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ERISA Disability Insurance Claims

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ACTIVE TREATMENT: I've heard that to receive benefits you have to being actively treated. My doctor has told me that I'm not a candidate for surgery and the best thing I can do is lose weight. How do I justify seeing him on a regular basis if he's not doing anything? Will the insurance carrier inquire as to what’s going on as far treatment, or can I just see him every 6 months for a check-up?

 

A: Most disability insurance policies do require that you be under the current care of a physician.  The term "actively treated" of course has different meanings for different illnesses.  At some point the insurance company may require you to be seen by an independent medical doctor to see whether the treatment you are receiving from your doctor is appropriate.  With some diseases/illnesses periodic checkups at six month intervals is appropriate.  Each case and each situation is different.  If you run into problems with your disability insurance company you should seek the advice of an experienced disability insurance attorney.


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