen as a breach of the policy terms and might lead to a denial of benefits.
Supporting Reevaluation of Benefits: Over time, disability benefits may need to be adjusted based on changes in your condition. Accurate and detailed updates ensure that any reevaluation of the amount or duration of your benefits is based on the most current and factual data.
Building a Strong Claim Record: Consistently providing accurate updates creates a comprehensive record of your disability and its impacts. This can be beneficial if your insurer disputes your claim or if there are legal proceedings regarding your disability status.
Accurate updates are fundamental to ensuring that you continue to receive the benefits you are entitled to, while also complying with policy obligations, and safeguarding against potential disputes or benefit termination.
How Detailed Should My Updates Be to My Insurance Company?
When providing updates to your long term disability insurance company, the level of detail you include is important for maintaining clarity and accuracy in your claim. Of course, it’s important to understand how to balance the need for thoroughness with the goal of not oversharing sensitive information.
Details that should be included in your updates to your insurance company include:
Relevant Medical Information: Include detailed reports of any new diagnoses, symptoms, changes in your condition, treatments, medications, and the outcomes of any medical tests or procedures. The goal is to provide enough detail to illustrate how your condition currently impacts your ability to work without going into unnecessary minutiae.
Functional Limitations: Describe how your disability affects your daily activities and your ability to perform work-related tasks. This should be specific enough to give clear insight into your limitations but generalized enough to maintain your privacy.
Employment and Income Changes: If there have been any changes in your work status, income, or attempts at work, including volunteer work or rehabilitation efforts, detail these changes succinctly. Be specific about the nature of the work and hours worked to prevent any misinterpretation.
Compliance with Treatment Plans: Explain your adherence to prescribed medical treatments or rehabilitation programs. Include any reasons for non-compliance if applicable, such as side effects or lack of improvement.
When providing your insurance company updated information, you may want to avoid the following:
Excessive Personal Information: Avoid sharing more personal information than what is necessary for the insurer to assess your claim. Remember that your doctor will typically include notes of your discussion in their office visit notes, so when meeting with your doctor, limit your conversation to your condition and symptoms rather than sharing too much personal information (such as hobbies, travel, etc.). If you provide your insurance company any personal statements, avoid disclosing sensitive information that does not directly relate to your claim or condition.
Speculative Information: Do not include unverified or speculative information about potential future treatments, hypothetical outcomes, hypothetical activities, or activities you hope to undertake. Focus on the current and factual status of your condition and the activities you have actually been engaged in.
It can be helpful to work with your physician to ensure that the medical information being provided is both accurate and adequately detailed. Your doctor can help phrase your condition’s impact in medical terms that are clear and precise. Additionally, consider consulting with a long term disability attorney with ERISA experience to review the details you plan to share. They can provide guidance on the appropriate level of detail to maintain your privacy while fulfilling your insurance company’s requirements.
By following these guidelines, you can ensure that your updates are detailed enough to support your claim, while also protecting your privacy and adhering to the terms of your disability insurance policy.
What Are the Risks of Providing Too Much Information in My Updates?
Providing too much information in your updates to a long term disability insurance company can inadvertently introduce risks and complications to your claim.
Providing too many details might lead to confusion or misinterpretation of your condition or circumstances. More information also increases the likelihood of seeming inconsistencies, which can be used to question the legitimacy of your claim.
For example, let’s say you suffer from a cervical condition that prevents you from working because you cannot sit for extended periods without severe back pain. You have successfully filed for disability and are receiving benefits. During a visit with your orthopedist, you mention a recent trip that required plane travel. If your insurance company sees this detail in your medical records, they may question how you are able to travel by plane if your condition and symptoms are as serious as you report. However, the mention of the trip may not include other important contextual factors, such as it being necessary due to a family emergency, or accommodations that were needed to make it possible (like purchasing an upgraded seat for comfort), or subsequent repercussions (needing to rest for an entire day afterward due to the pain caused by traveling).
Excessive details can prompt insurers to scrutinize your claim more closely, potentially leading to additional investigations or challenges. Insurance companies may use extraneous details to find reasons to deny or limit your benefits, interpreting some activities as indications of a lesser degree of disability.
Here are some general guidelines for appropriate information sharing:
Relevance: Ensure that all information shared is directly relevant to your disability and its impact on your ability to work.
Conciseness: Be concise and clear, providing just enough detail to substantiate your claim without unnecessary elaboration.
Legal Consultation: Consult with a long term disability attorney before submitting information who can identify potential red flags and preemptively address any purported inconsistencies with your insurance company.
By being mindful of the amount and type of information you share, you can maintain the integrity of your long term disability claim while protecting your personal and legal interests.
What Are the Consequences of Not Providing Sufficient Information?
Failing to provide sufficient information in your updates to a long term disability (“LTD”) insurer can lead to several negative consequences that could impact the status and outcome of your claim, including:
Claim Delays: Insufficient information can cause delays in the processing of your claim as your insurance company may require additional time to request and review further documentation.
Risk of Claim Denial: Your insurance company may deny your claim if they believe they don’t have enough evidence to verify your disability and its impact on your ability to work. The lack of detailed updates may lead your insurance company to presume that your condition has improved, potentially resulting in the termination or reduction of benefits.
Increased Scrutiny of Your LTD Claim: If the information provided is not comprehensive, the insurer might request more detailed documentation or more frequent updates, increasing the burden on you. You might also be asked to undergo independent medical evaluations with your insurance company’s doctors to provide the needed proof of your disability, which can be time-consuming and invasive. These evaluations are often used as grounds to terminate an LTD claim.
Misrepresentation of Severity: Without adequate details, there might be a misunderstanding about the severity of your disability, leading to inappropriate decisions about your eligibility for benefits.
Policy Obligations: Not providing required updates as stipulated in your insurance policy can be seen as a breach of contract. Your benefits may therefore be terminated.
Complications in Appeals and Litigation: Should your claim be terminated, a lack of sufficient historical information can weaken your position and make it more difficult to defend your entitlement to benefits during an appeal or litigation.
To avoid inadequate updates, keep your insurer regularly informed with clear and relevant updates regarding your medical condition and any changes in your employment status. It’s important to meet your insurance company’s deadlines when they request these updates. Consulting with an experienced long term disability attorney can help ensure that the information you provide meets your insurance company’s requirements without compromising your privacy or claim integrity.
Are There Specific Types of Information I Should Always Include in My Updates?
When updating your long term disability (“LTD”) insurance company, it’s crucial to include specific types of information that accurately reflect the current status of your condition, treatments, and any relevant changes in your life. Providing complete and accurate updates helps ensure that your LTD claim is assessed correctly based on the most current information.
Information you should always include in your insurance company’s update requests include:
Doctor’s Reports and Notes: Regular updates from your treating physician, detailing any changes in your condition, treatments, and responses to treatments.
Diagnostic Results: Results from recent medical tests, X-rays, MRIs, or other diagnostic tools that provide objective evidence of your condition.
Treatment and Medication Changes: Information about any new treatments, changes in treatment protocols, surgeries, or adjustments in medication, including dosages and the introduction of new medications.
Functional Limitations: Updates on how your condition affects your daily living and work capabilities, focusing on any changes since the last update.
Employment and Income Changes: Any changes in your work status, attempts to return to work, or changes in your income level.
Rehabilitation Progress: Reports on physical, occupational, or psychological rehabilitation programs, including your progress and any setbacks.
Personal Statements: Periodic personal statements describing your daily activities and the impact of your disability on your life, which help provide a personal context to the clinical data.
By including this essential information, you ensure that your insurance company has a comprehensive view of your situation, allowing for a fair and thorough evaluation of your claim. This practice also minimizes the risk of claim delays or disputes due to insufficient or outdated information.
How Often Should I Expect to Provide Updates to My Insurance Company?
The frequency with which you should provide updates to your long term disability (“LTD”) insurer can vary depending on the specifics of your policy and the nature of your disability.
However, there are some general guidelines you can expect:
Initial Stages of the Claim: During the early stages of your LTD claim, you may need to provide updates more frequently, possibly every month or every few months. This helps your insurance company monitor your condition and the initial impact of your disability on your ability to work.
Stable Conditions: If your condition stabilizes, updates might be required less frequently, such as every six months to a year. This schedule allows your insurance company to stay informed of any significant changes without needing constant detailed updates.
Change in Condition: Should there be a significant change in your medical condition, either improvement or deterioration, you should provide an update to your insurance company. This ensures that your benefits reflect your current needs and status.
Policy Requirements: Always refer to your specific insurance policy for guidance on update frequency. Policies may outline specific intervals or circumstances under which you need to provide updates.
Request by Insurer: Sometimes, insurers might request updates at specific intervals that they determine necessary based on the nature of your disability and the details of your case.
Who Can Help Me Determine the Appropriate Amount of Information to Share?
A long term disability attorney can help you determine the appropriate amount of information to share with your insurance company, ensuring that you protect your privacy while maintaining compliance with your policy.
A lawyer specializing in disability claims can provide legal advice on what information is necessary and appropriate to share. They can help you understand your rights and the implications of the information you provide, ensuring that your communications are both compliant and strategically sound.
Using these resources, you can ensure that you are providing the right amount of information—enough to substantiate your claim but not so much that it infringes on your privacy or opens the door to potential disputes.
How Can The Maddox Firm Prove My Long Term Disability Claim?
The Maddox Firm understands the complexities of long term disability (“LTD”) claims and is dedicated to helping you navigate this challenging process effectively. Our approach is comprehensive, ensuring every aspect of your claim is handled professionally to maximize your chances of securing and maintaining the benefits you deserve.
We Examine Your Policy and Assess Your Claim: Our first step is to thoroughly review your disability insurance policy. This allows us to understand the specific provisions and exclusions that apply to your case. We assess your claim against these criteria, ensuring that we tailor our strategy to meet the exact requirements of your policy.
We Handle All Communications with Your Insurance Company: To ensure consistent and effective communication, we manage all interactions with your insurance company. This includes submitting necessary documentation and ensuring that all communications are timely and documented. We also assist you in providing regular updates about your condition to your insurance company, reviewing and supplementing documentation so that they are complete, accurate, and strategically aligned with the requirements of your claim.
We Help You Obtain Evidence to Support Your Claim: Gathering robust evidence is critical in substantiating your LTD claim. We help you collect comprehensive medical records, expert opinions, and additional testing such as functional capacity evaluations and neuropsychological evaluations that demonstrate the extent of your disability. We guide you in how to document your symptoms and treatments effectively, ensuring that every piece of evidence supports your claim convincingly.
We Handle Appeals and Litigation: If your claim is denied, we are prepared to handle appeals and, if necessary, litigation. Our team is skilled in navigating the appeals process, preparing detailed briefs, and representing you in court to challenge unjust denials and fight for your rights under the policy.
A short term disability or long term disability claim can be a complicated process. If you need help during the claims process, with appealing a claim denial, or with litigating a final adverse short term or long term disability decision, The Maddox Firm can help. The experienced team at The Maddox Firm will examine your insurance policy, correspondence from your insurance company, medical records, and any other relevant documentation in order to give you personalized guidance on how we can help you win your short and/or long term disability claim. Our New Jersey and New York long term disability attorneys help clients nationwide.
