LTD

[lstrl]

I was reading another thread about disability and someone said that long term disability claims have been filed after termination. I was wondering, if my disability was documented before I officially quit (and that was documented due to medical reasons), is there any chance I would be able to file a claim? I can't find any info about it in my employee paperwork or online where they have policies. I never had short term disability (couldn't find the option to enroll when I did all my benefits), but I did pay for long term disability after taxes.

My first day out of work was December 17, I had a document from my neuro December 21, and my official resignation was January 15 (and that's only because they told me that's what I had to do). I figured that I was ineligible since I no longer work for them, but I'd be grateful if I was told otherwise. Any advice would be greatly appreciated.

[MSW1963]

"and that's only because they told me that's what I had to do"

I'm not sure who 'they' are or what they told you, but I'm always a bit suspicious when there's the appearence HR or the insurer is less than forthcoming. My radar would be in heightened mode based on your post.

You would first want to determine that you met all the LTD policy limitations. Assuming you met the Group LTD eligibility to participate waiting period, usually one year of continous employment before eligibility to participate in the Group LTD plan.

The next is the waiting period, usually a one year waiting period during which you pay premiums but a period during which claims are not eligible for payment according to typical Group LTD policy provisions.

The next is usually a very important one to MSers, it's the 'look back' provision in most Group LTD policies. The look back period means that any claims submitted within 2 years of the policy effective date are subject to looking back in your medical history for evidence of a pre-existing condition.

For example, any doctor you consulted about anything in your medical records that could be MS related; doctor's notes about sx's you experienced or doc's observations regarding your medical condition, etc; even if you were not dx'd and there was no suspicion of MS at the time, could result in a pre-existing condition exclusion for payment of LTD benefits during the look back period.

Once you have met the 2 yr look back provision, claims typically can't be denied for a pre-existing condition, if you were dx'd 2 wk or 10 yrs.

Your resignation is fairly recent and based on the dates, your MS disability pre-dated your resignation. I know medical plans allow up to a year in many cases for medical claims to be filed, sometimes longer depending on the policy.

You are required to file a claim for benefits according to policy provisions, first and foremost; usually through HR. You can also contact the insurance carrier, if you know the Group LTD insurer.

If there is any hesitation at all, attempts to discourage you, etc., I would contact an attorney. If the deadline to file a claim is not met by you, you could forfeite your right to claim benefits, or it could make the process much more difficult. If you can pick up your claim forms or have someone pick them up for you, the effort it might be worth while to assure you don't get the run around from someone.

Best to conduct business with HR and the insurer in writing, and document anyone you speak with, including details of conversations, date, times, names.



Good luck and keep us posted.

[lstrl]

Thanks for all the info. When I look back, I should have done things a little differently, but I didn't know what I know now, and my employer wasn't exactly helpful. My manager consulted with HR, and it was a lady from HR that told her (at least that's what she told me) that I should resign. The weird thing about it though is the people who take care of benefits don't even have on record that I no longer work there. I also still have no info on cobra, and it's been almost a month since I quit (the other places I worked got it out quickly).

I did some further research today and I did find some provisions for LTD, but still not everything I need to know. One benefit summary said that LTD coverage starts the first day of employment if the employee chooses to pay for it (it's free for everyone after a year, but I only worked there 3 weeks before I couldn't do the job anymore). I did pay for it starting on my first paycheck.

The only waiting period I can find on the papers they provided online is the 90 day waiting period from the time the disability starts until they start paying. I wouldn't think there would be a year up front or else why would they let us choose to pay for it starting day one (something else I'll bring up if they tell me otherwise).

I did find some info that states they won't approve it for a pre-existing condition, but there were a few exceptions to that rule. One of them is that they look back and if you haven't received any treatment in the 365 days prior to the start of the LTD policy, then you can still be approved. I do have documentation since July 2011 showing that I've been seeing drs for MS related issues, but I never received any kind of treatment until January 2013, the day I was diagnosed. I also never had any symptoms bad enough that prevented me from working until the second week of December 2012 (sadly, I started working there November 26).

I'm going to call the benefit support center tomorrow to see what I can find out, and if they can't help me, I'll try to speak to HR directly (they're extremely difficult to get ahold of for anything though). I'm hoping I can get some good news, but I am not counting on it.

[MSW1963]

Thas has to be one of the most generous Group LTD policies I've heard of. LTD with those generous provisions haven't existed since the 1940s or 50s. For your sake, I hope all is as it appears. Definately not impossible for that to be the case.

Best of luck and keep us posted.