Sep 30, 2025 - Disability Insurance by Seltzer & Associates
Having disability insurance is a great security measure to protect you against the unknowns of the future. But it is important to understand that disability insurance benefits and terms can change, and you need to be prepared for that possibility. It is important to review policy details periodically and consider speaking with an attorney who specializes in disability insurance to determine whether your coverage is adequate to meet your needs.
At Seltzer & Associates, we don’t sell insurance, so we have nothing to gain by pointing out deficiencies in your coverage. We help policyholders when they need to prepare and file a claim or appeal a denial of benefits or when insurance companies act in bad faith. So we’ve seen how insurance companies interpret policies, and we can help you avoid potential problems.
In a blog like this, we can’t address all the issues that could cause an insurance company to reconsider your disability benefits. But here are some general factors to be aware of. You can schedule a free consultation with us if you’d like a review of your particular policies.
If Your Disability Insurance is Provided Through a Group Policy, Terms or Attitudes Could Change
When you have disability insurance provided through your employer or another group that aggregates policies, you have no control over what happens to that policy. Your employer might renegotiate terms to get better premiums. If you looked at your disability coverage initially but haven’t examined it since then, it is a good idea to see what your policy currently provides. You may need to supplement your coverage with individual disability insurance to provide the protection you need.
The company you work for might start buying disability policies from another insurer, leaving your policy as a relic with the former company. The former insurer providing coverage for you no longer has an incentive to keep your employer happy. Their attitude toward claims under your policy could change drastically. They might become more willing to deny or delay claims. If you’re currently receiving benefits and have your claim reviewed, they may scrutinize your evidence more closely and find that you no longer meet their eligibility standards. A Philadelphia insurance bad faith attorney could review the situation and determine whether the company is complying with legal obligations in the handling of claims.
Legal Requirements or Interpretations Could Change
Disability insurance, like other forms of insurance, is regulated by state and federal law. Policies provided through employers are subject to the requirements of the Employee Retirement Income Security Act of 1974 (ERISA), including implementing regulations and administrative guidance. Individual insurance policies are generally governed by state law. For instance, Section 88.167 of the Pennsylvania Code establishes certain minimum standards for disability income protection policies regarding benefit reduction and waiting periods. If state or federal lawmakers amend the laws or issue guidance specifying that provisions should be interpreted a particular way, that can change the way insurers pay benefits under your policy.
Additionally, policy terms and company actions are subject to interpretation and review by the courts. A court might determine that an insurer is acting in bad faith when it engages in a practice that has been a common operating procedure for years. The court’s finding should prompt the company to reevaluate how it handles similar claims. If it does not, a Philadelphia insurance bad faith attorney could help other policyholders obtain fair treatment by filing an additional lawsuit.
Similarly, a court might determine that language in a long-term disability insurance policy should be interpreted to provide classic “own occupation” coverage while the insurer views the language as only requiring the payment of benefits when the policyholder demonstrates that the disability prevents them from performing any occupation. The court’s interpretation should change the way the company addresses policies with similar language. But an experienced Philadelphia long-term disability appeal lawyer could take legal action to get the company to reconsider claims if the company does not initiate such action internally.
Changes in Your Condition
Disability insurance companies are always looking for ways to justify terminating long-term disability benefits. As part of the maintenance required for a claim when a policyholder is receiving disability benefits, policyholders must submit information periodically so the insurer can reevaluate the condition causing the disability and its impact on the ability to work.
Insurers frequently reduce or terminate benefits after this type of review. They might conclude that the policyholder has recovered to the point that they no longer meet the standards to be considered disabled. Or they might determine that the policyholder has done something that makes them ineligible for coverage. Sometimes a company may be justified in changing benefits, but frequently it makes decisions based on incomplete or faulty information. An insurance appeals attorney can identify problems with the company’s reassessment and work to have benefits reinstated.
New Corporate Philosophy
Sometimes, insurance company leaders change the approach they take with an aim toward improving profit margins. As an oversimplified example, they might require claimants to submit six pieces of medical or vocational evidence, instead of the two they used to. If you follow old procedures and only submit two pieces of evidence with your disability claim, it will be denied under the new policies.
The insurance company hopes you’ll accept the answer and give up. However, you can obtain and submit additional evidence as requested and appeal the denial. If an internal appeal is unsuccessful, an attorney can litigate to ensure the insurance company honors its policy obligations.
Your Policy Provides for a Review and Reconsideration
Since insurance companies do not want to continue paying disability benefits if they can avoid doing so, they usually include provisions in their policies that provide for the submission of new evidence and a review of your circumstances. Even if your condition has not changed, the insurer could reconsider its opinion about your level of disability.
Your policy might also specify that benefits will only continue for a limited period of time and that after that time, a more rigorous standard will be applied to assess whether you should continue to receive benefits. It is important to review all the fine print in your policy to determine whether the insurance company is acting within its legal rights or attempting to bypass legal requirements in the hopes that policyholders will simply accept the result.
Seltzer & Associates Answers Questions and Works to Recover Full Benefits in Disability Insurance Claims
Disability insurance can provide an essential lifeline to keep a professional practice operating and help you meet regular obligations if you ever find yourself in a situation where a physical or mental disability prevents you from working. But sometimes that lifeline gets tangled or dropped, and then it helps to work with an experienced legal advisor who can help restore the protection you’re entitled to under your disability insurance policy.
At Seltzer & Associates, we have focused our practice on helping professionals receive full benefits under their disability insurance policies, so we understand how to avoid common pitfalls and delays by presenting the right evidence in a format insurance companies find most persuasive. When insurers refuse to honor their policy obligations, we know how to enforce policy rights through litigation. If you have questions about the benefits provided in your current policy or you need assistance filing a claim or resolving a problem anywhere in the U.S., we invite you to schedule a free confidential consultation with us today.