For disabled individuals receiving long-term disability benefits, insurance companies
require their insureds to fill out progress reports. Depending on the nature of the claim
and the insurance company, insureds may be required to submit those reports monthly,
quarterly, semi-annually, or annually.
For most disabled individuals, their activity levels and activities change over time. Just
like everyone else, you may be more active during certain periods, or less active. You
may not work at all or engage in some limited work activities. You might remain living in
the same place and engaging in the same activities on a daily basis, or you may move,
resulting in a change of activity level.
Sometimes, those changes and activities can have an impact on how the insurance
company chooses to evaluate your benefits. Either way, the insurance company is
relying on how you represent your activities on those claim forms or progress reports in
order to determine whether to continue to fund your claim. Even if it is not your intention,
your cookie-cutter answers can significantly misrepresent your activities, since they
have shifted and changed.
For those who receive ongoing benefits, there can be a tendency to copy or cut and
paste the same information into each submitted progress report. Having represented
many clients during the claims process over extended periods of time, we can tell you
that this cavalier, cookie-cutter approach is dangerous and may result in significant
problems with your claim.
In reality, most changes in activity typically will not result in a change in status or
cessation of benefits. However, filing even unintentionally false representations on your
insurance claims and/or progress reports may result in the insurance company opening
an investigation to determine the claim’s validity and quite possibly, the suspension or
termination of your benefits.
So before you send your claim forms or progress reports to your insurance company,
we urge you to carefully review them and ensure that they are accurate representations.
If you believe you have a problem in this regard or are experiencing a problem with the
insurance company related to this issue, please do not hesitate to contact us.
Evan S. Schwartz
Founder of Schwartz, Conroy & Hack