Approved for SSDI but LTD carrier now denying

[OhioKris]

My long term disability carrier has determined I am no longer disabled and should return to my prior job. I filed appeal but they denied. I have 6 months to file another appeal but feel I need an attorney to handle this now. Can anyone recommend someone in Philadelphia or Northeast PA?
Thank you!
Kris

[pennstater]

Replied to your other thread. I didn't realize you already appealed with LTD. I am not sure my attorney would take case or not. If you email, will send contact info.

Was your appeal denied before or after your SSDI approval? Was your SSDI approved initially or did you have to appeal at federal judge level? Is your LTD appeal with the insurance company or now in legal system?

I know the language specific to your policy is critical to the definition of LTD. Some policies are your own occupation, some are any reasonable occupation within a specific financial amount, and some are just any occupation. A lot of policies also have a 2 year clause which changes the definition.

Mine was my own occupation for 2 years, then it was any occupation that paid 80% of pre-disability income. I was fortunate in timing. My SSDI appeal was with federal judge and approved 2 months before LTD had to rule on my appeal. If LTD denied, it next step was with courts. Federal judges don't like to rule opposite of other federal judges, so LTD finally approved.

I know some attorneys don't like to take a case if you already lost an appeal. They like to be involved in initial appeal. If mine won't, maybe he would know someone who would.

[kelm10]

What I had to do.

I was denied for my LTD company.

What I had to insist on doing was they do what is called a functional capacity exam. It is a 8 hour day PT and OT tests. To show whether you can function in an 8 hour day.

I also had a neuro psych testing done because I had loss some cognitively.

[OhioKris]

Thank you for your reply

Replied to your other thread. I didn't realize you already appealed with LTD. I am not sure my attorney would take case or not. If you email, will send contact info.

Was your appeal denied before or after your SSDI approval? Was your SSDI approved initially or did you have to appeal at federal judge level? Is your LTD appeal with the insurance company or now in legal system?

I know the language specific to your policy is critical to the definition of LTD. Some policies are your own occupation, some are any reasonable occupation within a specific financial amount, and some are just any occupation. A lot of policies also have a 2 year clause which changes the definition.

Mine was my own occupation for 2 years, then it was any occupation that paid 80% of pre-disability income. I was fortunate in timing. My SSDI appeal was with federal judge and approved 2 months before LTD had to rule on my appeal. If LTD denied, it next step was with courts. Federal judges don't like to rule opposite of other federal judges, so LTD finally approved.

I know some attorneys don't like to take a case if you already lost an appeal. They like to be involved in initial appeal. If mine won't, maybe he would know someone who would.

I was referred to an attorney by my LTD carrier as soon as my disability kicked in. Their policy is I have to apply for SSDI immediately. I was approved for that fairly quickly and LTD continued to pay their portion until 5 months ago when they did a peer review and their Dr says based on my med reports, I can return to my prior job. I filed the initial appeal myself- I used to be a claims adjuster and it was just ludicrous!! I just received the denial and I can deny again within 6 months. I will try to send you an email. Thanks again!

[Marco]

I was referred to an attorney by my LTD carrier as soon as my disability kicked in. Their policy is I have to apply for SSDI immediately. I was approved for that fairly quickly and LTD continued to pay their portion until 5 months ago when they did a peer review and their Dr says based on my med reports, I can return to my prior job. I filed the initial appeal myself- I used to be a claims adjuster and it was just ludicrous!! I just received the denial and I can deny again within 6 months. I will try to send you an email. Thanks again!

Kris,
You doing your appeal did not have a negative consequence on your case. A law firm that specializes in ERISA drafted mine and it too was denied. The LTD insurance company believes you are fit to return to work and without additional information they will most likely stick to their guns.

Like Kelm, I did a neuropsych examination and was found to have deficits that would prevent me from working. I did not do a functional capacity exam as it was unnecessary.

You may even have to return to work and "melt down" before they get it. It's so frustrating, but it's all part of the game to try to get you to give up or give in.

I am so sorry you are going through this. If your policy is governed by ERISA then contact an ERISA attorney. They normally will give you a free case review, but you'll need to share with them your actual policy contract and some specifics about your case.

I wish you well ....

[pb909]

I was approved mid-2015 for both LTD and SSDI for my PPMS without issues and it's sad to read about denials for those that actually qualify. I just received an LTD annual verification letter and forms to complete, I'm always worried that the insurance company is always looking for something to drop me!

[pennstater]

I was referred to an attorney by my LTD carrier as soon as my disability kicked in. Their policy is I have to apply for SSDI immediately. I was approved for that fairly quickly and LTD continued to pay their portion until 5 months ago when they did a peer review and their Dr says based on my med reports, I can return to my prior job. I filed the initial appeal myself- I used to be a claims adjuster and it was just ludicrous!! I just received the denial and I can deny again within 6 months. I will try to send you an email. Thanks again!

Did the peer review occur as part of a policy condition? A lot of policies have a 2 year clause. After 24 months of LTD, the definition of disability changes. It changes in the insurer's favor.

Most LTD policies want you to apply for SSDI, since they contain an offset clause. This clause enables the LTD benefit to be reduced by your SSDI amount.

My lawyer explained to me that the reason they usually don't represent someone after 1st LTD appeal was denied is that at the Federal level appeal, their hands are tied on "new" evidence that can be introduced. If that winds up being case, not sure if option to go back to work as trial with SSDI, then go back out and file new LTD with employer. I would definitely make sure how your policy works, timing between being able to file new claim vs. SSDI trial work period, etc...

[pennstater]

Just wondering OhioKris if any changes?

[Memphis Slim]

My long term disability carrier has determined I am no longer disabled and should return to my prior job. I filed appeal but they denied. I have 6 months to file another appeal but feel I need an attorney to handle this now. Can anyone recommend someone in Philadelphia or Northeast PA?
Thank you!
Kris

The same thing happened to me. They are discontinuing my LTD as of October, 2017. They seem to think my MS got better. LOL

Question: I will be 65 years old in June 2018. Does LTD automatically end at 65? The reason I ask is that if LTD ends at 65, I will only miss six months of LTD checks. This is not a large amount of money after LTD reduces the monthly benefit after factoring in my SSDI.

So, if LTD ends at 65 years old, hiring a lawyer would probably be more expensive than six months of LTD if I lose the appeal.

I was just planning on doing the appeal myself. My original LTD was denied in May 2015, then immediately approved after SSDI approved full disability in only EIGHT working days. SSDI is not in jeopardy, thank God!

[Mamabug]

For me, my LTD benefits convert to retirement benefits when I reach retirement age.

KPERS (Kansas Public Employment Retirement System) currently pays my LTD. I worked for a KPERS employer for 10 or 11 years prior to going on disability in 2008. The KPERS retirement system will add the years of disability to my work record, as if I continued to work for them. When I reach age 61 (in six years from now), I will have contributed the required number of employment years, based on the combination of my years of employment plus my years of disability.

At that point, my $100 monthly KPERS LTD benefit will convert to my KPERS retirement benefit, which for me, based on my income (which was part time) and my "years of service" will be approximately $650 per month.

I also receive SSDI. When I reach Social Security's retirement age, my understanding is that my SSDI benefit will remain the same, but will come out of their retirement benefits, rather than their disability benefits.

I don't know the details regarding why your LTD benefits would be ending in October 2017 or if you will be eligible for retirement benefits through your previous employer. Perhaps you need to make some phone calls to your benefits people. (Did they tell you they think you are no longer disabled? Did they tell you that you need to appeal in order to continue to receive benefits?) Maybe you're not losing anything but what you have is simply converting to something else?

[pennstater]

The same thing happened to me. They are discontinuing my LTD as of October, 2017. They seem to think my MS got better. LOL

Question: I will be 65 years old in June 2018. Does LTD automatically end at 65? The reason I ask is that if LTD ends at 65, I will only miss six months of LTD checks. This is not a large amount of money after LTD reduces the monthly benefit after factoring in my SSDI.

So, if LTD ends at 65 years old, hiring a lawyer would probably be more expensive than six months of LTD if I lose the appeal.

I was just planning on doing the appeal myself. My original LTD was denied in May 2015, then immediately approved after SSDI approved full disability in only EIGHT working days. SSDI is not in jeopardy, thank God!

Most commercial LTD, as well as private end at 65. They assume that is retirement age when actuaries price the policy. You can always call the carrier, let them know you are considering options and would like a copy of the policy (if you don't have one).

Lots of luck.

[kmallory1]

Full retirement age is 66 for those of us born between 1943 and 1954. My group LTD from my job stopped paying when I turned 66. I don't know how much difference another year will make in determining whether it's worth fighting.

[pb909]

You will need to check your LTD policy.

My LTD policy payout is good until I reach 65 (think it is a minimum of 5 years if you are 60 or older when approved...but I was under 60 so it's good til I'm 65).

My understanding of SSDI converting as stated above is the same.

[TheMSLawyer]

Memphis Slim - Most LTD policies terminate benefits at age 65, unless you are very close to your 65th birthday when you begin to collect under the policy. A simple call to the insurer or review of the policy should confirm your individual termination date.

[brave]

Hi
If larest social security statement says
You get paid XX, If you retire today

You get paid YY , if you retire at age 65

You go on LTD today , continue on LTD until age 65 that retirement kicks off

So will social security pay at age 65 , be XX or YY ?

Thanks