Permanent total disability (PTD) benefits exist to support workers who can no longer perform work. However, insurers frequently challenge that status using various tactics. This blog breaks down the most common insurer tactics and what you can do to protect your PTD benefits.
How insurers dispute PTD claims
To dispute a PTD claim, insurers must show that you retain some capacity to work in the open labor market. Meeting that standard requires building a detailed case against your disability status. Insurers use several key tools to gather evidence.
Insurers dispute PTD claims for financial reasons. PTD benefits are long-term obligations. Reducing or ending them can save insurers much money.
The role of surveillance in PTD disputes
Surveillance is one of the most commonly used tactics in PTD disputes. Insurers can present footage of routine tasks to challenge your reported physical limits. However, that footage alone does not disprove PTD status unless it shows that you can still perform regular work.
How insurers use IMEs and labor market surveys
In addition to surveillance, insurers often request an independent medical examination (IME). The doctor running the IME works at the insurer’s direction. This can influence the findings. Insurers may also order labor market surveys. These surveys claim that jobs exist in your area that match your physical limits. In reality, those positions are often not realistic for your situation.
What triggers a re-evaluation
Under South Dakota law, PTD benefits are subject to ongoing review. An insurer can file a petition with the South Dakota Department of Labor and Regulation if they believe a major change in your medical or physical condition has occurred. That petition can then start a review of your PTD status. Even a partial return to work could raise questions about your PTD status.
Understanding your rights during a PTD dispute
When an insurer tries to end or reduce your PTD benefits, you have clear legal rights. South Dakota law allows workers to request hearings before the Department of Labor and Regulation to contest a termination attempt. Workers can also dispute unfavorable IME findings and challenge inaccurate labor market surveys.
Protecting your PTD benefits
Insurers may order vocational assessments to support a return-to-work argument. Disputing those conclusions starts with a consistent record of your condition. Attend medical appointments regularly, record your daily limits and save all insurer messages. These steps can support your PTD claim. A strong record can help you defend your PTD status.