New Year, New Denials: How to Survive an Insurance Disability Review
You’re just getting back into the swing of things after the holidays when an official-looking envelope shows up from your insurance company. Inside, there’s a request for “updated medical information” and a stack of forms to fill out. Sound familiar? If you’ve been receiving long term disability benefits, this is the moment that can send your heart racing: the long term disability review.
Take a breath. A review doesn’t mean you’re about to lose your benefits—but it does mean it’s time to pay attention.
The good news? With the right preparation (and the right support), you can get through this. Let’s break down what’s really going on, what your insurance company is looking for, and how to protect yourself.
Why Insurance Companies Conduct a Long Term Disability Review
Here’s something many people don’t realize when they’re first approved for benefits: that approval wasn’t a lifetime guarantee. Insurance companies build periodic reviews into every policy to reassess whether you still meet their definition of “disabled.”
These reviews might happen once a year, every few months, or even monthly—it depends on your policy and your condition. But they’re especially likely at certain trigger points:
- The two-year mark, when many policies shift from an “own occupation” standard (you can’t do your specific job) to an “any occupation” standard (you can’t do any job at all)
- After a gap in medical treatment, like skipping appointments over the busy holiday season
- When your doctor notes improvement in your medical records—even offhand comments can raise flags
- When the insurer sees something questionable through surveillance or social media
Here’s the tough reality: unlike Social Security disability, private insurance companies don’t have to prove your condition has improved before cutting off your benefits. They just have to decide—by their own standards—that you no longer qualify.
That might sound scary, but knowledge is power. When you understand how the process works, you’re in a much better position to protect yourself. And if you’re feeling overwhelmed, our team at Tucker Disability Law is always here to answer questions—even if you just want to talk through your situation.
What Your Insurance Company Is Looking For
During a long term disability review, your insurer is essentially building a case. They’re gathering evidence to decide whether to continue your benefits—or find a reason to stop them. Here’s what they typically zero in on:
Medical records: They’ll request updated records from all your providers, looking for any notes that suggest improvement. Even innocent comments like “patient reports feeling a bit better today” can be taken out of context.
Treatment consistency: Have you been keeping up with your appointments? Gaps in treatment—especially over the holidays—can be used to argue that your condition isn’t as serious as you’ve claimed.
Functional capacity: They want to know what you can and can’t do. Can you sit for an hour? Walk to the mailbox? Concentrate on a task? Any changes here could affect your claim.
Surveillance and social media: It might feel invasive, but yes—they may be watching. Photos of you at a family event, picking up groceries, or even just smiling in a photo can be twisted to suggest you’re doing better than you say.
Independent medical examinations (IMEs): Your insurer might require you to see a doctor they choose. These aren’t always the neutral evaluations they’re made out to be, so it’s important to know your rights going in.
If you’ve been asked to attend an IME, that’s a good time to give us a call. Our attorneys at Tucker Disability Law can help you understand what to expect and how to prepare so you’re not caught off guard.
How to Prepare for a Long Term Disability Review: Your Checklist
The best way to protect your benefits is to stay consistent and keep good records. Here’s a checklist to help you stay on track:
☑ Keep all your medical appointments—yes, even during the holidays. Consistency matters, and gaps can raise red flags.
☑ Be honest with your doctors about how you’re really doing. It’s tempting to put on a brave face, but your medical records need to reflect the reality of your limitations—including your worst days.
☑ Keep a symptom journal at home. Jot down your pain levels, fatigue, and how your condition affects your daily life. These notes can be incredibly helpful if your claim is ever questioned. Need a simple way to get started? Click HERE to Download Tucker Disability Law’s Exclusive FREE Daily Capability Journal—it’s designed to help you track the details that matter most to your claim.
☑ Take a hard look at your social media. Consider making your accounts private—or taking a break altogether. That cheerful photo from your niece’s birthday party doesn’t show the three days you spent recovering in bed afterward.
☑ Read every form carefully before you sign. Insurance questionnaires are often designed to get you to downplay your symptoms. Take your time, be precise, and don’t rush through.
☑ Talk to your doctors about documentation. Make sure they understand what’s at stake. If they write “patient is doing well” when they mean “condition is stable but still disabling,” that small difference can hurt your claim.
☑ Know your policy inside and out. Especially if you’re approaching the two-year mark, make sure you understand how your policy defines disability—and whether that definition is about to change.
Not sure where you stand? Our team can review your policy and help you understand what to expect. Sometimes a quick conversation can give you peace of mind—or help you catch a potential problem before it becomes a crisis.
What to Do If Your Benefits Are Terminated: Your Action Plan
If the worst happens and you get a termination letter, we know how devastating that can feel. But please don’t lose hope—and don’t wait to take action. Here’s what to do:
☑ Read the termination letter carefully. It should explain why your benefits are ending and spell out your appeal rights and deadlines.
☑ Mark the deadline on your calendar right now. Most employer-sponsored policies give you just 180 days to appeal. Miss that window, and you could lose your chance to fight back.
☑ Reach out to your doctors immediately. Ask for updated records, supporting letters, and anything that documents your ongoing limitations.
☑ Understand that your appeal may be your only shot. In many cases, once you file your appeal, the record is “closed.” That means if you end up in court later, you can’t add new evidence—the judge only looks at what was already submitted. This is why getting it right the first time matters so much.
☑ Talk to a disability attorney before you file your appeal. Seriously—this step can make all the difference. An experienced attorney can help you figure out what went wrong, gather the right evidence, and put together the strongest case possible.
At Tucker Disability Law, we’ve seen how insurance companies operate—and we know how to fight back. If you’ve received a termination letter, please reach out to us right away. The sooner we get involved, the more options you’ll have.
You Don’t Have to Face a Long Term Disability Review Alone
Dealing with a disability is hard enough. Worrying about whether your benefits will be taken away shouldn’t be something you have to handle by yourself.
Whether you’re preparing for an upcoming review, you’ve been asked to attend an IME, or you’ve just received a termination letter, our team at Tucker Disability Law is here for you. We’ve helped countless people protect their benefits—and we’ve fought hard for clients who were wrongly denied.
Here’s our promise: we never give up. Not on your case, and not on you.
Ready to talk? Contact us today for a free consultation. Let’s figure out your next steps together—and make sure you have someone in your corner who truly understands what you’re going through.
Use the blue contact section to call us, live chat with us, or message us. You can also message us using our confidential contact form
