The decision to return to work after a prolonged absence due to illness or disability can be equal parts exciting and nerve-wracking.
While you and your doctor may feel the time is right to return to work, it’s important to keep in mind that things might not go as planned. It is not uncommon for an injury or disability to become aggravated once you are back at work — rehabilitation and recovery are not a straight line. That said, employers are obligated to make accommodations in the workplace to allow employees on LTD to gradually return to work.
If returning to work is on the horizon, there are some critical steps to take to set yourself up for success and avoid termination of your long-term disability (LTD) benefits.
Read your policy
Learning about your insurance policy’s approach to returning to work is crucial. If you don’t have your policy, ask for a copy from either your insurer or employer and review the return-to-work provisions.
Some policies offer a rehab return to work program coordinated by your insurer, employer and your doctor or treating specialist. Typically, you will slowly build the number of hours and days you work until you return to your regular hours. Often, some provisions allow you to earn income during this return-to-work attempt, and your LTD payments will not technically stop.
With this approach, your insurer will request medical clearance, and if your doctor thinks it’s safe, you can gradually return to work through this rehab program. The advantage is if the return-to-work attempt does not succeed, you can revert to your LTD benefits as long as you have the medical evidence to back up your claim.
Some policies may not offer a formal return to work program but might have a recurrent disability clause. This is where things can get a little tricky. With this clause, you return to work, and if your disability resurfaces within a specific timeframe, you can go back to receiving LTD benefits without having to reapply and without having another waiting period.
However, every policy sets out what period this recurrence can happen — some give you five to six months, but it can be less. Therefore, before agreeing to return to work, it’s essential to understand your policy. If your return-to-work attempt fails outside that time frame, you start your disability claim from scratch. You will have to make a new claim and endure a waiting period.
Involve your doctor
Regardless of the scenario, continue to involve your doctor and/or treatment providers throughout the process to ensure that any return-to-work attempt is made safely and is well-documented. Suppose you have physical disabilities, for example. In that case, you may need to consult with your employer ahead of time, so they can accommodate with special furniture, equipment or assistive devices to help you do your job.
Even after you have given clearance and are back at work, check in with your health care provider regularly to discuss how things are going. If your return-to-work attempt is unsuccessful, your doctor will need to provide medical records and reports as to why.
If you have an anxiety claim, for example, you might start to feel better after being off work for some time and feel ready to go back. However, being back at work might trigger your anxiety, and there could be a setback in your progress. It may get to the point where you can no longer function. In a scenario like this, you have to make sure that you have the medical evidence to justify why you need to go back on leave.
Keep in touch with your disability analyst or adjuster handling your claim as well, particularly if you feel like your return is not going well. If the insurer has a recurrent disability clause, you want to keep everyone in the loop rather than surprising them at the six-month mark.
The bottom line is that if your return-to-work attempt is unsuccessful, you will have to provide the medical records and reports supporting your disability claim. Your LTD benefits are only payable if you continue to meet the test of disability laid out in your policy. The terms can be different for each policy, so it is important to know the terms of your particular policy.
Refusal to reinstate
It’s important to note that your insurer can sometimes stop your benefits. For example, if your insurer and employer want you to return to work under the rehab provision and your doctor is on board, and you refuse, that could be a basis for terminating your benefits for non-compliance.
Ultimately, if your return to work fails your insurer should reinstate your benefits if you meet the policy’s test of disability. But, again, it all comes down to the medical reports and records you provide to back it up. You can’t just say you tried and failed. The insurer will need to see the medical reason and proof that you meet that test of disability.
If you and your doctor have provided this evidence and your insurer still refuses to reinstate your benefits, speak with an experienced disability insurance lawyer to help ensure you get what you are entitled to.
Let us be your long-term disability lawyers!
If your claim for disability benefits has been denied or terminated and you would like an opinion on your case, call our office at (289) 529-0404 to schedule a consultation.