Jun 30, 2025 - Disability Insurance by Seltzer & Associates
It can take considerable effort to satisfy the insurance company’s requirements to receive benefits for a long-term disability claim. Once claimants receive notice that they have been approved, they often breathe a sigh of relief and assume the work is over.
It isn’t. As a legal team that has focused on disability insurance claims for decades, we understand that insurance companies often seek reasons to terminate disability benefits. No matter how severe your condition and how obvious your disabilities may be, it is vitally important to follow the requirements established in your policy, or you could find your benefits discontinued at the time you need them most.
Many professionals choose to work with legal advisors who can handle the process of benefit maintenance so they don’t have to worry about losing resources at a critical time. It is vitally important to ensure that you are receiving the proper treatment before, during, and after the application process. While the ongoing treatment and documentation required will vary for each policyholder, the following general principles should be kept in mind when it comes to disability insurance claims.
You Need to Follow the Requirements in Your Disability Insurance Policy
One of the most important reasons to ensure that you receive the proper ongoing treatment for your condition is that your insurance policy probably requires you to do so. Disability benefits are provided in accordance with the terms outlined in your policy. If you don’t comply with the requirements, then that generally gives the insurance company the right to deny your claim or terminate benefits. Therefore, it is essential to carefully review your policy with a magnifying glass and ensure that you understand how to comply with each and every requirement, including those specifying the types of medical exams you need to undergo and the follow-up treatment you must receive at particular intervals.
Insurance policies are often written in complex language, using terms of art that have specialized meanings within the industry. It can be very helpful to work with an attorney who deals with disability insurance policy compliance because we can explain the requirements to you in rational terms and outline the steps needed to maintain compliance.
Ongoing Treatment Will Provide Valuable Medical Records
How do you prove that you’ve been receiving ongoing treatment as required by your disability insurance policy? You submit copies of your medical records. So, getting treatment provides the evidence you need to satisfy insurance requirements. In addition, the records you obtain from treatment can also provide evidence that your condition is still severe enough to lead to disabilities that prevent you from working. The only way to obtain the medical records you need is to receive timely treatment as recommended by physicians in charge of your case or at the intervals required by your insurance policy.
You May Benefit from Adjustments in Your Treatment Plan
Another reason it is important to receive ongoing, regular treatment from your doctor is that they may notice changes in your condition and recommend alternative treatments. Alternatively, they may determine that your treatment regimen is not producing the expected results and that you might benefit from a different approach. Your doctors may inform you about new treatments that you may want to consider.
It is rare for an individual’s condition to remain exactly the same over time, so as your condition changes, you can receive treatment tailored to those changes if you continue to see the doctor regularly.
Increasing Understanding
When a disabling condition strikes, whether caused by an illness or injury, and whether it primarily affects the body or the mind, the person affected usually needs to see one or more medical specialists who are intimately familiar with treating that condition. This will involve a doctor and medical team unfamiliar to the patient. It can be hard to trust new medical providers and to open up around them.
On the other hand, it is challenging for new providers to understand the lifestyle, personality, and physical characteristics of new patients. It takes time to establish a foundation of knowledge and trust between a doctor and a patient. Therefore, regular visits to the specialist will provide the healthcare team in the office with a better understanding of you and your condition in relation to your overall health. This allows the medical team to customize treatment to you personally.
In addition, it gives you, as the patient, more opportunities to learn about your condition and recommended ways of addressing the challenges that come along with it. The more interactions you have, the more opportunities you gain to ask questions and seek information that can help you going forward.
When your doctor needs to write a report for the insurance company, there will be a larger base of knowledge to draw on, so the report will be more complete and persuasive.
Gaps in Care Raise Red Flags to Insurance Companies
Insurance companies are in business to make a profit, and they achieve this goal more quickly when they pay out fewer claims to policyholders. So there are certain features they search for routinely when reviewing a claim for benefits. If there are gaps in treatment records, that raises a red flag, indicating that a claimant is not doing what they should be doing to improve their condition.
It doesn’t matter whether the patient gets no new test results, medication, or treatment. It may feel like the visit with the doctor accomplishes nothing. But at the very least, regular visits to the doctor show that a patient is following directions and making reasonable efforts to improve their condition and recover.
Regular Treatment Improves Mental Well-Being
When busy professionals who are used to a fast-paced work environment are removed from that environment and routine due to a disability, the mental shock can have far greater effects than expected. Deprived of the stimulation and activity that enabled them to thrive, professionals often sink into depression when they are unable to work.
Regular doctor visits and ongoing treatment enable a professional to stay engaged with their medical care and connected with other professionals. Continuing treatment has been shown to reduce the feelings of isolation and neglect that frequently plague claimants who are unable to work due to long-term disabilities. The connection, interaction, and progress toward a better future can significantly enhance the sense of well-being in numerous ways.
Even if the condition itself is unlikely to improve, ongoing treatment provides opportunities to learn new ways to adjust and overcome challenges, enabling a claimant to move forward.
Need Help Managing a Disability Insurance Claim? Seltzer & Associates is Ready to Assist
Ongoing treatment is essential for a variety of reasons when a disability prevents you from working. But you need to fulfill other requirements as well, and these can be overwhelming when you’re not familiar with the process.
Whether you are filing an initial claim for disability benefits, appealing a denial, or need to maintain your eligibility, the experienced disability insurance attorneys at Seltzer & Associates are ready to help. For decades, we have dedicated our practice to helping professionals get the disability benefits they need so they can focus on recovery. We invite you to schedule a free, confidential consultation to learn how we could assist in your case.