I would like to take this opportunity to try and help anyone who is currently dealing with an injury or illness and at the same time dealing with an insurance company with a disability policy. I had my first introduction to this situation over ten years ago. Luckily, I was a survivor, not only of illness, but a survivor of the murky waters of disability insurance companies.

Believe me, when I tell you that for the most part, these insurance companies love to collect their premiums, but do everything they can possibly do so they won't have to pay you. If you are truly due moneys from a disability insurer and can provide accurate documentation, pursue every avenue you have to collect what is due you! If you are too ill to fight, have a family member or advocate represent you. All too often, deserving people do not get what should be coming to them. Of course, the insurance companies state that fraud is why they are so careful to check everything, but in most cases it's just an excuse not to pay you.

In many instances, you will need an attorney who specializes in disability insurance. An attorney who has been recommended and has your interests in mind work very nicely. I have found that a very strong letter from an attorney representing you can be very helpful. These companies will back off if they see you have representation and your case is valid.

I have so much to say, but I will do it over a period of time. The message I would like to leave today to anyone that is fighting for their just and due benefits, is be sure to contact your HR dept. if you have a group disability policy with your employer and let them know what you are dealing with. After all, they are paying all or part of the premium and should know how their employee is being treated!
Steven 6530

Hello.. well i am in the process of my lawyer trying to get my LTD longer than 2 yaers. My payment stopped last month and the laywer said today that they are giving the insurance company 10 days from this past friday to let them know if they are gonna continue to send me my checks every month. if my laywer does not hear anything then the insurance company will have a law suit. I just hope it moves fast i have no money coming in right now to pay my bills.
Littlelady2852

Hello...Yes this is a common practice of disability insurance companies.
It depends on what the terms of the policy are, but if they suddenly stopped paying without explanation, then they are definitely trying to see if you will respond with representation by an attorney.

They know you are depending on that money and they hold the upper hand.
However, if they refuse to pay and you sue and win in court, they are subject for all back pay and much more. It amazes me how they do this and get away with it! They love collecting the premiums though, but seem to have a hard time paying benefits. Good Luck...
Steven6530

They stopped my benefits because by what they were saying i could only get it for 2 years, due to that i could not preform the duties that i was able to do when i was working there. But my problems with the back now are worst than they were before and i cannot work at all. Thats what 3 doctors told me in writing and said that my problem with my cack is getting worst on the nerves in my back.
Do you think they would pay for me to have my surgery on my back or would that be included in the pay out if there is one ?
Littlelady 2852

I am a 45 year old male and make a great living. I have STD and LTD at work and I have been on pain medication due to a neck injury years ago. I go to a pain management doctor and some days the pain is so unbearable I hide out in my office for a couple of hours and just try to relax. A co-worker saw me taking some of my medication last week and made the comment that if HR found out I was taking pain medication they would send me home because it is against company policy and I could injure myself or someone else. I have thought at times to just go out on disability but have never done it. My doctor has asked me in the past if I wanted him to write a report and take me out of work due to my pain. Basically, my spinal cord is crimped between two vertebrates with no relief...even tried facets. I take an average of 6 Hyrocodone, 3 SOMA pd.

My questions are...can they make me quit work because I am on pain medication?

Would I get disability?

In a way, yes. In my line of work, mental accuteness is absolutely necessary. We can not remain on the job if we have even taken a cold medication that causes drowsiness. A couple seconds of unattentiveness can cost someone's life. If you have an injury requiring pain meds, administration can require an employee to have a doctor's note stating their fitness for duty. If that can not be accomplished by the time FMLA is exhausted, the employee may be terminated.

As far as disability goes, I would hope your employer would ask you to go out on disability. We do no have STD & LTD at my job, so someone else would have to tell you how that would work.

Should I automatically file FMLA? What is the purpose of doing this?

steven6530
I always read from folks here being cut-off of LTD after "2 Years".
Is 2 Years a standard amount of time?
The reason I ask is because my LTD, a major carrier, thru my emplyer, cut me off after 12 Months. That was a year ago. Since then the SSA ruled me "Disabled" for my entire time since application filed.
Do I have any recourse to get the other 12 Months?
I'm sure they will want some of my SSDI Backpay, but I say they owe me too.

I thought the disability paid you until you retire?

Should I automatically file FMLA? What is the purpose of doing this?

FMLA is the Family Medical Leave Act. This gives you 12 weeks of leave, whether paid or unpaid sick leave. Therefore, you are not quitting your job, you are taking sick leave. Your employer provided health insurance will continue until the end of the 12 weeks. Take your short term disability leave at this time. That gives you time to get your affairs in order, such as making sure that your other insurance policies are going to pay, BEFORE your put all your eggs in one basket and quit your job.

You may even be able to make a formal request to extend your leave for an additional time period. At my job, I can request additional time up to 1 year. Therefore I am still job attached and my health insurance, although I pay the premium, has not switched to cobra.

I thought the disability paid you until you retire?

LTD will only pay for the number of years that the contract states (average is 2 yrs). Social Security Disability, SSD is altogether different. That you will apply for through the SSA and it will probably take 2 to 3 years to get a final determination. If you get a favorable determination, you will have a review every so often to verify that you are still disabled. For any time that you are approved for SSD and LTD at the same time, there is a offset. Your SSD amount will be reduced so that you will be getting no more than 80% of your gross wage at the time you became disabled. Also, you will not have insurance unless you cobra your employer provided insurance, which is only good for 18 months. You will not be eligible for medicare until 2 years after you are approved for SSD.

sounds to me you should take out Private health insurance and maybe a separate disability policy for your self and family. That way if you become disabled you will be covered. I think this is okay but maybe someone else can chime in and say something. I know people that have donw that but are not disabled.

My LTD insurance company sent me the last check the end of june 2007. They sent me a letter stating that the medical staff will look over my medical report and that I would have to go to an independent doctor and after seeing the doctor that the medical staff will look over the report again and let me know what they decide.All of this was to take place within 45 days. I called the person handling my claim to find out why it's taking so long. She told me that maybe my address is not right but the address was right. I waited another week still I didn't hear anything from them. When I called back she told me that maybe the phone number was wrong. She had my mom's phone number so I gave her my home number. I told her if they called my moms house that she would have told me. I felt like she was giving me the run around. So I remember reading Steven's post to get in touch with HR. I did that and the person in hr told me to fax her the last letter that was sent to me from the insurance co. She called them to find out what was going on. She called me back and said she was told that the mix up was the phone number (45 days) and that I should be hearing from them soon. I faxed the letter on thursday and on friday morning I got a call from the external vendor ( my phone) asking me what day would be a good day for me to see the doctor. On monday evening she called and left message on my moms answer machine for me to call her. I can't figure out why she called me at my home number on friday and at my moms on monday?:confused: I will be going to see the doctor on oct. 16th. I hope it doesn't take long for them to get back to me. I was approved for LTD until I reach retirement age.

Anyone had to go to an IME for LTD insurance company?

I was told by my company that my health insurance would expire at the end of Oct unless I was approved for LTD. So I waited and waited and finally in the beginning of Nov I called the person handling the LTD claims and he said he had not made his decision yet. so Now I was without a paycheck and didnt know if I had insurance anymore. I decided to go to the doctor to see if I was still insured and guess what I am still insured and it is now Dec. but they will not call me and they have not paid any of my paychecks since Sept ( I am supposed to get 65% of my salary) My new Neurosurgeon stated in a letter that I am temporarally and totally disabled, and I sent the letter via fax 1st and then I sent it certified mail but no one signed for it on Thursday. Should I just go ahead and get an attorney (this is not a workmens comp claim)? I fugure that I must be approved for LTD since my insurance is still in force, but I need my paycheck more that anything. Please give me some advice.

Hello,
Due to a variety of things going on in my life my depression reached an all time high in October. I took a medical leave from work and was receiving partial hospitalization treatment for depression and anxiety. In addition I have fibromyalgia which is a severe flare right now. I was discharged a few weeks ago due to insurance purposes, and was told I can recovene after January 1. My work pays for long term disability policy and I can become eligible to apply for it at the end of March. A large part of my anxiety occurs when I have to deal with issues with work and speaking to work. Therefore I am hoping somebody might have received long term disability through work and can answer a few questions so I am a bit prepared when I make that phone call to work.

Specifically my questions are:
If you have received long term disability through a work policy:
--did you have difficulties getting approved for depression?
--were you doctors reports (therapists, pyschiatrists reports enough or did you have to see the insurance company's doctors)
--any advice you may have
--did your doctors have to provide a date to return to work
--did you receive money based upon your net or gross income

Thank you so much for any advice or answers you can provide?

I was told by my company that my health insurance would expire at the end of Oct unless I was approved for LTD. So I waited and waited and finally in the beginning of Nov I called the person handling the LTD claims and he said he had not made his decision yet. so Now I was without a paycheck and didnt know if I had insurance anymore. I decided to go to the doctor to see if I was still insured and guess what I am still insured and it is now Dec. but they will not call me and they have not paid any of my paychecks since Sept ( I am supposed to get 65% of my salary) My new Neurosurgeon stated in a letter that I am temporarally and totally disabled, and I sent the letter via fax 1st and then I sent it certified mail but no one signed for it on Thursday. Should I just go ahead and get an attorney (this is not a workmens comp claim)? I fugure that I must be approved for LTD since my insurance is still in force, but I need my paycheck more that anything. Please give me some advice.

First, your health insurance and disability insurance are two separate things which do not affect each other. Your disability policy cannot "run out". It was in place at the time or your disability, so even if you are fired you still are covered for this disability. I assume you have a waiting period? (Usually 90-180 days from last day of work and is defined in the policy). You will never get an approval before the waiting period is up. Do you have short term disability that covers the LTD waiting period?
Your employer cannot discontinue your Health Insurance benefits based on not being approved for LTD before your waiting period has run...since it is impossible for LTD to be approved at that point. Also, your employer must first send you COBRA insurance information giving you the opportunity to continue insurance at your own expense. this must be done 30 days prior to canceling.
\Once your waiting period is up, keep after the LTD provider. :cool:

Initially I was approved for LTD because of depression. I actually had a tbi but they were trying to get out of paying for it through wc. After finally paying out of pocket for a non wc psychoneurologist, I got a diagnosis of brain damage, neurological dementia, acute memory deficits and so on. I sent them the documents through my psychiatrist and received a letter stating that my benefits were over. I had been told before that if I could get a medical document stating that it was brain damage not depression they would pay me until SSD took over which from my mouth to God's ear will be in March. I cannot pay the bills with my tiny pension since I had to go out of work at a young age. This is so frustrating and it takes all my mental stamina just to deal with much less fight with. Suggestions???
MimGregg

My waiting period for LTD was up at the end of Sept.

First, your health insurance and disability insurance are two separate things which do not affect each other. Your disability policy cannot "run out". It was in place at the time or your disability, so even if you are fired you still are covered for this disability. I assume you have a waiting period? (Usually 90-180 days from last day of work and is defined in the policy). You will never get an approval before the waiting period is up. Do you have short term disability that covers the LTD waiting period?
Your employer cannot discontinue your Health Insurance benefits based on not being approved for LTD before your waiting period has run...since it is impossible for LTD to be approved at that point. Also, your employer must first send you COBRA insurance information giving you the opportunity to continue insurance at your own expense. this must be done 30 days prior to canceling.
\Once your waiting period is up, keep after the LTD provider. :cool: