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keepingthefaith
Regular Member


Date Joined Aug 2006
Total Posts : 331
   Posted 3/24/2009 4:04 AM (GMT -7)   
I have been on Long Term Disability (LTD) since April 2007, along with SSDI being awarded this past year with a disbility date of from 2007.  SSDI states I am being awarded for CD, Depression.  Since then, I have had a 2 level cervical fusion & chronic pain in hips & legs which a rheumy is treating me for with neurotin & going to physical therapy.  Not sure if the fusion worked will know in a few weeks after xrays.  Anyway, LTD reviews your claim after 2 years, the 1st 2 years is on your own job, then after 2 yrs they review for any type of job.  They have determined that they feel I can do a sit down job.  For numerous reasons I cannot.  I don't understand how the government grants me benefits & the LTD can terminate me just like that.  Of course, they informed via phone & they read what the adjuster work, which I believe all info was not looked at.  I am going to appeal.  Has anyone had a similiar situation?  Should a get a lawyer?  The lawyer who did my SSDI only does SSDI and Iam awaiting a referral from them.  In the meantime, I need to appeal but just don't have the physical & mental energy to appeal all this. I only have 60 days.  My last check was to be April 13, 2009, however, they sent it early & closed my claim already.  I live in NW Indiana if anyone has a referral for a lawyer.  Thanks for reading.
Dx with CD 1987, 3 colon resections, 3 rectal abcess sx, anterior cervical neck fusion with plate & screws,6/2008. Major depression/anxiety, kidney stones & sx to remove, now 45 yrs old.  Still trying to figure out this disease & all the little extra complications that come with this rollarcoaster of a life with CD. Meds:Humira 40mg every other wk, Imuran .75 daily, welchol 625 x 3 daily, cymbalta 60 mg daily, fish oil, folic acid,Vit B12,inject monthly, Oscal w/Vit D, Darvocet N 100 4-5 daily, xanex .5 nightly
 
         
 
 


AlwaysRosie
Veteran Member


Date Joined Jan 2005
Total Posts : 8616
   Posted 3/24/2009 5:10 AM (GMT -7)   
(((((((((((( Faith )))))))))))))

So sorry you are dealing with this red tape on top of your medical issues.

I don't have any answers for you, but some of the ladies on the Lupus forum have had problems exactly as you describe. If you post on the Lupus forum and talk to "Lynnwood", she has just gone through this and is very articulate. She may be able to shed some light on it for you.

Blessings!

In His Grip

AlwaysRosie           "We can't control the waves, but we can learn how to surf!!"

Psalms 139

Co-Moderator - Lupus Forum

UCTD, Inflammatory Arthritis, Diverticulosis, (recent dx - Sjogrens, Crohn’s 4/08)

Clickable Links:  Lupus Resources    Lupous.Org   Lupus Criteria (4 of 11)   Lupus Chapter Locator


Stef17
Veteran Member


Date Joined Feb 2003
Total Posts : 1811
   Posted 3/24/2009 6:52 AM (GMT -7)   
From my own experience - my understanding is that you can't have the LTD and the SSDI at the same time. When you were awarded your $ from the gov't, didn't the LTD people try to take most, if not all of your award back as payment? That's what they did to me. My company's policy was that if you get on disability from the gov't then they only pay 10% of what they were paying you before. For example - $1000 a month, then became $100.

You need to find out what your company's policy is. If the policy is not in your favor (and they usually aren't) then it won't be worth it to fight it. Their goal is to NOT pay you anything. They want to keep their money. So, if they think that you are capable in the slightest, you will not get a dime. If you really want to fight it you need to appeal by writing a letter stating all of the reasons why you cannot work a desk job. Show how your illnesses make you disabled in quantifiable terms. For example - "I am so weak I am unable to sit up for more than 5 minutes at a time." or "The side effects from xyz prescription med makes me so shaky that I am unable to hold a pen steady enough to sign my name and I am unable to drive." Whatever it is that you CAN'T do, you need to spell it out for them. You can't just say, "I feel bad" or "I need a bathroom" because they don't give a crap.

It is tedious to go through the process, so I completely understand why you wouldn't want to. I say you should find out what the LTD policy is about payment in conjunction with SSDI. If they don't have to pay you any more, then appealing is a moot point. If they do have to pay, then decide if you want to appeal or not. You'll need medical records to back it all up. Remember they are looking for ANY and EVERY reason not to have to pay you. Good luck!

keepingthefaith
Regular Member


Date Joined Aug 2006
Total Posts : 331
   Posted 3/25/2009 7:03 AM (GMT -7)   
Thank you guys for replying.  Yes the appeal process is a pain in my A..  However, I am going to appeal, a lawyer is calling me tomorrow.  Actually, if they decide to take the case then I know I have a good chance.  I'm just so confused, SSDI says one thing & I really feel the LTD just pushed the "terminate" button.  They told me over the phone & I still don't have official papers, but the file is "closed".  Another problem with "corporate america".  I know I can't work right now & thats the principal here.  If anyone else has advice please reply, thank you so much everyone.

Dx with CD 1987, 3 colon resections, 3 rectal abscess sx, anterior cervical neck fusion with plate & screws,6/2008. Major depression/anxiety, kidney stones & sx to remove, now 45 yrs old.  Still trying to figure out this disease & all the little extra complications that come with this rollarcoaster of a life with CD. Meds:Humira 40mg every other wk, Imuran .75 daily, welchol 625 x 3 daily, cymbalta 60 mg 2xdaily, Wellbutrin xl 150mg 1x daily, fish oil, folic acid,Vit B12,inject monthly, Oscal w/Vit D, xanex .5 nightly, Gabapentin 600 mg 3x daily, Soma 350 mg nightly & Tramadol/apap 37.5/325 mg 3-4x daily
 
         
 
 


FitzyK23
Veteran Member


Date Joined May 2005
Total Posts : 4219
   Posted 3/25/2009 7:35 AM (GMT -7)   
I'm not sure if this is really "advice" as it is more of an explanation. I know a little about this stuff b/c my husband used to work in LTD claims. Each policy has different coverage set by the contract with the employer. Some have maximum benefit times regardless of whether you are still disabled. Typically any "self-reported" disability has the shortest benefit time. Self-reported does not mean you are making it up. It means there is no concrete proof a doctor could give the company. Good examples are pain and depression. Depression is diagnosed based on symptoms reported to the doctor, not based on a cat scan that sees a tumor. So your CD would probably be covered under the longer provision because it is verifiable by tests. However, CD alone doesn't make one disabled. It is the symptoms, and those are often self-reported. If the part of your CD making you disabled is bathroom trips and pain those can't be "proven" by the doctor. If the part making you disabled was fistula, abcesss, etc. then you would probably fall under the other longer coverage provision.

So assuming your symptoms are mostly self-reported they evaluate you under step two (and since it has been 2 years) to see if with an accomodation you could work any job. They found that you could work a seated job. That is not enough for them to find. There has to be jobs available, in your area, for which you are qualified that provide that accommodation. I believe even if they close your claim they are supposed to transition you. Give you a career coach, help you find the kind of work that you can do, start you with a reduced schedule, etc. I would call the disability company and ask about getting those kinds of benefits if you lose your appeal for full coverage.

I am guessing that if you read your contract there will be a strict time limit on self-reported disabilities. Even verifiable disabilites (ie: cancer) have a time limit on how long one can receive benefits under some plans.

Good luck!

They will also take into account if you could work with accommodations such as frequent bathroom breaks, reduced work schedule, adjusted work station so you can alternate sitting and standing, etc. SSDI may still find you disabled because they don't have a time limit on their coverage. It is a government benefit.
 
----------------
 
Edited to add: also look at your contract to see what qualifies as symptoms of the disability.  Under 99% of plans not being able to drive has no bearing on if you are disabled.  I don't know how they expect you to get to work if you live in a rural are but those are just the arbitrary rules.  I guess they want you to carpool or something.  Also, being on a medication that effects your ability to concentrate does not qualify under a lot of plans.  You didn't elaborate on why you can't go back to work so I can't give you my opinion if they are reasons the company will accept. 


27 Year old married female law student (last year!!). Diagnosed w/ CD 4 years ago, IBS for over 10 years before that, which was probably the CD. I am sort of lactose intollerant too but can handle anything cultured and do well w/ lactose pills and lactaid. For crohns I am currently on Pentasa 4 pills/4x day and hysociamine prn. I also have bad acid reflux and have been on PPI's since age 13. I have been through prilosec, prevacid, and nexium. Currently I am on Protonix in the morning and Zantac at night.  I take xanax prn for situational anxiety (aka no easy bathroom access). 

Post Edited (FitzyK23) : 3/25/2009 8:38:23 AM (GMT-6)


Homeboy
Veteran Member


Date Joined Dec 2005
Total Posts : 637
   Posted 3/25/2009 12:06 PM (GMT -7)   
www.diforums.com -- Lots of ERISA experienced lawyers read this forum, and will help you. There are also links for ERISA lawyers, who only work on group LTD insurance.

or

www.disabilityinsuranceforums.com

Both links take you to same place.

smilewinkgrin
CD dx @ 13 (1987)
Prednisone 8mg every other day
Imuran 100mg day -- Stoppped March 09
Celexa 20mg day
Pain Meds -- Morphine Sulfate
Vitamins + B12 Injections Once Per Week
Gallbladder Resection -- 3/19/09 -- Fingers crossed


keepingthefaith
Regular Member


Date Joined Aug 2006
Total Posts : 331
   Posted 3/26/2009 11:21 AM (GMT -7)   
Thank you again for everyones advice.  I have gone on the suggested website & they are very informative.  I spoke with a firm this am, just giving info on the claim & I will know in a week if they feel the case is worth pursing.  I do believe it is, but, we'll see.  Its been a week since the LTD called & I have not recd any formal paperwork at all.  After re-reading the policy, I do feel I must appeal.  However, the firm will advise me & I will let all of you know what they suggested.  Take care & thanks again.  smilewinkgrin
Dx with CD 1987, 3 colon resections, 3 rectal abscess sx, anterior cervical neck fusion with plate & screws,6/2008. Major depression/anxiety, kidney stones & sx to remove, now 45 yrs old.  Still trying to figure out this disease & all the little extra complications that come with this rollarcoaster of a life with CD. Meds:Humira 40mg every other wk, Imuran .75 daily, welchol 625 x 3 daily, cymbalta 60 mg 2xdaily, Wellbutrin xl 150mg 1x daily, fish oil, folic acid,Vit B12,inject monthly, Oscal w/Vit D, xanex .5 nightly, Gabapentin 600 mg 3x daily, Soma 350 mg nightly & Tramadol/apap 37.5/325 mg 3-4x daily
 
         
 
 


inflamed
Veteran Member


Date Joined Nov 2005
Total Posts : 1340
   Posted 3/26/2009 11:58 AM (GMT -7)   
Yes, get an attorney who specializes in ERISA. The problem with LTD is that with most of them the people who review your claim also pay the claim. They have a conflict of interest in the process. Getting the assistance of an attorney can help you deal with this.

The fact that you qualify for SSDI is relevant and should be considered when they review your situation. There are all sorts of technical differences in plans/policies, but the attorney you talk to can sort through it and tell you what you are facing. Good luck.
Hoping to stay in remission after the birth of a healthy baby girl. On Pentasa during my pregnancy, went med-free 2 months to nurse (stupid), but back on Pentasa and still nursing.

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