Long Term Disability

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New Member

Date Joined Jun 2011
Total Posts : 2
   Posted 6/14/2011 7:38 PM (GMT -6)   
I need help in getting my long term disability approved. I had a spinal fusion/laminectomy last July. My employer paid for the long term and they approved me thru Nov 2010. I am still off work, my surgeon has not released me to return and even if he did I would not be able to sit for the six hours that the disability company states my job requires. I'm still experiencing a lot of pain and I'm told its due to SI joint issues. I have just started the Fentanyl patch 12mcg for the constant pain I'm having. I've appealed once already..and my favorite quote is "We respectfully disagree with Dr. SoAndSo." I'm going to lose my home as I've had no income at all this year. I need some suggestions on what I need to provide to this company to approve me and give me this back payment. I've also applied for SS but its too soon to have a decision yet.  And it gets better. Notes I've received from my doctor/surgeon have incorrect information in them, I plan to have a sit down with the doctor to review these mistakes and hopefully get them corrected. The problem with this is my just telling the Long Term company of these mistakes are not good enough. Anyone with any ideals I would greatly appreciate your input.

Veteran Member

Date Joined Jul 2009
Total Posts : 2042
   Posted 6/14/2011 7:48 PM (GMT -6)   
I would start by asking the insurance company exactly what they require to extend your long term disability payments. They may very well want a 2nd opinion from a doctor outside of your current doctors practice.

In the end though you may end up having to consult and hire an attorney.
2 confirmed herniated lumbar discs. Spinal Arthritis. Spinal Stenosis, diabetic peripheral nueropathy.

Forum Moderator

Date Joined Feb 2003
Total Posts : 15835
   Posted 6/14/2011 9:17 PM (GMT -6)   
Hi Kitty, welcome to Healing Well's chronic pain forum. I am so sorry to hear of the problems you are having with the long term disability insurance, but please know this is very typical of them to do this. When I worked it was in the legal field and we had many clients that were in your situation. They used every excuse in the book to deny a claim, but they would not always say "denied " instead it was we are investigating the claim, or the claim is being assigned to a new adjuster who will contact you, that sort of thing, I think you know what I am talking about.

I urge you to contact an attorneyy immediately. Get online and do your homework in locating a local atty to help you out in this. if you have a local bar association, contact them and tell them you need an atty that can handle a claim against a LTD company. Here several years back UNUM which is one of the biggest LTD companys out there was sued and fined big bucks for their claims handling practices, they denied a very high percentage of their claims for one reason or another.

Yes, you do need to get your dr onboard and get his medical records corrected as soon as he can, although I truly doubt that has had much bearing with the LTD. Most LTD company policy is after being off for x amount of time require the person to file for SSD.

Yes, it seems like it takes forever for SSD to get the ball rolling. How long has it been since you filed your claim? Well, like most people who file for SSD, they always get denied on the first time, that is just par for the course dealing with SS. If for some reason you get a denial letter, please contact an atty on this. Make sure the atty handles nothing but SSD claims and again, try to hire a local attorney. Find an attorney that takes the case on a contingency basis, meaning he gets paid if he wins your case, most attys handle the cases this way. I do not suggest paying an atty up front to take the claim. I would also stay away from what we called the tv guide attys that advertise how great they are, those guys are not worth shooting, lol. With them its a number game, high volume cases and they have no idea who their clients are either.

Anyway, I wanted to pop on here and tell you welcome aboard. Plese keep us posted on how you are coming along.
Moderator Chronic Pain Forum

New Member

Date Joined Jun 2011
Total Posts : 2
   Posted 6/15/2011 9:21 AM (GMT -6)   
Thank you so much for the advice. I have been searching for an attorney but because this is not a Workers Comp or injury claim I have yet to find one that wants to deal with it. I had severe spinal stenois in the L3 to L5 region which my surgeon did a fusion and laminectomy. I did so want this to be the end but I still have a lot of pain, I was told with the SI joint not much can be done surgerywise.  The LTD company has not requested a second opinion, I even asked them if they had a doctor who would examine me and they stated in some cases that warrent it...whatever that means but didn't suggest that in my case.  It hasn't been long in the SSD wait, I just got paperwork asking about work history...so no denial so far..fingerscrossed... If I had known that the LTD company was going to denie me after only one payment I sure would have done this all differently.  I put off the surgery since 2003 with therapy and just pain torrance and pills of coruse but it just got too bad..I spend most of my days lying down. I'm only 53 and do not want to spend the rest of my life like this...I know I'm just a baby compared to some of the stories I've read on this website and feel I shouldn't even complain. confused

New Member

Date Joined Mar 2012
Total Posts : 1
   Posted 3/25/2012 10:04 AM (GMT -6)   
Kitty - I have SOOOO BEEN DOWN THIS ROAD. I am three years post-spnal fusion (L-4 / L-5/ S-1) I would love to hear an update on your issue. Trust me when I tell you, this can NOT be done without a lawyer. (Specifically an lawyer who deals with ERISA cases) Be VERY CAREFUL going it alone. I am hoping that you have this issue resolved by this time. (although.....I can also tell you...the issue is never really resolved with these LTD companies) Please feel free to contact me at any time.....Misery loves company. If you would like to communicate, I would gladly provide you with my personal email as well.

Forum Moderator

Date Joined Mar 2011
Total Posts : 1276
   Posted 3/25/2012 12:51 PM (GMT -6)   
Hi watc2012 and welcome to the Chronic Pain forum, though I'm very sorry that you have had reason to join us here.

It would be fantastic if you could start a new topic and introduce yourself that members might all give you a proper welcome. You may not have noticed that this particular one has been 'dead' for more than nine months. For that reason, I'm going to go ahead and lock it.
Moderator - Chronic Pain Forum

Full body CRPS with spasms, dystonia & contractures, gastroparesis, orthostatic hypotension,bradycardia/tachycardia, bursitis, CTS, osteoporosis, multiple compression fx, disc bulges.

Oxycodone ER/IR, Topamax, Mobic, Somac, Cipramil, Midodrine, Vit D & C, SCS, baclofen/bupivacaine pump
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