Receiving disability insurance benefits can bring much-needed financial stability when you’re unable to work due to an injury, disease, or medical condition. When those payments suddenly stop, the stress can be overwhelming. Many employees assume that once their benefits begin, they’ll continue until they recover or reach the policy’s end date, but that’s not always the case. Employers and insurance companies sometimes halt payments mid-claim, leaving individuals unsure of what to do next.
If you find yourself in this situation, it’s important to understand your rights and the legal options available to you. With guidance from an experienced lawyer, you can take the proper steps to protect your benefits and hold your employer or insurer accountable.
Why Disability Benefits May Stop Mid-Claim
Disability insurance benefits may be discontinued for several reasons, and understanding the potential causes can help you determine your next move.
Common Reasons for Payment Termination
- Reevaluation by the insurance company: Insurers often require ongoing proof of disability through medical documentation or exams. If they decide that your condition has improved, they may terminate benefits.
- Administrative or clerical errors: Mistakes in claim processing, missing forms, or incorrect employment information can interrupt payments.
- Policy limitations: Some disability insurance policies cover benefits only for a certain number of months or for specific types of conditions.
- Failure to respond to requests: Missing a deadline for providing medical records, income information, or treatment updates can lead to suspension of benefits.
- Employer intervention: In group disability insurance plans, your employer may have influence over the claim. Miscommunication between the employer and the insurance company can cause unnecessary payment delays or cancellations.
If your benefits have stopped and you’ve received no clear explanation, a lawyer who understands disability law can help you request a written reason for the termination and assess whether it complies with federal and state regulations.
What You Should Do Immediately
The most critical step after benefits stop is to act quickly and strategically. The longer you wait, the harder it may become to reinstate your payments.
1. Review All Correspondence
Check your email and mail for letters from the insurance company or your employer. Often, they will provide details about why payments have stopped. Keep every communication you receive, including digital messages, as they may become vital evidence in a future appeal or lawsuit.
2. Gather Your Policy Documents
Locate your disability insurance policy and any related paperwork provided by your employer or insurer. Pay close attention to sections detailing:
- Coverage limits and definitions of disability
- Medical evidence requirements
- Duration of benefits
- Conditions under which payments can be reduced or terminated
An attorney can review these details to determine if your benefits were stopped in violation of the policy or the law.
3. Contact the Insurance Company
If you haven’t received clear communication, call your insurance company’s claims department to ask for a written explanation. Take careful notes, including the name of the representative and the date and time of your call. Written documentation can support your position in any future dispute.
4. Speak to a Disability Lawyer
A qualified lawyer can analyze your claim, identify any legal violations, and help you navigate the appeal process. Disability law can be complex, involving private contracts and federal statutes such as the Employee Retirement Income Security Act (ERISA). Working with an attorney experienced in disability insurance and employment law gives you a strong advantage.
The Role of Medical Evidence
Your eligibility for continued benefits depends largely on the strength of your medical evidence. The insurance company may argue that your condition has improved, but your physician’s opinion and medical records often tell a different story.
Types of Evidence That Strengthen Your Claim
- Doctor’s reports describing the impact of your disease or injury on your ability to work
- Test results or hospital records for conditions such as cancer, diabetes, epilepsy, or multiple sclerosis
- Statements from specialists detailing ongoing symptoms related to heart failure or immune system disorders
- Records from mental health professionals if your claim involves psychiatric or cognitive limitations
An experienced lawyer can coordinate with your physicians to gather documentation that meets the insurance company’s standards and refutes inaccurate assumptions.
Appealing a Termination Decision
If your disability insurance benefits are terminated, you have the right to appeal the decision. This process can vary based on your policy, the type of insurance plan, and the governing law.
Steps in the Appeal Process
- Request a Review: Submit a formal request for reconsideration to the insurance company within the required timeframe.
- Submit Additional Evidence: Include updated medical records, test results, or statements from healthcare providers that demonstrate ongoing disability.
- Consult With Lawyers Experienced in Disability Claims: Attorneys who handle appeals can identify procedural errors, overlooked evidence, or violations of your rights under ERISA or state law.
- Prepare for Litigation: If the insurance company continues to deny your claim, your lawyer may recommend filing a lawsuit to recover benefits.
Appealing can be emotionally taxing, especially while dealing with health concerns, but professional legal aid can relieve much of the burden.
Special Circumstances That Affect Disability Claims
Not all claims follow a straightforward path. Certain life situations can complicate your eligibility or the insurer’s assessment of your benefits.
Examples of Complex Situations
- Pregnancy-related disability: Temporary medical leave can sometimes overlap with employer-provided disability benefits.
- Divorce or family changes: Financial obligations such as child support may influence benefit calculations or payment methods.
- Mental health conditions: Disabilities stemming from mental health or cognitive disorders are often more heavily scrutinized by insurance companies.
- Chronic or progressive illnesses: Diseases like multiple sclerosis, diabetes, or cancer can fluctuate over time, leading insurers to reassess eligibility.
In all these cases, having a knowledgeable lawyer on your side is essential. Legal professionals can interpret medical information and present it in a way that strengthens your claim.
How Rosen Moss Snyder LLP Can Protect Your Rights
When your employer or insurance company stops paying benefits mid-claim, you deserve immediate support from a firm that understands the law, your rights, and the financial pressures you face. At Rosen Moss Snyder LLP, our lawyers focus exclusively on disability law and have successfully represented clients across the United States.
Why Clients Choose Us
- Experience and Focus: Our legal team, including dedicated law clerks and attorneys, concentrates on disability insurance and related claims.
- Personalized Representation: We take the time to learn about your employment history, medical condition, and unique challenges to build the strongest case possible.
- Comprehensive Support: From filing an appeal to pursuing a lawsuit against an insurance company, we manage every step while keeping you informed through consistent communication.
- Access to Legal Aid and Pro Bono Resources: For those facing financial hardship, we can connect you with education and legal aid opportunities that may offset the cost of representation.
We’ve seen how diseases, injuries, and mental health challenges can change lives overnight. If you are dealing with stopped disability benefits, do not face the insurance company alone. Contact Rosen Moss Snyder LLP today to speak directly with a lawyer who understands disability law and knows how to protect your financial and personal well-being. Your future deserves a firm that fights to restore the support you’ve earned, so reach out today to start rebuilding your financial security.