Dealing with my work's long term disability

[michael09070]

I just recieved a letter from my long term disability carrier and they informed me my symtoms were not sever enough to qualify. I am so pissed off I cant stand it. SSDI has approved me but my ins company( which I paid for monthly) says they dont agree with my nero. I have to submit an appeal to the insurance company. Has this happened to anyone else and if so did you win or lose. Just trying to keep the faith.

Thanks

[mjan]

No wonder you are pissed!! It usually happens the other way around. Does your LTD company know that SSDI was approved? That should take precedence..wouldn't you think?

Have you done a search on here to see about other LTD issues? There is a section, for social security issues..maybe in that section?

Hugs.. hope you get answers..and soon!! IF your ins keeps this crazy stuff up, then maybe you can add mental health DX to MS..Sorry.

Warmly, Jan

[onlyairfare]

Most LTD companies require you to apply for SSDI at some point, and then they reduce your monthly payment by the SSDI amount so they save money. So yes, they usually go by Social Security determinations, and usually SSDI is stricter than private LTD.

However, some companies make a practice of denying most or all claims, in hopes that you will not appeal, just go away, then they don't pay anything. You should definitely appeal the adverse determination - follow each and every step of the process so you can get what you have paid for. Some companies will try to deny your claim because "you didn't follow the rules."

You can always call the office of your state's Insurance Commissioner for help and advice. He or she is a public servant paid by your tax dollars just to be sure that insurance companies doing business in your state follow the law. It probably wouldn't hurt to make sure your LTD carrier knows that SSDI has approved you, and if the company does not treat you fairly you will call the insurance commissioner.

I used to be a health insurance executive so I know that most good insurers want to obey the law and pay you what they owe you without a lot of bad publicity and political pressure. Not all carriers are "good ones" though.

[Hawkeye]

My situation played out very much like yours, and it was one of the most frustrating and challenging periods of my life. It came to the point where I felt my struggle with the insurance company was WORSE than the life-changing MS symptoms I was dealing with.

My one bit of advice is: STAY AFTER IT FOR AS LONG AS IT TAKES to receive what you really deserve.

As I got sicker and sicker, and lost my farming career and then my once-thriving business, I was denied the coverage I had been paying for for 20 years at least three times. Their opinion was that I was still "OK," whatever that meant. They forced me to apply for Social Security Disability, and I was approved immediately. The insurance company, though, said their requirements were a bit different, and I "just didn't qualify."

I wrote letters, paid premiums, wrote more letters, paid more premiums, got letters from the doctors, paid premiums, paid premiums, and paid...

I was so frustrated (and by this time so broke) that I was ready to give up and stop paying them for coverage I nw thought would never be honored.

Fortunately for me, I decided to speak with an attorney acquaintance who I had respected for years. When he looked at the documentation from the case he was outraged, and offered to write a note on his letterhead to the company... and to do it for no charge!

Rather than continuing to deny, delay, and refuse to pay, the "sleeping bear" of the insurance company arose to respond to his letter with a vengeance. They ended up putting a private investigator on me to track my activities (a lot like watching a mushroom's growth, I think). After he came to my door unannounced and interviewed me personally, the PI said I'd have no more trouble getting my payments from the insurance company after his report.

Not so, Buffalo Breath!!

They AGAIN denied the claim, then issued summons for a sworn deposition. After a 3 1/2 hour inquisition that left me exhausted, confused, and "wrung out" like a washcloth, the company's attorney apologized after his findings, and said I'd have no more trouble getting my payments from the insurance company. Sound familiar??? By now, I didn't believe it.

BUT a week later, I received an "award letter" from the insurance company saying my claim had been approved, and that I would be receiving 3 1/2 years of back payment for most of the time frame they had fought the claim.

I could tell more, but I apologize for the length of this saga. When I saw your note, though, I wanted to try to tell this story to encourage you. The disability insurance game is fraught with fraud, so it is no wonder they are skeptical, but truly sick people deserve the coverage they've paid for for so long... and now really qualify for.

Don't give up, and don't quit.

I wish you the best,

Hawkeye

[michael09070]

Thank You All

I just want to say thanks to all who took the time to answer.
They know I have been approved for my SSDI but I never sent them the evaluation from my Psychologist who the Social Security department had me see for my claim. My psychologist said I have sever coginative issue and I believe that was the key to my claim with SSDI. I am sending the Psych eval. along with my appeal letter this time. I think it will be hard for them to fight that part of my disability.

Thanks again

[Windwalker]

What I learned from years in the insurance industry is simply this..."Insurance companies don't make money by paying claims...and certainly not by paying them quickly."

My LTD went through instantly, as well as the SS Disability.
The advice I think was sound was that you make the initial applications yourself...then if you get denied, and believe you are truly disabled and unable to work, get a Lawyer. There are a ton of lawyers and firms who specialize in this type of law.

What is key is that you can prove a history of symptoms and illness over time...like maybe visits to a PCP where you complained of the issues that prevent you from working.

Good luck...get an Attorney at this point. Make sure to have a copy of the LTD Policy in your possession.

[michael09070]

ltd ins

Just got a copy of my ssdi claim that was approved. I am going to send this to my ins company and let then read the reasons social security believes I can not work anymore. It states in my report the pych. says my cog skill keep me from remembering easy tasks and my ex skills are gone. Hope this helps dont want my company to fire me for not returning to work. Then I will lose my ins. that would be a major set back.

Thank You

[michael09070]

good or bad

Does anyone think it is a bad idea to send them my ssdi approval paperwork??

[onlyairfare]

Does anyone think it is a bad idea to send them my ssdi approval paperwork??

There may be some indication of what the insurer is looking for in the instructions on how to appeal. Usually you have to provide an explanation of why you believe the denial is wrong, and in this case, the fact that you are approved for SSDI indicates you are truly disabled, so naturally you believe the denial is in error.

If you can find an informed but impartial third party to look at the paperwork and then discuss this with you, that would be a good strategy. If your employer is a large company, you might talk to Human Resources. An attorney is always a possibility, though that would involve expenses.

I don't understand why you think your employer would fire you for not coming back to work. Do they not know you are ill? As a general rule, the company is not supposed to fire you because of illness and disability, that is against the law (ADA and FMLA).

[mtnwillow]

I was separated from my employment after being on sick leave for 12 months. They explained that I am eligible for rehire should my health improve. I lost my seniority and salary rate. I am still drawing disability from them though.