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    LTD Appeal Successful

    I finally received some good news. My lawyer called to tell me that our appeal of the initial LTD denial was successful.

    They approved based on a neuropsych basis. They made sure he knew it was not approved on a neurological basis. So I fully expect that in 2 years, I will be fighting this battle again. So they agree can't do own occupation now. But when policy switches to any occupation that pays within 80% of my former wage after 2 years of disability, I am guessing they will say OK, you can work.

    But for now, I will be grateful that The appeal was successful. What a relief.
    Kathy
    DX 01/06, currently on Tysabri

    #2
    pennstater, relieved and happy to hear about your successful LTD appeal!

    I hope everyone considering appeal or in the process of a LTD appeal is inspired to not give up.

    Slugging it out with insurers with a legal team, deep pockets and vast resourses who wear down applicants who are sick, experiencing loss of income and medical insurance, with dwindeling resourses, and did I mention people who are sick? It takes a warrior to confront those odds. Huge congrats and enjoy your victory lap.

    Comment


      #3
      Thanks MSW. If I could take the lap, I definitely would. Maybe after the Ty infusion tomorrow.
      Kathy
      DX 01/06, currently on Tysabri

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        #4
        Make that a victory nap? Whatever you do to celebrate your victory, enjoy yourself.

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          #5
          Lol..victory nap taken!
          Kathy
          DX 01/06, currently on Tysabri

          Comment


            #6
            good for you

            I too was approved a year ago so now I wait for another year to see if they will screw me over and say I can work!!! No way I can , so we'll see . Good Luck!

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              #7
              Congrats!!!!

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                #8
                Thanks Limppy. I really hope neither of us have to go thru it again, but am skeptical. I wonder why....

                Thanks for the congrats Evolvn.
                Kathy
                DX 01/06, currently on Tysabri

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                  #9
                  Congrats Pennstater

                  Originally posted by pennstater View Post
                  I finally received some good news. My lawyer called to tell me that our appeal of the initial LTD denial was successful.

                  They approved based on a neuropsych basis. They made sure he knew it was not approved on a neurological basis. So I fully expect that in 2 years, I will be fighting this battle again. So they agree can't do own occupation now. But when policy switches to any occupation that pays within 80% of my former wage after 2 years of disability, I am guessing they will say OK, you can work.

                  But for now, I will be grateful that The appeal was successful. What a relief.
                  Congrats Pennstater
                  I'm happy for you.
                  My employer offers STD and LTD . my neuro is very supportive and has been asking me to stop working since 2 years ago but what worries me is my family medical insurance is under my plan and going on COBRA is very expensive.
                  do you know when you can apply for Medicare? I don't know if you're on COBRA or not , I'm wondering if one goes on COBRA then have to stay with COBRA for 18 months before applying for Medicare or what?

                  Thanks,
                  brave

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                    #10
                    Hi Brave,

                    I am fortunate to be on my husbands health plan. My understanding is that Medicare has nothing to do with your employer benefits. I think you can only get medicare when retired or if under retirement age, if considered disabled by social Security. The determination for SSDI is independent of your employer's LTD and STD determination. If you do get approved for SSDI, you qualify for medicare two years after your determined disability date. That is just my understanding. You may be able to call the NMSS to get further info.

                    If you have kids, there is also Medicaid, but I think that is determined by income, but really am not sure. You could also look into health plans offered on the new website that went live with "obamacare".

                    Good luck to you.
                    Kathy
                    DX 01/06, currently on Tysabri

                    Comment


                      #11
                      Brave

                      You can stop Cobra at any time. If the premiums become unaffordable, or if you aquire coverage under another policy, you can drop Cobra at any time.

                      Cobra coverage must be provided for no less than 18mos, but can be dropped for non-payment of premiums, or anytime the covered individual requests cancellation of the coverage.

                      There are circumstances that extend Cobra coverage for family members, aka 'Cobra qualified beneficiaries'?, who experience a 'life status change'.

                      For example if due to divorce, a spouse loses coverage during Cobra eligibility, the former spouse can't be denied Cobra, and may re-start the manditory coverage period.

                      Also, if a former spouse remarries during the cobra coverage period, cobra can extend coverage to uninsured new spouse and dependent children.

                      I haven't read Cobra rules in quite a while, but there are several status changes that extend coverage due to 'life status changes'. You can google cobra regs to become familiar with the various life status changes.

                      Good luck.

                      Comment


                        #12
                        MSW1963

                        Originally posted by MSW1963 View Post
                        You can stop Cobra at any time. If the premiums become unaffordable, or if you aquire coverage under another policy, you can drop Cobra at any time.

                        Cobra coverage must be provided for no less than 18mos, but can be dropped for non-payment of premiums, or anytime the covered individual requests cancellation of the coverage.

                        There are circumstances that extend Cobra coverage for family members, aka 'Cobra qualified beneficiaries'?, who experience a 'life status change'.

                        For example if due to divorce, a spouse loses coverage during Cobra eligibility, the former spouse can't be denied Cobra, and may re-start the manditory coverage period.

                        Also, if a former spouse remarries during the cobra coverage period, cobra can extend coverage to uninsured new spouse and dependent children.

                        I haven't read Cobra rules in quite a while, but there are several status changes that extend coverage due to 'life status changes'. You can google cobra regs to become familiar with the various life status changes.

                        Good luck.
                        Thank you very much MSW1963 for your reply
                        i love to drop Cobra ASAP but my ruestion is "from the time one goes on LTD and apply for SSDI , how long does it take for Medicare to kick-off? " then I'll be covered by Medicare and can drop from Cobra.

                        Thanks

                        Comment


                          #13
                          I think the Medicare waiting period is 2yrs from SSDI effective date of disability. That can be a very long time to pay premium cost for cobra coverage if you're recently approved for SSDI.

                          There may be some better, more affordable options available either for you or family members, possibly subsidized coverage for family members under Obama care, or with recent expanded state Medicaid coverage for yourself and/or dependents.

                          Consider working with a local insurance agent who can help you determine if you or dependents qualify for medicaid or a combination of subsidized coverage and medicaid.

                          Best of luck

                          Comment


                            #14
                            Congrats!

                            Pennstater,

                            For whatever reason, I am just now seeing your post. I'm so glad you were approved. You've been through so much through the process...I know you are not only delighted, but relieved it's over (for now)!

                            I'm so happy for you!!!!

                            Debbie

                            Comment


                              #15
                              Debbie,

                              Thanks so much for the congrats. I am incredibly relieved and have some peace of mind for now. I know what I will face later, but for now, I am taking it a day at a time and trying to save what I can.

                              Appreciate the well wishes.
                              Kathy
                              DX 01/06, currently on Tysabri

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