No announcement yet.

A couple questions

  • Filter
  • Time
  • Show
Clear All
new posts

    A couple questions

    Hi Jamie! I so appreciate you offering up services on MS World....thank you!

    I am in the process of applying for LTD through my employer paid program as my STD ended in early December.

    My MS was diagnosed in 2009 and I have been working for a few employers over this time period. In the past I had not missed work and did not take disability or FMLA (one employer company was too small to offer it). I am a married female in my later 50s with two teen daughters. My husband travels for work about 50% of the time. Sometimes it can be up to 10 days in a row and other times just a day or two.

    - the LTD policy mentions a “pre-existing conditions” clause. I have had an MS dx since 2009, long prior to eligibility and before I was employed by this current employer. My most recent issues surfaced this past calendar year. When I became eligible under the LTD policy my MS was doing quite well and overall not an issue in my job. In fact, I worked hard and long hours in a professional white collar job at an office downtown. Does this “pre-existing” clause include my MS dx back from 2009 and thus make this whole process not worth it? I can’t seem to get an answer from the insurance company.

    - the insurance company has asked for copies of my psychiatrist’s notes in addition to the summary she prepared for them. (She helps me manage depression, pain, anxiety, loss, and family stuff....I have seen her for almost 10 years). I don’t know what she puts in her notes but I am sure that some of it does not relate to the current issue of my disability and is of a personal and private nature. Is this amount of information always required? And what are my risks? I know she has other patients on disability and to my knowledge she has not typicallly submitted full meeting notes.

    - the ins company contracted with a 3rd party to help me apply for SSDI. Is it safe to use a 3rd party paid for by the LTD firm? If I am denied by insurance, what happens then with the SSDI application?

    - do you offer your services in the State of Colorado? If not, is there an attorney (or attorneys) in this state that you could recommend. (Someone that understands the complexity of MS with other multiple autoimmune diseases).

    - what can I expect to pay for legal services charge by an attorney for both LTD and SSDI?

    Between my health and the holidays, I feel very overwhelmed by this process. Any insight you can provide is truly appreciated!

    Thank you! Happy New Year!!

    Do you have a copy of the LTD policy? They will define a pre-existing condition- usually you get around this by having already been on the company´s prior plan for a certain amount of time or having been on this plan for a certain amount of time before applying for LTD. Ex. for me, if I had been covered by the LTD policy for at least 12 months before trying to use it, then the MS dx did NOT count as pre-existing. You must have your company´s policy and read through the fine print and definitions. I must have looked mine over 40 times and still needed attorney help to understand it all.

    I would go read the Linda Nee blog about applying for disability in regards to the psychiatry notes. LTD companies will ask for more info than they are legally allowed to request in hopes that they can pin your disability on a mental health issue and cut you off at the 24 month mark.

    3rd party "help" can get you the claim approval BUT you are giving the LTD company access to SSA/SSDI information that they would not otherwise have. By using a private attorney, you are limiting the info that the LTD co. can get. The LTD co. stays profitable by denying claims. Whether you use the 3rd party or hire an attorney, the payment is regulated by the SSA and has a maximum amount.


      Hi MGM,

      There was a thread started 8/4 "SSDI during STD/LTD process" which discussed using third party rep. Jamie replied with some things to think about that you may find helpful.

      As Temagami said, having the actual policy is critical. Most policies don't exclude pre-existing conditions as a whole, but have conditional terms. Mine was 24 months. I was immediately eligible for coverage once my employer started paying premium for me, which was Day 1 of employment. This would cover disability for a new condition. After 24 months of employment, my pre-existing conditions were covered.

      Also, my policy had wording specific to anxiety and depression. It covered it for 2 years as a cause of LTD, but after 2 years, only covered if in an institution. So it was important that if depression/anxiety were part of LTD claim, that it was secondary to MS related symptoms. My lawyer made sure of that so that they could not deny it at 24 month review.

      You can ask you psychiatrist/therapist for copies of medical records. Mine only sent the records that were included in the file. There were some personal things in there, which was hard to read. Actual notes they took were not sent, but if the discussion made it into the medical record, it was there.

      As for Payment, SSDI caps legal fees and should only be paid if you win. You may have incidental fees for medical records as well.

      For LTD, this is not capped. Some will bill by the hour, some a flat fee. The laws that govern LTD are ERISA laws and are different from SSDI. So you may find a lawyer who does both, or may need two. I had two as used an ERISA specialist first, then when SSDI denied, needed to obtain SSDI as well. My ERISA lawyer focused solely on that and did not get involved in SSDI. In the end, it was worth it for me. Since you are considering an attorney early, you may find one who does both. But I would make sure that is the bulk of their practice and not something they do occasionally.

      Good luck. It is overwhelming, so a good lawyer(s) really helps. I am going thru my 5 year LTD review currently. Reengaged my lawyer - don't want any issues.
      DX 01/06, currently on Tysabri


        FYI Jamie does both

        Hi MGM,

        During the LTD case that Jamie handled for my husband he suggested that he also take on the SSDI case if they initial application was denied (we did that ourself). We would have turned it over to him at that point but thankfully it was approved first time.

        You can always call Jamie and talk to him about your case instead of waiting for him to check the board for a reply. His number is somewhere in the stickies (I found it there).

        I too was feeling overwhelmed by trying to handle the LTD and SSDI processes as well as the medical conditions that required them to be filed, but Jamie took the brunt of that load from me and as such I was able to concentrate on the important task of the doctor appointments and treatments for my husband.

        Good luck.



          There are a lot of great answers to your questions posted here already!

          Pre-existing conditions clause: These clauses are not written as absolutes. Generally, policies have a waiting period to ensure that you are not hired and immediately claim disability based on a pre-existing condition. Many policies permit benefits if the person has worked for over a year under the policy before making a claim, or if the person wasn't actively treating for the condition in the months immediately preceding coverage. For patients with long-standing MS, you will generally be covered by LTD if you have been with the employer for a while. As Temagami helpfully mentioned, requesting a copy of the policy and reviewing this language would be wise.

          Psychiatrist notes: As noted previously, most policies include a two-year limitation for psychological-based disability. I've frequently seen insurers place MS patients and traumatic brain injury patients on disability for psychological reasons in an attempt to end benefits after two years. This type of limited approval can and should be appealed. Nevertheless, it is the insurer's right to request psychiatrist notes, and I would rather that they use these notes for a limited approval and appeal later (while benefits are being received) than have the claim denied up front.

          Insurer-based Assistance with SSDI: This has been discussed frequently on this message board; I don't support using the insurer's attorneys for SSDI. I believe that it is common for such entities to get confused about who the client is, the claimant or the insurer, when they rely upon the insurer to fill their caseload. Additionally, as mentioned, these entities will often share information with the insurer that a private attorney will not. What the insurer will not tell you is that, assuming LTD is approved, they will normally pay for ANY attorney to represent you in SSDI, not just their attorney. Although some have experienced success with the insurer-based groups, the quality of representation varies greatly, and my belief is that the benefits do not outweigh the risks.

          Colorado representation: My office has successfully represented claimants in the state of Colorado (I posted earlier today in response to Cavan's inquiry about how such representation generally works). As to expertise, over 50% of my clients experience neurological dysfunction, and the majority of those are MS patients. You are welcome to direct message, call or e-mail if you would like to discuss this further. Regardless of what counsel you choose, it is imperative that he/she be well versed in MS and specialize in disability claims.

          Fees: As for fees, SSDI is simple and LTD is more claim-specific. SSDI representation will likely be free if your LTD is approved (as the insurer essentially pays for your attorney). If LTD is denied, SSDI representation is set by statute at 25% of the past due benefit, not to exceed $6000. LTD assistance varies by office and depending on your claim. My office handles such matters only on a contingency basis (we only are paid if benefits are approved), but there is variation among attorneys, with some billing hourly, etc.

          Finally, don't let the process overwhelm you. Take it step by step, and know that people go through it successfully every day! Good luck!
          Attorney Jamie R. Hall's practice is focused on assisting individuals with claims and appeals for Social Security Disability and Long Term Disability benefits. He has assisted claimants nationwide, approximately half of whom are MS patients, from his Pennsylvania and Ohio locations. **No attorney/client relationship is created by this communication, and information provided herein is not a substitute for formal advisement.**