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    STD approved partially

    Hi
    I'm starting a new thread as my other other thread's subjects are irrelevant to current status

    Recap
    I was diagnosed with PPMS 20 years ago and have managed to work fulltime until recently that employer put some pressure and too much stress at work got me to point that my MS symptoms worsened and not manageable

    My neuro has been supportive of me going on disability since 4-5 years ago, but I preferred to continue working as long as manageable.

    Now neuro ordered me to stop working immediately , go on disability for 3 months.

    Following company's policies, I notified my manager and submitted claim to insurance provider

    Insurance provider approved my claim promptly before receiving medical documents from neuro
    But approved for one month and said "if your disability extend beyond that point, we will need an update from your healthcare provider "

    My question/concern :
    Is this common to approve claim partially and request for update ?

    Or could be employer is interfering in process ?

    Please share if you have experienced such.

    Thanks in advance.

    #2
    Mine was approved this way. It was initially approved for 4 weeks, with update needed to extend it. Since no change and no improvement, extended. Second time, I think they required medical update in another 8 weeks. But the STD claim adjuster called me every 2 weeks to see if any change.

    Your STD policy may state how often they need medical forms filled out to extend. Then again, it may not, and based in doctors notes and you, may be up to discretion of adjuster.

    Glad you were approved.
    Kathy
    DX 01/06, currently on Tysabri

    Comment


      #3
      Originally posted by brave View Post
      I'm starting a new thread as my other other thread's subjects are irrelevant to current status
      Actually, those subjects aren't irrelevant because they serve as markers for how you got to your current status. And they can be important reminders when the details start to drift over time and from thread to thread.

      One of those important details is that you live in California. So no matter what anyone else's experience is, you're subject to the laws of California, which may be different than in many other states. It's your responsibility to know what the state and federal laws are that apply to your situation, and to get the information directly from an official source, not by just asking around.

      California has its own short-term disability insurance plan. The state runs its own program but allows employers to take over and administer the SDI program for their company in a Voluntary Plan, subject to state laws. So depending on the employer, an employee might apply for SDI directly with the California SDI program or through their employer's Voluntary Plan. It sounds like your company has a Voluntary Plan and you applied through their SDI administrator.

      Both the state-run SDI program and Voluntary Plans have mandatory periodic medical recertification periods that are independent of the length of the SDI leave. That's a requirement of the California SDI program, not your employer. If an employee misses a deadline for submitting their continuing medical certification for SDI, no matter how short or how long their SDI leave is, their benefit payments will stop.

      Originally posted by brave View Post
      Or could be employer is interfering in process?
      Before you start getting paranoid and making things harder on yourself than they need to be, it's in your best interest to contact the California Employment Development Department (EDD) and find out exactly what the regulations for SDI in California are for both your employer and you. It would be really sad to have to read a post from you saying that you relied on bad information, missed some kind of a requirement, and had your SDI terminated.

      Comment


        #4
        Good point about state regulations. The key is to know what the plan regulations are, regardless of who actually administers it (state, insurance company, 3rd party, or even employer).

        But even if you know the rules, I can understand still wanting to know people's experiences going thru the process. It always helped me, either by reassuring me during a scary time or by helping alert me to something I should explore further.

        The best advice I received: don't exaggerate, never lie, keep a good symptom log, and document all conversations so I could refer back later.

        Continued good luck.
        Kathy
        DX 01/06, currently on Tysabri

        Comment


          #5
          re:
          My question/concern :
          Is this common to approve claim partially and request for update ?
          - I was required to have my dr. re-certify my disability once a month.

          Other Notes:
          - My STD was not originally approved until my dr. submitted the medical forms.
          - In my case my employer handled all CA-SDI related requirements transparent to me. My pay and benefits continued just as if I was working full-time.
          - As stated above it was really important documenting everything as I worked thru the process.

          Comment


            #6
            Yes, I have had to provide medical updates during STD. Sometimes I would just hold up the scrip, take a selfie and send that to HR.

            Comment


              #7
              Hi brave,

              The worst time I had was when I was trying to decide whether I could keep working or not and did I make the right decision. I went on anti-anxiety and depression meds. 3 years later, I still miss work and it's challenges, but I know physically,it was the right decision. I was retired at 50. Every now and then, I have a good stretch and think that just maybe, I could go back. Then MS shows me who the boss really is.

              Please talk to your neuro about your feelings. Do what needs to be done to get to a healthier you. Take it a day at a time. It is a big adjustment. And please, hate MS, but not yourself! You did nothing but fight hard!
              Kathy
              DX 01/06, currently on Tysabri

              Comment


                #8
                Thanks Koko and Pennstater for sharing your experiences

                Brave

                Comment


                  #9
                  Originally posted by brave View Post
                  Thanks Koko and Pennstater for sharing your experiences

                  Brave
                  Brave

                  Hope you're feeling better.

                  This stuff we go through sure isn't easy!

                  Share your stuff whenever you need to.

                  Take Care
                  PPMS for 26 years (dx 1998)
                  ~ Worrying will not take away tomorrow's troubles ~ But it will take away today's peace. ~

                  Comment


                    #10
                    Is lowering performance expectation a reasonable accommodation

                    Hi
                    I do have limited functionality in one hand only
                    My job requires me all day using mouse and typing on keyboard

                    I'm wondering due to my physical impairment , if Neuro request for accompdation of lowering the performance expectation and expect longer turn around time would be a reasonable accommodation to be considered ?

                    Thanks

                    Comment


                      #11
                      Originally posted by brave View Post
                      Hi
                      I do have limited functionality in one hand only
                      My job requires me all day using mouse and typing on keyboard

                      I'm wondering due to my physical impairment , if Neuro request for accompdation of lowering the performance expectation and expect longer turn around time would be a reasonable accommodation to be considered ?

                      Thanks
                      Hi brave

                      This info is from the Job Accommodations Network, US Department of Labor, and might help answer your question:

                      The following are not considered forms of reasonable accommodation and therefore not required under the ADA:

                      *removing or eliminating an essential function from a job
                      *lowering production standards
                      *providing personal use items such as a prosthetic limb, a wheelchair, eyeglasses, hearing aids, or similar devices if they are also needed off the job

                      Note: While employers are not required to eliminate an essential function, lower a production standard, or provide personal use items, they can do so if they wish.


                      You can read about Job Accommodations here:

                      https://askjan.org/Eeguide/IIRequest.htm

                      Hope this helps!

                      Take Care
                      PPMS for 26 years (dx 1998)
                      ~ Worrying will not take away tomorrow's troubles ~ But it will take away today's peace. ~

                      Comment

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