SSD Approved - What is next? Employer, Medical, STD, LTD questions

[MemphisSlim]

Ok, first the good news: I applied for SSD in the spring and was approved in record time (8 work days).

I will receive my first check in November (for October).

I am 62, so not Medicare eligible.

When do I inform my employer I will not be returning to work? I am appealing my work "benefit" for denial of short and long term disability. As expected, they have been doing everything to delay my appeal/decision.

My employer has me listed as "employed" but I have not worked there in 5 1/2 months.

If they "retire" me, because I am on SSD, and not likely to return, what happens to my private insurance appeal for short and long term disability coverage. I was hoping to get a lump sum settlement, to cover six months of savings I had to burn to replace income, as well as six months of my current medical copay I have kept in "escrow" (about $4,500).

I retained a lawyer at one point but cannot afford to pay him up front anymore to continue. SSD lawyers are paid if application is denied and they win an appeal. Private disability STD/LTD is paid out of pocket.

Questions:

1. Do I call Human Resources and tell them my status? How soon before SSD kicks in do I need to tell them? The current date is 10/15/2015.

2. If I am no longer employed, can the disagreeable private STD/LTD "benefit" appeal be dismissed?

3. If I am no longer employed, does my current health plan immediately end, or default to COBRA?

4. I am looking at health care options through the Affordable Care and NY State of Health sites and prefer tha to COBRA.

Any input to give me direction would help. I have learned the hard way that providing the correct answer to a question, phrased poorly, can cost you a LOT.

thx

memphis slim

[pb909]

I can only give you an overview of my experience:

I was approved for STD in Feb which could last a max of 6 months and when I was not going to return to work, I applied and was approved for LTD in August. I am now in the process of applying for SSDI which will offset my LTD payment if/when approved.

I remained in active status while on STD and was required to meet with my manager weekly, but once I was on LTD I was changed to inactive. I was then offered medical plans I could choose at discounted employer-friendly rates (I was never offered COBRA and I am not eligible for Medicare.)

Good luck with your journey and finding direction.

[MemphisSlim]

then "bad" news ...

Ironically, the private disability insurance provider denied my claim for STD and LTD, and that is what is under appeal.

My employer has not released me yet since the case is under appeal.

My dilemma is that my Soc Sec Disability will be effective Oct 15, and I am not sure how to proceed without risking loss of healthcare and closure of my STD appeal since I am not an employee.

My relationship with my lawyer has become very strained. I do not feel free to ask him questions about this without paying him an additional retainer.

I do need some legal advice but cannot afford it. I spoke to legal aid but household income, though modest, was too much to get free advice.

[jreagan70]

3. If I am no longer employed, does my current health plan immediately end, or default to COBRA?

This is a standard question, and the answer about when your insurance ends should be in your employee handbook. In my past jobs, health insurance has ended either at the end of my last working day (that's pretty immediate ) or the last day of the month in which my employment ended.

Whatever the effective date of the end of your employee health insurance, it's over and done on that date. You're eligible for COBRA at the end of your employee coverage, but COBRA isn't a direct continuation of your employee health insurance. COBRA doesn't go into effect until your insurance through your employee plan ends, and your COBRA plan has its own administrator.

Although the coverage under COBRA is with the same insurance company with the same benefits, it's a separate, individual plan, and the terms of your enrollment might be different than for your employee plan (or with an ACA plan). An indication of that is that, under COBRA, you pay individual rather than group rates for your premium. Your rights under the plan may also be different, and you'll have to comply with the COBRA administrator's terms of enrollment.

Also, somewhere in your employee paperwork, there should be documentation that explains your coverage under your STD and LTD insurance plans and the legalities they operate under. It's the same documentation you logically would have referred to when you filed your claims and your appeals.

If you don't have the information anymore, your HR representative should be able to provide it to you.

[MemphisSlim]

Update on Benefits - a good news story!

I spoke to my employer after checking out the NY State of Health website for options for medical insurance. FINALLY I received some good news without running a gauntlet.

My employer's policy is to allow me to carry my same benefits (medical, vision and dental) at the same rate as an employee, not COBRA rates for 29 months. This should bridge the gap between now and Medicare so I have some room to work things out. My wife can stay on the policy too.

I have been very lucky, when I hear some of the stories here. The stress has been hard on me and my wife, I can only imagine what it would like to wait a year or two for answers.

Be well.

[Mamabug]

Thanks for the update. I didn't notice your post, earlier this month. When I began reading, today, I was going to recommend that you read your employee handbook; I suspect every employer is different. My employer provided no STD; I could apply for LTD for up to 6 months following no longer being an employee.

The HR person didn't know that when I applied; she tried to tell me that I couldn't apply since I was no longer an employee. I'm so glad that I had read the policy. Because of that, I receive $100 per month for 20 years (over $20,000 by the time I reach retirement age) and my retirement income from them will be triple what it would have been, because they will count my years of employment as 30, rather than the 10 I actually worked.

[MemphisSlim]

Thanks for the update. I didn't notice your post, earlier this month. When I began reading, today, I was going to recommend that you read your employee handbook; I suspect every employer is different. My employer provided no STD; I could apply for LTD for up to 6 months following no longer being an employee.

The HR person didn't know that when I applied; she tried to tell me that I couldn't apply since I was no longer an employee. I'm so glad that I had read the policy. Because of that, I receive $100 per month for 20 years (over $20,000 by the time I reach retirement age) and my retirement income from them will be triple what it would have been, because they will count my years of employment as 30, rather than the 10 I actually worked.

Actually I read the policy, but I could not find anything about continuing my benefits on LTD except our private benefit (which had been denied, appealed, and finally approved).

It looks like I will receive LTD through my company, reduced because of SSD, but still almost another $100/month on top of SSD.

Everything that mentioned Social Security in HR Manuals, spoke to retirement not disability.

I am happy for you, mamabug! You are an "old timer" here like me! LOL

[pennstater]

Glad things are working out. It is so difficult as each state, and within companies, rules can be different. I am in PA, and for my company, if on LTD or if under appeal when turned down, still an employee.

But the benefits are limited, cobra for health insurance to bridge gap to medicare, can no longer contribute to 401k, and you no longer accrue time for any future benefits. I am considered an employee because if at some point I return to the workforce, the LTD policy says if a job is open and I qualify for it, then it is mine. At that point, I resume full benefits and start accruing time. However if denied LTD and exhaust appeals, then no longer an employee.



You really have to know your benefits. My advice for anyone still working is to have copies of STD and LTD, as well as employee handbook for benefits. And pay close attention to changes in these areas.

[Mamabug]

Actually I read the policy, but I could not find anything about continuing my benefits on LTD except our private benefit (which had been denied, appealed, and finally approved).

It looks like I will receive LTD through my company, reduced because of SSD, but still almost another $100/month on top of SSD.

Everything that mentioned Social Security in HR Manuals, spoke to retirement not disability.

I am happy for you, mamabug! You are an "old timer" here like me! LOL

Glad that you will also likely receive LTD. And, yes -- we are "old timers" here.

[MemphisSlim]

So far things are on track...

My first Social Security Disability check should be here in a week or so (fingers crossed). They approved my SSA application in a record setting eight working days!

Private disability STD insurance, provided by my company, was immediately denied. After I retained a lawyer and appealed, I was finally approved in September and was back paid to April 16th.

I will continue to get private LTD insurance, not a large amount after being adjusted for SSDI, but every amount helps, until October 2019.

I can stay on my company's benefit plan for medical, vision, dental if I pay the premium, for about two more years. The cost is scary though.

All together, with an STD lawyer for the private insurance appeal, and only my wife's part time income, we have spent about $8,000, out of pocket over the last 6 to 7 months.

SSDI appeals are paid to the lawyer only if the appeal is successful (but read the fine print to be sure of that). STD appeal lawyers for private insurance want money up front!

IF YOU CAN, make sure you put away savings to cover a disaster. If we had not been fortunate enough to build a safety net, we would have been draining our retirement account. This has been one of the most stressful years of my life, but it looks like everything is going to be OK.

We are happy living a somewhat frugal life. So we are very thankful for what we have.

God Bless you all. I will pray for all who are struggling and will try to give back as much as we can to others in need.

[Mamabug]

You are fortunate that your company offers STD as well. Mine did not, so I was without income during the five month waiting period.

Like you, my LTD is also reduced, because I am on SSDI. But my combined LTD and SSDI income matches the part time income I'd been earning prior to discontinuing work, so I also feel fortunate.

Glad things are working out for you.

[thelegendlc]

A couple of clarifications

MemphisSlim:

In your first post to your thread you indicated that you were approved for SSD. I assume you meant SSDI for the Social Security disability insurance program. In a later post, you noted that if you use a lawyer for a SSDI appeal you need to check the fine print of the agreement between you and the attorney. That is not really necessary, as the government sets their allowable fee at 25% of back payments that are recovered up to a maximum of $6000.

[MemphisSlim]

MemphisSlim:

In your first post to your thread you indicated that you were approved for SSD. I assume you meant SSDI for the Social Security disability insurance program. In a later post, you noted that if you use a lawyer for a SSDI appeal you need to check the fine print of the agreement between you and the attorney. That is not really necessary, as the government sets their allowable fee at 25% of back payments that are recovered up to a maximum of $6000.

My apology for the alphabet soup confusion! I do understand the differences, but did not communicate well.

When my application for short term disability insurance through my employer was denied,
I panicked and assumed my Social Security Disability application would also be denied.

I retained a lawyer to appeal the employer short term disability. He also wrote up a standard retainer for Social Security Disability, with payment to be provided as a percentage of my back payments if it was denied, as you described.

But he added in a clause that if my Social Security Disability applicaton was approved, I would pay him $1,000 for his time and counsel out of pocket. I did not really understand the impact of this since everything was happening so quickly, I was a cognitive mess, and I had TWO disability cases now.

My Social Security Disability application was approved in just two weeks, and he actually had very little to do with it!

I met with him and asked him to remove the $1,000 but ended up settling for paying him $500 out of pocket to END the stress litigation was causing me.

You could argue he took advantage of my stress aggravated anxiety disorder and cognitive issues. Legally, I cannot afford to argue it!

THAT is why I said to make sure you understand exactly what is in in your contract with the lawyer.

[thelegendlc]

Fee Settled

I am not sure if the $1,000 fee is appropriate. However, I think you did the right thing by settling for $500 and being done with the situation.

[pennstater]

STD/LTD are part of federal ERISA laws (employer based), while Social Security is totally separate law. The definition of disability can be different between the two, with STD/LTD defined by insurance policies, not governed by the SSDI definition.

My lawyer for my appeal of LTD would not represent me for SSDI, and conversely, my SSDI attorney only does Social Security. They have shared information/records to minimize cost where feasible. LTD lawyer was per hour fee with $500 retainer. No mention of Social Security at all in contract. SSDI gets paid only if I win, subject to the limitations described above: minimum of $6,000 or 25% of back award. If I lose, he can be reimbursed for medical fees if he incurred charges to get the records, and testing fees...but not his or his office's time.

Since you won SSDI, and your STD lawyer added language in the contract that enabled him to recover, I guess he was within his rights to do so. Personally, I find it very questionable legal practice.