Need advice on the progression from STD to LTD to SSDI - Disabilities Message Board

GracefulOne · 08-05-2007, 09:11 AM

This is my first post to this board. I've read all 16 pages in archives and still have some questions.

I'm 31 years old and in the past year have had 3 surgies for spine/disc problems. I had two hemilaminectomies - September 06 on L5/S1 and November 06 on L4/L5. Approximately a month after my second one I was in a great deal of pain and my neurosurgeon repeated my MRI and found that both levels reherniated to a point that they were worse after surgery than before. It was then decided I would have a two level fusion with rods to try and support my spine - I had this surgery in January 07.

At six months post surgical, I'm still in a great deal of pain since the fusion and most times I'm in more pain than prior to having it. I returned to work exactly 3 months post fusion and have been struggling since. At my last neurosurgeon appointment he recommended that I reduce my hours to 20/week and see if it makes a difference in my pain level. Well, it's been almost a month and it hasn't made a bit of difference.

When I asked about the option of SSDI in the event my pain doesn't get better and I can no longer do my job, my neuro's OR Nurse said I should look for a new position. I have a sedentary job in which I work at a computer - what could be less stressful on the back than this? They have said that I'm so short out in the recovery from the fusion in addition to the prior to surgeries that it may take 18-24 months before I recover completely and have less pain - if ever.

In contrary, after seeing my pain management physcian last week he recommend I try Methadone for pain control and stated that there is always disability. I don't understand how these doctors work for the same affiliation and have such differing view points. I believe my neurosurgeon may be telling me this because they do not want me to give up so quickly and if the situation came down to it he would support me in applying for SSDI, however I'm not sure that is the case.

I've exhausted my FMLA leave for the year and am dipping into STD for the hours I'm not working. After meeting with my HR Consultant last week she mentioned that I may end up looking at LTD if this continues. I'm extremely concerned that I may lose my job of 11 years because of this pain level and the thought that I may not get approved for SSDI because of my age, condition, and/or not being supported by my neurosurgeon.

What has been your experience in the progression from STD to LTD to Disability?

Anyone with a similar condition have any advice or care to share their experience in getting approved for SSDI?

Thank you for your time.

kaybee · 08-05-2007, 03:13 PM

Alright Graceful, hope you don't regret asking...My husband followed the same scenario - first STD, then LTD and now SSDI. Initially he went out with a bad knee and was unable to return to his own occupation - ever. He received LTD for 24 months under his own occupation clause and then he had to be reviewed and approved under 'any occupation' which was a lot tougher to prove. One bad knee wasn't going to get him approval under 'any occupation'.

His LTD company required him to apply for SSDI benefits right away. After about a year of long term disability, he was terminated from his job since he could not return to that type of work. He tried going to college to learn a new trade and put in a full year of studying and then was hit with back problems followed by neck problems. During that time, he was denied twice for SSDI. He ended up with a 4 level fusion/4 level bilateral lami/foraminotomy (he had had a microdiscectomy the year before). He also needed a total knee replacement, opposite knee scope and 4 level cervical fusion. He was denied in spite of all that by SSDI a third time. His LTD insurance continued his benefits under 'any occupation' due to the other health issues that occurred right at the same time. They offered representation to appeal the SSDI decision. It worked to dh's benefit because he received a partially favorable 'on the record decision'. His review was scheduled for 18 months and it's overdue.

The LTD company still carries dh as active although his benefits are completely offset by SSDI. He doesn't get a check from LTD but if he's ever denied again by SSDI, then his LTD will kick back in. Two of his children shared 50% of his SSDI benefit. Now one child is 18 and our 6 yr old gets the total amount himself.

The SSA found dh disabled two years prior to the date he filed so he received backpay for 19 months and so did the kids. Most of that went to the LTD company, however. They didn't charge for the atty but took back every cent they paid dh for the previous 19 months.

That's our story in a nutshell. Hope you made it through the lengthy saga. BTW, dh is 47 now but was considered completely disabled at 44. The sad thing is, he had total support from his neuro and orthopedic surgeons as well as a lengthy history with his pain management dr. He even had the support of the dr. the SSA sent him to but was still denied. It makes no sense.

kaybee · 08-05-2007, 03:31 PM

Graceful, as to your personal situation, your HR person has probably told you about the LTD policy you have. Dh's was a very common cheap policy that he upgraded so he'd have 65% of his salary covered. We upgraded on a whim but it was a good one!

STD covered the first 6 months then turned into LTD for 24 months. If you go out on disability the same way, you'll be out of work while applying for SSDI. You'll potentially be covered with a monthly benefit for about 30 months and possibly longer if you are under the own occ/any occ type of policy. Unfortunately, the LTD companies often use anything against you to support a denial so like with SSDI, you have to have complete cooperation from your doctors. If your neuro isn't supportive and you know you can't work, maybe it's time to switch doctors. Maybe your neuro will come around if you sit down and have a heart to heart with him. Either way, SSDI needs to know that your disability will keep you from working for at least 12 months. Like you mentioned, it can take 18 months or more for a fusion to completely heal and there is no promise of being pain free.

Best of luck to you. There are plenty of people here who have traveled down this overwhelming path that also have some insight. Sorry I'm so long-winded!

GracefulOne · 08-05-2007, 05:08 PM

Kaybee,

Thanks for sharing your story...I'm definately overwhelmed already...so many life changing decisions to make...I guess I'll keep looking for more examples and try to keep learning so I can make the most informed choices as possible.

I'm also thinking that if I had a heart to heart with my neurosurgeon and he understood the gravity of my situation perhaps his story would change...as I said before I know they don't want me to just give up...but...I don't know how much longer I can keep trying...it's exhausting!

Thanks so much for sharing.

littlelady2852 · 08-05-2007, 05:38 PM

Hello.. i am a 44 year old female and i was on STD then LTD for 2 years. I have a cyst on my spine and have been out of work almost 3 years.I have no health Insurance to have my surgery to have it removed.
Since my LTD stopped last month i hired a LTD lawyer and he is now working on getting my money from this insurance company. He said it looks like he has a good case and takes about 2 to 3 months to recieve any thing from them.
I just wonder what that process is like ? What will my lawyer do to see that i get what i deserve.I didn't ask him so i just need to know. I have never been through so much crap in my life and in pain all day every day.
I need my surgery so bad so i can go back to work.But i have no health insurance.I applied for SSD but i was denied 2 times.Suppose to go back again in the morning and apply again.
Thanks so much ! littlelady 2852