Your long-term disability claim has been approved, and a new letter arrives asking for medical records, an updated physician statement, or information about work and income. Approval can bring relief while leaving ongoing responsibilities. The next step is to identify what the reviewer needs, when it is due, and which policy provisions govern continued benefits.
Read the approval alongside the plan
Keep the approval letter, governing policy or plan documents, summary plan description, and amendments together. Review the disability definition, any scheduled change in that definition, proof requirements, benefit limits, and reporting duties. The Department of Labor explains that disability eligibility depends on the particular plan’s rules. Another person’s approval or reporting schedule may not apply to you.
For an ERISA-covered plan, summary plan description requirements include circumstances that can cause a reduction, offset, or recovery of benefits. Check the actual provisions addressing earnings or other benefits, and request a written explanation of an unfamiliar calculation. Keep award letters and payment records. Do not assume every payment counts the same way. Tax questions require separate review of your circumstances with a qualified tax adviser.
The ERISA notice and appeal protections discussed below apply to covered employer plans. Confirm the legal framework governing your coverage when reviewing its procedures.
Give the reviewer usable, truthful updates
Read each request before sending records. Identify the requested treatment period, forms, authorizations, deadline, and submission method. If you cannot obtain something on time, contact the reviewer promptly, explain the obstacle, and request an extension in writing. Keep the response; an extension should not be assumed.
Give your clinician the form and relevant occupational demands with enough time to respond. Discuss what has changed and what remains difficult: sustained sitting or standing, lifting, concentration, pace, attendance, or medication effects, as applicable. Ask the clinician to explain restrictions and limitations within their medical judgment. A diagnosis alone may leave the reviewer without the functional information the policy requires.
Follow medically appropriate care, and explain access problems or changes in treatment. Report improvement as accurately as continuing difficulties. Respond truthfully to questions about employment, self-employment, hours, duties, earnings, and other benefits. Describe any assistance or accommodations involved in work. Check the policy before relying on assumptions about how an attempted return to work affects payments.
Keep a submission record and review changes
Retain copies of completed forms, records, correspondence, and delivery confirmations. Record when a request arrived and when each item was submitted. If a clinician or employer sends information directly, ask what was sent and whether the reviewer received it. An organized file helps you identify gaps without assuming that a requested document reached the claim file.
The Department of Labor’s claims procedure guidance, question C18, explains that terminating disability payments after a continuing-disability review is an adverse benefit determination requiring notice and appeal rights under ERISA rules. It distinguishes benefits ending after a predetermined fixed period. Read any change notice promptly and preserve its stated reasons and deadlines.
For an initial appeal of a disability denial or termination subject to these rules, the ERISA claims regulation provides at least 180 days after receipt of the adverse benefit notice and access, on request, to relevant claim materials without charge. Later appeal levels and court deadlines require separate review. Obtain advice early; continued eligibility and the appropriate response depend on your evidence and plan terms.
Learn about Feden Law Group’s disability practice or schedule an initial consultation to discuss a review or change in benefits.
You can also explore the FLG Claim Analyst (Beta).
Sources: Department of Labor plan and claims guidance, and the ERISA regulations linked above.
This guide provides general information, not legal advice. Reading it does not create an attorney-client relationship.