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Old 01-27-2011, 05:31 PM   #1
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Please help - Should I try for STD/LTD through my employer?

A little background..

I had a spine fusion L5-S1 in 2006 for a grade 4 spondy that the doctors said I've had since birth. While the surgery was a success, because my bones did fuse, I feel it just transferred the pain to other areas of my body, and put more stress on the other vertebrae. I work a desk job and am in extreme pain and discomfort throughout the day. All of the pain radiates into my upper back, neck, shoulders, and legs. I deal face to face with my customers and I find it very hard to concentrate on my job and provide good customer service. Also, I can't really sit for longer than 30 minutes without being in pain. It is very depressing.

I went to my doctor the other day and he said I will not be able to get disability because SSI will not approve it. He said SSI will need to see some sort of fracture or other problem, and because my spine is fused there is no longer a fracture.

I work for a very large company and have a STD/LTD program through them. Is there a chance of me being approved through my employer for STD/LTD? Has anyone here had success with this?

Thank you.

Last edited by guestguy; 01-27-2011 at 05:44 PM.

 
Old 01-27-2011, 08:25 PM   #2
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Re: Please help - Should I try for STD/LTD through my employer?

Sorry don't know much about STD/LTD but want to comment on the SSI. (Do you mean the SSA, disability determination? SSI is Supplemental Security Income.)

Are you working full-time? If so, you would probably be earning too much to get SS disability. You need to be earning less than Substantial Gainful Activity. If you are working part-time, you would have a better chance, but still- SS may think if you can work part-time, you can work full-time at a less stressful job than the one you have now.

You may want to get a 2nd opinion. Many people have been approved based on 'invisible' conditions or pain conditions like fibromyalgia and others. If you have the medical documentation to prove that you are unable to work, then you may have a good chance. Consult a lawyer or national disability firm to find out what your chances would be of getting SS based on your condition alone. But if you work full-time, most likely they won't take your case. But it doesn't hurt to ask if your condition would medically qualify in general.

Last edited by sunni123; 01-28-2011 at 12:50 PM.

 
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Old 01-28-2011, 07:42 AM   #3
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Re: Please help - Should I try for STD/LTD through my employer?

Thanks for the reply. I am working full time and would exceed the SGA amounts. I am getting a 2nd opinion with another doctor in my area. Hopefully I get better news from this doctor.

 
Old 01-28-2011, 09:23 PM   #4
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Re: Please help - Should I try for STD/LTD through my employer?

guestguy,

My first concern is that if you are still in pain, then you may still have a problem causing the pain. I'm glad to see you're getting a 2nd opinion, and I'd even encourage you to get a 3rd opinion. Be sure you are talking to some good spine surgeons that have at least 10+ years of experience. Have you had a recent MRI? Sometimes people develop scar tissue after having back surgery, and this is one possible cause of your pain which should (but not necessarily) show up on your MRI.

Have you seen a pain management doctor? If not, I would also recommend you see one to get their ideas and see if they think some injections might help your pain.

I would first explore the above avenues before considering going on STD/LTD or applying for SSDI. These options are hard to get, require strong doctor recommendations, and can be very hard on you financially and mentally. Find out what the doctors above say about any problems that may show up that may explain your pain. I wouldn't recommend asking any of them right away about whether they think you should go out on any type of disability as they will almost always say no and may label you as someone who is just looking for a doctor to let you go out on disability. If they find a problem and you have seen them several times and your pain still is unresolved, then you can explain to them how hard it is to do your job and ask their thoughts.

For me, I couldn't do my job no matter how hard I tried (spine problems also), so for me it was where I told my doctors I couldn't do my job, and listed clearly what was preventing me from doing my job.

Best wishes, and let us know how your 2nd opinion visit goes!

 
Old 01-28-2011, 09:40 PM   #5
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Re: Please help - Should I try for STD/LTD through my employer?

Yes, if your employer offers STD and LTD you may indeed qualify. PLEASE be sure to get a copy of both the STD and LTD plan so you understand what the benefits will be, I can help you understand some of the provisions.

My STD was 80% of my pre-disability wages and was taxable as it was paid for by the employer, and lasted 6 mo.

My LTD is 60% of my pre-disability income and did include commissions/bonuses. It is NOT taxable as I chose this option at initial enrollment when starting employment and thus paid all the premiums myself. {Having worked in the STD/LTD industry for 15 yr I knew which one to choose, never knowing I'd actually use it.

LTD is taxable to the extent to which the employer paid the LTD premiums.

Many employers cease employment either at the end of FMLA which is 12 weeks. FMLA often runs concurrently with LTD. OR they may cease your status as an employee when LTD begins. My company is rare in that I am retained as a "disability retiree" as long as I am on LTD and am therefore eligible for medical insurance though at retiree rates which are higher than employee rates.

STD will be evaluating to see if you are disabled from doing your own occupation. To do so they need at least one relevant treating doctor fill out what is called an Attending Physician Statement (APS) and all relevant doctors to provide medical records. By relevant I mean those which are treating you for the problem. So a podiatrist can't do an APS for spinal problems. And a PCP can, but it would need to be backed up by records, proof of evaluation and opinion of a spinal surgeon and pain management records.

Throughout STD the insurance company will evaluate your claim to see if you are improving, what treatment you are under, etc. Most back and neck pain claims are easily approvable for the first 4-6 weeks. After that they need to see ongoing medical proof in the form of test results, office notes, etc.

If you remain disabled throughout the STD period (which varies by employer but can be 3 mo, 6 mo, 9mo, etc) then your claim is evaluated for LTD.

For the majority of LTD plans the first 24 months (or 18/36/etc) is when the insurance company evaluates to determine if you are disabled from your Own Occupation. That means your occupation as it is performed in the national economy. So if your employer requires an accountant to lift 100 lb boxes that would not be a requirement of the occupation (odd example, but you get the point)

Then after 24 months the evaluation is if you are able to do Any Occupation for which you are reasonably trained by education, experience, reasonable wages, etc. So a teacher who is required to stand all day may be expected to seek out a sitting job if that's viable given her disability.

I went on STD 4/2009. STD was approved immediately and they needed updated medial every 6-8 weeks. To start the STD claim I had my spine doc and my pain doc complete an APS. The PM doc wasn't enthusiastic but agreed to do one APS and from then on only provide records.

After 6 mo on STD my claim did transition to LTD in 11/2009and LTD was approved. They do request medical every 4-6 months now. About 6 months after LTD started I had surgery and they didn't need an update for 12 months. I just recently had to send them an update.

LTD does requires that you apply for SSDI.

SS has two types of disability benefits:

(1) SSDI is for those with a recent and substantial earning history. Your award amount is determined by your earning history. Every year around 3-4 mo before your birthday SS sends you a statement of your potential award amount for SSDI and for SS Retirement. SSDI requires you be out of work 5 full calendar months to be eligible. STD and LTD are NOT earned income so they don't affect eligibility. So don't worry about SGA as noted above.

(2) SSI is for people that do not have recent or substantial work history so it is based on disability and financial need. The person must have minimal assets and money.

My example:
Went out of work in April 2009
STD started 7 days later (every policy varies)
LTD started 6 months later
After one year on LTD I was required to file for SSDI
LTD provided me an attorney and they will credit met the cost of the attorney
Since I last worked 4/2009 my SSDI waiting period is May, June, July, Aug and Sept
SSDI could begin 10/01/2009

Under most LTD plans SSDI application is required AND anything you get from SSDI is offest from LTD.

So if LTD pays you $3000/mo and SS awards you $2000/mo you will then get $1000/mo from LTD and the $2,000/mo from LTD. Neither SSDI nor LTD were meant to alone, or in combination, replace all of your lost wages. Thus SSDI is offset from LTD.

HOWEVER, the beauty of STD and LTD is that you have the money coming in every month during the SSDI process which can take years. I applied for SSDI in August 2010, was denied in November 2010, and my attorney filed for reconsideration in December 2010. They fully expect this to take years based on my "young" age of 44 and SS's notorious long process. While LTD evaluates to determine if you are disabled from your own occ and then any occ, SS looks at ANY JOB. So if a lawyer was earning $300,000/yr but can work at a $9/hr job SS considers that person employable. LTD is different. LTD would never expect someone who was an attorney to take a $9/hr job, that would not be applicable under "any occ"
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Old 01-29-2011, 09:30 AM   #6
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Re: Please help - Should I try for STD/LTD through my employer?

SpineAz, thank you for the detailed post. I'm very familiar with my STD/LTD plans at work. I actually get 100% STD for 4 weeks, then 65% STD for 22 weeks. After that it's LTD at 65%.

My primary concern is my fusion has healed and the x-rays and MRI's will show that. The fusion did stabalize my spine, but it really didn't take away much pain. Will the fact that I had a spine fusion be evidence enough for the insurance company to grant the claim?

Thank you!

 
Old 01-29-2011, 11:04 AM   #7
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Re: Please help - Should I try for STD/LTD through my employer?

My husband got hurt at work almost 3 yrs ago but didn't file workers comp at the time because they tend to find ways to get rid of people who do. He found out he was not going to be able to go back to work and got his STD without any trouble. Then while he was on that he filled out for LTD so that it could be in the approval process while getting the STD. All he needed was something from his Dr. and was approved in no time at all. He ended up not being able to return to work and LTD has been paying ever since. He had 5 yrs. of LTD but just got approved for disability so that will stop soon, but it wasn't no problem getting the STD or LTD.
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Old 01-29-2011, 11:06 AM   #8
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Re: Please help - Should I try for STD/LTD through my employer?

Awesome! Hopefully it goes just as smoothly for me

Take care.

 
Old 01-29-2011, 05:07 PM   #9
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Re: Please help - Should I try for STD/LTD through my employer?

If you are not already doing so be sure you've had recent evaluation with a spine surgeon (orth spine surgeon or neurosurgeon ) and active treatment with a Pain Management doctor as well. If you aren't in active pain management the disability insurance company wont be able to see proof of active and recent treatment for pain if that's your primary system.

Just seeing a primary care doc wont be sufficient beyond the first few weeks. Many disability insurance companies will authorize a period of 2-6 weeks for back pain and no specialty treatment or testing. Beyond that they need proof that the symptoms are being actively addressed. For someone Wichman. A history of back surgery the dis in co will want to see testing, physician eval, etc.

Have you had recent testing?
Are you actively seeing a spine doc?
Are you in active pain mgmt with prescription meds or pain treatments?

STD and LTD are "managed " meaning your claim is continually scrutinized.

I currently see my orthopedic spine surgeon as needed. I see my pain mgmt doc every month as he requires. I may need one more neck surgery and if that's successful after a year of seeing my spine surgeon every few months I may get to the point where I only see him on occasion for an eval to support nothing is changed and I remain unable to work. Based on the pain meds I am on I have to see the pain doc monthly (Ms continue requires a monthly visit ).

If you'd like I can share with you a template for a "personal statement " I provide to my doctors regularly. The forms required for STD and LTD ask doctors questions they really don't k ow how to address. The info I give my doctor gives him detailed info on what my job requires, what I can't do, why I can't due to spine pain, etc.

Currently I'm helping a friend who is an IT tech for a major financial company navigate STD. They approved him for 3 weeks for neck pain and now need medical records to substantiate more STD. The good news is that at a large employer you have 12 weeks of FMLA which includes job protection. During that time you can see if your STD claim is moving forward well enough to remain out of work.

STD and LTD can be work in itself as you have to be seeing the right docs and getting docs to provide what the ins co requests.

Age plays into it as well. An older worker may have more history to show an inability to work in part due to age. Someone with my surgery history at age 58 who has continued pain and dysfunction will find STD and LTD more "secure" in terms of less expectation of return to work.
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Fusions: L5-S1 (87), L4-S1 (93), C5-C7 ('06), L3-S1 ('10)
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Old 01-29-2011, 05:37 PM   #10
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Re: Please help - Should I try for STD/LTD through my employer?

SpineAZ, I have been seeing my spine docs multiple times yearly for the past 10 years. I've never been to a pain management doctor because my spine surgeon has never asked me to go. I've done physical therapy many times, chiropratic, massage, pain meds that the docs has given me, such as IB Profuen, muscle relaxers, etc.. I don't really like to take drugs to alleviate the pain. They make me very drowsy, high, and upset my stomach.

My age is 30 years old, which might be used against me, but I can show history dating back about 12 years with doctors visits, chiropractic, physical therapy, etc.

I have had recent testing like an MRI and nerve testing, but it doesnt show any major problems.

Thank you.

 
Old 01-29-2011, 06:56 PM   #11
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Re: Please help - Should I try for STD/LTD through my employer?

Yeah my husband does have to show he is being followed by a Dr. for his back. He was required to fill out for Disability but he was going to do that anyways. We were told originally that he would recieve it for 2 yrs. but when they checked the records and found that it was employee paid and not employer paid it extends it to 5 years. My husbad has been on it almost 3 years so we're glad he was finally approved for his SSDI but that took a ALJ hearing to get it. We're still waiting on the approval letter, but was told the day of the hearing he was approved. The company that he's with is Unum which has been pretty good for us. Now when & if you get approved for SSDI if you plan to fill out for it you have to pay them back what you have recieved unless you fill out and get approved for a Hardship Waiver.
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Old 01-29-2011, 09:45 PM   #12
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Re: Please help - Should I try for STD/LTD through my employer?

You may have a struggle getting STD to pay for more than a few weeks. And at the age of 30 your LTD likely pays to your SSNRA which is the Social Security Normal Retirement Age. For you it would be age 67 (and if I remain disabled my LTD goes to age 67) www.ssa.gov has info on SSNRA by year of birth.

I kept working due to pain management. First with epidural injections, a TENS unit, and medications. Over time ESI didn't work, pain meds had increased, etc. That showed the dis ins co that things had progressively gotten worse.

Pain management should be something you speak to your spine doc or PCP about. Good Pain management doctors can be hard to find so it takes suggestions from doctors or friends going through chronic pain.

Back pain with normal test findings, no diagnosis of a problem from a doc, and no proof of any kind of pain meds would lead STD to possibly be of the opinion the records don't show an impairment that would limit you from working. STD is closely managed as is LTD and they'll require medical records from the last few months to show treatment, referrals, etc. If the pain is sudden they want to see recent spike in treatment, testing, referrals, etc. It's not just stating your back hurts but having extensive and constant medical records that show ongoing treatment. That was the path of my condition. First it was injections and occasional vicodin and flexeril, then as pain became more constant they saw a change in medications to include a long acting pain med (first Opana ER and then MS Contin), neurontin, percocet, and soma. Plus they looked at my job that required car and plane travel with presentations and meetings at my customers, lifting of boxes of materials, extended sitting , etc. IF your job is very heavy then back pain again can get you 2-6 weeks of STD and then they need proof in medical records you can't work.

Biggest misconception about STD and LTD is that it only requires a doctor's note saying you can't work. To the contrary, what the doctor says must be backed up by all the medical records, exams, testing, treatment, etc.

If recently pain has spiked you have to advocate for yourself with seeking pain control andmaybe a second spine doc opinion. If you are in severe pain all day tell your doctors and work toward a treatment plan.

What meds are you taking?
What type of work do you do?
What is it that prevents you from doing your job?
What leisure activities do you do?
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Rt&Lt thumb arthroplasty 2012 ; RT TKR & Bilat CTS 2011
Fusions: L5-S1 (87), L4-S1 (93), C5-C7 ('06), L3-S1 ('10)
C5-C7 foraminotomy 08

 
Old 01-30-2011, 06:30 PM   #13
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Re: Please help - Should I try for STD/LTD through my employer?

I agree with SpineAZ that staying on LTD isn't as easy as having a doctor say you can't work. I've been out of work for about 3 years now, have had 5 spine surgeries, and am about to have a 6th. Even though I won SSDI at the AJL hearing and have MRI's that show I have scar tissue in my spine along with other problems, I am constantly hounded by my LTD company to provide proof of my on-going disability. Unless there is strong medical evidence of a disabling condition along with your doctors saying you can't work, they won't allow you to stay on the policy very long.

Also, if you've been working since your back surgery and then all of a sudden go out on disability, they will ask why you were able to work without missing any or much time, and then one day couldn't any more. They would want to see what medical evidence there was to support that.

 
Old 01-31-2011, 04:10 AM   #14
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Re: Please help - Should I try for STD/LTD through my employer?

SpineAZ, right now im just taking IBProfen. I've tried taking all sorts of meds which I hate doing. They upset my stomach and make me feel "high". There's no way I can concentrate at work on them.

What prevents me from doing my job is sitting for long periods of time. I work in a bank and I sit for 8-10 hours a day in front of a computer. After about 30-45 minutes my back is on fire. Everyone tells me, "cant you just get up and walk around and take breaks?". That really does nothing for me. Also, it's very uncomfortable and depressing which makes it hard for me to put a smile on my face. I'm paid 100% comission with my job, so this is a problem for me.

After reading everything here I might just have to wait until things get worse..

Bummer.

 
Old 01-31-2011, 05:08 AM   #15
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Re: Please help - Should I try for STD/LTD through my employer?

Perhaps get 1-2 other opinions from spine docs AND see a pain management doctor. PM doctors can work with you to help find the source of pain and give you treatment options. One of the reasons I think my claim continue to be approved nearly 2 years later is my continual treatment with pain management and that i am on pain meds. I cant work on the pain meds yet overtime its become easier to tolerate meds. You may have to try some medications and see which work for you.

By simply seeking spine doc opinions and seeking pain management you build a history of alerting doctors to your pain level and starting down the pain treatment road. Then you may need to use STD to pursue more treatment.

One thing. To look for in the STD plan is how STD is see. My employer allowed 26 weeks of STD in any 52 weeks. In 2008 I had used 6 weeks of STD in June. Less than a year later, in April, I went out of work again and thus had 20 weeks of STD left. Since I ended up not being able to return to work I had a 6 week gap between STD and LTD. As my position was not held for me after FMLA ended (12 weeks) I asked for vacation time payout for the 6 wk gap. I actually was only eligible for 6 weeks of FMLA since I had used 6 weeks within the last year but they held my job for 12 weeks )
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Fusions: L5-S1 (87), L4-S1 (93), C5-C7 ('06), L3-S1 ('10)
C5-C7 foraminotomy 08

 
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