I am 32 and have been on short term disability leave from my job since the middle of July. Today I received a call from a nurse who works for the short term disability company that pays out my benefits.
To put it nicely she was sooo rude to me in the beginning of the call. She had gotten vague information from my doctor regarding my medical condition, so she assumed I was taking advantage of the system! She said, "You know, we're not paying for you to sit around!" I then told her, "Of course I know you're not paying me to sit around and eat bon bons all day! You're paying me because I can't even do simple everyday tasks!" Then I told her everything that was discussed at my doctor's appointment, and she was much nicer by the end of the call.
Before we hung up, I told her that it's my doctor's job to update my medical status to (short term disability company). I said, "Next time you talk with my doctor, get all the information before calling me."
Have any of you had to deal with nasty employees from disability companies? This is my first experience, but I am assuming that no one should treat me like that over the phone! The lady even said she might call me back after my next doctor's appointment. If she does, she had better be nicer than she was today otherwise she'll be seeing a different side of me!
You should have pro-active continual contact with the STD insurance company. Doctor's offices don't often provide more than the most recent treatment note when an STD/LTD company requests an update. Anytime something changes, you have a treatment, a surgery, a test, etc - contact STD to let them know. Fax them results of all of the above as well (copies of MRI, CT, surgical reports, etc).
Most STD plans last 26 weeks and as you get to 13 weeks they are likely to begin to evaluate your claim for Long Term Disability (LTD) if you have it.
I had bilateral Carpal Tunnel Surgery (one in March and one in April). After both, in May, I requested a copy of the surgical reports. I then faxed them to my LTD claim manager. When I found out in July that I needed knee replacement I put together a letter for LTD detailing I had changed knee doctors, the full name and contact information for the new doctor, the date of the TKR, the hospital contact information, etc. I faxed that to LTD and then 5 days later called to make sure they had received it. (I also have a private disability policy and have an attorney working on my SSDI appeal - so I fax to them all the same stuff I faxed to LTD).
You might want to ask each of your doctor for 3 months of records. Review them and see what is included and you may be surprised how limited they are or how one doctor's office is quite complete while the other doctor's records are minimal. I saw way too many times key information left out of records.
I have be handling my situation as much as the STD company will let me. They made it clear to me that they would call my doctor and therapist about my medical conditions as the weeks go by. (Which is why the nurse from STD contacted my doctor.)
The STD company has made no mention to me that I am responsible to update them. When I have offered to, they tell me not to bother. That they will contact my doctor as needed.
Maybe some STD companies work differently?? I don't know. Like I mentioned, this is my first time dealing with something like this. So I am always asking STD company what they need from me, and so on and so to keep my benefits going. But they always tell me that they will contact my doctors. And every time I speak with someone from the STD company they are very snappy and rude to me.
They won't require that you be proactive, but it will help your claim to do so. Otherwise you risk having STD insurance company only get from the doctor/provider office whatever the doctor/provider provides. If it's insufficient it can lead to delay or even termination of benefits (they'd call you before doing so, but then you may have to hustle to get medical information from doctors and other providers).
I was in the industry for 15 yr so I took my experience and use it in my claims. I've often had my STD and then LTD case manager say thank you with sincerity. They've said they didn't know this/it wasn't yet provided to them/the doctor doesn't mention it in the notes/etc.
You'd be amazed how much can be left out. I worked on a claim once for a woman with simple abdominal surgery (tubaligation - tubes tied) and I got pages of notes from the surgeon and then her primary care and all they said is her wound was healing well and she was no longer in need of pain medications. I couldn't see anything limiting her from going back to work. Before terminating the claim I called her. She kept saying "just ask my doctors". I said "without your help this claim may end as the information we have is that you have healed enough to go back to work". She was stunned, quiet, and said "didn't they mention that it's likely ovarian cancer?" NO, not in the surgical report, the surgeon's records, nor the primary care doctor's records. NO indication of referral to an oncologist and the plan for surgery in the next week or so for total hysterectomy, etc .
So, in my case I want to be sure my LTD case manager knows everying and especially that I changed knee surgeons or else after the TKR the LTD case manager would have gone to my prior knee doc who would have said "haven't seen her in 6 mo".
I had one full year of STD and never had a problem. It was administered inhouse by the company I worked for. The benefit was very generous too. It provided for a full year of STD. It did not matter if they had just hired you or you had been OTJ (on-the-job) for 25 years. Everyone got 1 year. The only difference in the STD was the % of pay you got. I had 25 years of service so I got 6 months at 100% pay and 6 moths at 60% pay (taxable). I had to use STD more than a dozen times during my 25 years. My longest absence was about 3 months before this last time when I just could no longer work and had to go on LTD and apply for SSDI.
In-house STD is rare (cost and ability to administer in-house vs "outsourcing") and often much easier in terms of applying, continuation of benefits, etc.. When the benefit is administered by an insurance company or third party administrator (TPA) company then it's more complex.
In my case most of my STD was sort of in-house as I worked for various insurance companies. But that almost makes it harder because either they work in the same building as I did or the simple fact that I know how they do claims since that's how my "side" did claims for customers so almost a higher level of proof needed.
Only at my last employer did they outsource STD and after I left LTD (for anyone disabled 1/1/10 and after so my LTD remains with my employer thus far) due to financial constraints (premium/fees cheaper than maintaining claim staff)
Usually, it is very hard for them to call and talk to your doctor. Doctors are very busy ppl and can't take many calls during the day and see patients too. Sometimes they will call and ask that the doc calls them back at his/her convenience. Did they actually talk to your doc or the doctor's staff? I think it depends a lot too on the disability company. I know of two companies where many ppl complain about how rude the disability company employees are. Luckily, I had STD administered inhouse by my employer. My LTD company has not given me too much flak either. The disability claims manager has always been nice and polite to me and I have been polite back. Do you see yourself going back to work? Do you have LTD if you can't return? Does this same insurance company administer the LTD?
BlueSkies: That's where the lack of information comes in. You see the doctor and discuss treatment for 20 min, he dictates a 40 second office note, and then on request his staff has to "translate" that to the disability insurance company (or send them a copy). Meanwhile, IF this is a doctor you know really well he/she would have much more to say to STD/LTD but they aren't the ones communicating with STD/LTD. These days many doctors charge STD/LTD a fee for actual communication directly with the doctor. But if the doctor barely knows you it isn't any benefit for him/her to be on the phone. In that case office/treatment notes often tell more.
In-house STD is rare (cost and ability to administer in-house vs "outsourcing") and often much easier in terms of applying, continuation of benefits, etc.. When the benefit is administered by an insurance company or third party administrator (TPA) company then it's more complex.
In my case most of my STD was sort of in-house as I worked for various insurance companies. But that almost makes it harder because either they work in the same building as I did or the simple fact that I know how they do claims since that's how my "side" did claims for customers so almost a higher level of proof needed.
Only at my last employer did they outsource STD and after I left LTD (for anyone disabled 1/1/10 and after so my LTD remains with my employer thus far) due to financial constraints (premium/fees cheaper than maintaining claim staff)
I don't think the company I worked for ever outsourced STD Spine and I worked for them about 25 years. STD was always inhouse. This company was a little atypical I suppose. It was also a huge fortune 100 company. I have told ppl in other forums that this company has never had a 2 year limit on mental health LTD and I have had ppl who sell indiv. disability insurance tell me that I was wrong and to review my policy because it was hidden in there somewhere. Even my min. benefit amount is atypical from what you see with most group policies.
BlueSkies: That's where the lack of information comes in. You see the doctor and discuss treatment for 20 min, he dictates a 40 second office note, and then on request his staff has to "translate" that to the disability insurance company (or send them a copy). Meanwhile, IF this is a doctor you know really well he/she would have much more to say to STD/LTD but they aren't the ones communicating with STD/LTD. These days many doctors charge STD/LTD a fee for actual communication directly with the doctor. But if the doctor barely knows you it isn't any benefit for him/her to be on the phone. In that case office/treatment notes often tell more.
I agree Spine. Basically, my company knew I had a 20 year history of panic/anxiety. I also had one long psychiatric hospital stay 2 years prior to the last STD. So when I went out, I simply had to have my doc fill out a simple form every month. My supervisor would call to check on me from time to time but they never made me feel like you had better hurry up and get better and come back to work or we are going to fire you. I think they knew I was not going to be coming back this time due to my medical history. I basically got progressively worse over the years.
They won't require that you be proactive, but it will help your claim to do so. Otherwise you risk having STD insurance company only get from the doctor/provider office whatever the doctor/provider provides. If it's insufficient it can lead to delay or even termination of benefits (they'd call you before doing so, but then you may have to hustle to get medical information from doctors and other providers).
I was in the industry for 15 yr so I took my experience and use it in my claims. I've often had my STD and then LTD case manager say thank you with sincerity. They've said they didn't know this/it wasn't yet provided to them/the doctor doesn't mention it in the notes/etc.
You'd be amazed how much can be left out. I worked on a claim once for a woman with simple abdominal surgery (tubaligation - tubes tied) and I got pages of notes from the surgeon and then her primary care and all they said is her wound was healing well and she was no longer in need of pain medications. I couldn't see anything limiting her from going back to work. Before terminating the claim I called her. She kept saying "just ask my doctors". I said "without your help this claim may end as the information we have is that you have healed enough to go back to work". She was stunned, quiet, and said "didn't they mention that it's likely ovarian cancer?" NO, not in the surgical report, the surgeon's records, nor the primary care doctor's records. NO indication of referral to an oncologist and the plan for surgery in the next week or so for total hysterectomy, etc .
So, in my case I want to be sure my LTD case manager knows everying and especially that I changed knee surgeons or else after the TKR the LTD case manager would have gone to my prior knee doc who would have said "haven't seen her in 6 mo".
This is excellent Spine. The best thing about your situation besides knowing how LTD works inside and out and what is required medically to be considered disabled is having a supportive doctor or doctors. If you have a doctor like this who is willing to go to bat for you and is very firm, there is very little that the insurance company can do but pay the claim. So many ppl have crummy doctors who want your money but hate filling out any forms or paperwork from the disability insurance companies (private LTD or govt. SSDI). If I had a doctor like this, I would change and keep changing until I found someone who will treat my medical condition and also support my disability claim.
SpineAZ, Thank you for being so insightful!! You have given great insight to how STD companies work.
I go to my neurologist next week, as well as my primary care doctor. At both appointments I will ask for medical records and I will fax that to my disability company. Even though they told me not to get envolved, it looks like there's a break down in communication between my doctors and short term company. So I will be more proactive to clear this up!
Regarding your story about the claim you worked on with the woman who had abdominal surgery.......I think this is why the nurse from the STD company was so rude to me at the beginning of the call today. As far as she knew I was just diagnosed with depression and anxiety, and thought I should go back to work. But upon being re-evaluated by my doctor (2 weeks ago) my condition is much worse than that. I can only assume my doctor was as vague as possible to protect my privacy. I'll have to let her know that if anyone from STD company calls her, that she needs to give them every detail about my medical conditions.
But I think from this point forward I will start faxing them medical records at each doctors appointment I go to.
But I think from this point forward I will start faxing them medical records at each doctors appointment I go to.
Thanks so much!
diznee25
I think this is a good thing to do. Be sure and tell your doctor also during the next office visit. Many patients fail in communicating with their doctors how important their STD/LTD/SSDI claim is. I told both of my doctors how important this is to me since i am no longer able to tolerate the stress of working due to my panic/anxiety/depression. This will make you feel more at ease knowing that your doctor is on your side in regards to your disability claim. Spine is also an excellent resource here. She has given me quite an education and some very valuable tips on LTD.
The majority of the time it is other clinical office staff, most commonly Medical Assistant or Nurse or Nurse Assistant, who responds to disability insurance company inquiries. Every doctor has his/her own style of record keeping and dictation which tends do follow a pattern for each post-appointment notation/dictation.
It will be tough to get the doctor to change his/her style of dictation or notes specifically for one patient BUT it's a great idea to see if there can be a change made. You may want to create some type of personal statement you give to the doctor / provider that bullet points your symptoms of all conditions, what it is that limits you from working, and areas of concern. For some people creating a document like this is challenging so it's not for everyone but personally I've found it immensely useful.
In my case I have a variety of providers (spine surgeon, pain management physician, hand surgeon, knee surgeon, primary care physician, physical therapists, etc). So one doesn't know what the other is doing or prescribing so the personal statement helps let each party know exactly what is going on with each condition and area of treatment.
I forgot to mention earlier, and some people aren't aware of this, be sure to claim any and all conditions that limit you from being able to work. WC is based on the one condition that led to WC claim. STD / LTD / SSDI is based on the totality of all conditions limiting functional ability to work. So if out of work for depression but also battling migraines the ins co/SSDI needs to know.
Also be aware that diagnosis does not equal an impairment. Someone disabled by back pain who is an insulin dependent diabetic should make sure the ins co is aware of the diabetes. If diabetes is well controlled the diabetes won't impact the claim. But should complications later arise the ins co is already aware that diabetes existed.
Just keeping up with all the disability crap and requests can be a full time job in itself. It causes some ppl considerable anxiety just staying on claim.
At this time sending physician treatment records to STD isn't needed unless the insurance company has asked for your assistance in getting records. The reason I mentioned records was so you get them for yourself and see what type of notes are made and thus what STD is seeing. It will give you perspective on how each of your providers keeps records. If you see the neurologist next week wait about 2 weeks and then request the office notes from that visit. Having had the recent appointment you'll be able to compare what you know was discussed against what the record actually states. Some doctors use a dictation service (so notes can take 1-2 wk to be available). Other doctors write their own notes by hand or via typing it in.
Many doctors are hesitant to release a bundle of records to you directly unless they see proof that insurance needs the record. But asking for 1-2 office notes is often something the office staff will be willing to do.
What I do is (1) After any MRI, CT, X-ray, or any test I get the radiology report (or whatever type of ressults that are produced) AND (2) After any procedure or surgery I request the procedure or operative report 2-4 weeks after the procedure/surgery. I fax these on to LTD. In the Spring I had 2 hand surgeries (1 in March and 1 in April), a knee MRI in Feb and nerve testing in January. LTD had not been asking for any information from me so I wasn't in a hurry. In late May (2 wk after last surgery) I requested the two operative reports. I put together all the test results and faxed them to LTD (and my SS attorney and my individual disability). Then I called LTD 5-10 days after to make sure they received all KC it and if they needed anything more.
Always keep a copy of everythyou send to STD. And if you don't already have it, request the STD and LTD plan documents from your HR/Benefits. Since you aren't really close to LTD perhaps just ask for STD and if you get closer to LTD ask for the LTD plan document. Employers change benefits over time so you want the plans in effect in the day you became disabled. For example, if I go out of work 03/01/2010 and at that time the LTD benefit is 66%. Effective 1/1/2011 the employer changes LTD to a 60% benefit and changes other provisions. I need the plan in effect as of 3/1/2010 (which is not necessarily a plan that is effective the exact date of 03/01/10, but the most recent plan effective when I became disabled. So, for examples, perhaps the employer hasn't changed the plan since 01/01/2009 and that would be the plan under which I am covered. I don't want the new plan document effective 1/1/2011 as that's only for people who become disabled 1/1/2011 or after. )
Just keeping up with all the disability crap and requests can be a full time job in itself. It causes some ppl considerable anxiety just staying on claim.
Agreed!! The ironic thing is I was put on medical leave for severe depression and anxiety. Dealing with STD benefits just agitates my symptoms even more. (And the only effort I've put in so far is just talking with a few people from the STD company! It won't be until next week that I grease my elbows with faxing medical records and stuff.) I told my husband that I secretly hope my benefits are denied next week, just so I don't have to deal with this anymore. It's just too much....
Diznee : I hope you saw my post above regarding medical records. ossibly not being needed. Call stand ask them (1) What date is my claim approved through? (2) Is there anything you need at.this time from any of my physicians (3) I want you to be aware I am seeing Dr. X on XX/XX/XXXX should you need anything from that doctor.
Also, since STD may be new to you, many people don't understand that STD and LTD are "managed " disability. Employers have contracted with the insurance company with the expectation that the insurance company will do aggressive claim case management including frequently reviewing the claim, continually requesting medical information to determine if the employee remains disabled from working and meets the "definition of disability" in the STD plan/policy. Thus it is not likely that STD will leave you alone and cease asking questions. During STD updates and claim reviews are constant. If LTD is approved you can hope for a decrease in claim review and requests. This can occur if you have a strong history of treatment for your diagnoses and it's clear from medical/psychological records that you have a long term impairment. If this is your first STD absence from work for this condition expect more stringent claim review as STD is expecting possible improvement to a level that will allow return to work. Even if your employer were to terminate your employment, this does not mean the claim continues. STD and LTD inly continue as long as the person meets the plan/policy definition of disability regardless employment status.
Agreed!! The ironic thing is I was put on medical leave for severe depression and anxiety. Dealing with STD benefits just agitates my symptoms even more. (And the only effort I've put in so far is just talking with a few people from the STD company! It won't be until next week that I grease my elbows with faxing medical records and stuff.) I told my husband that I secretly hope my benefits are denied next week, just so I don't have to deal with this anymore. It's just too much....
diznee25
Is is frustrating diznee25. Spine gave you some very good advice. I speak more from a personal POV (point of view) which really has no bearing as to whether you continue to receive STD benefits or not. My company operated a little differently. They did STd inhouse. I was out on STD actually more than a full year if you count all the attempts I made trying to go back to work. I think had my company contracted out the STD to a third party to administer, they would have probably been more aggressive but the outcome would have been the same. I was sick and could no longer work....bottom line.
Here is the thing. You are already sick. You feel like hell and the last thing ppl want is disability insurance carriers breathing down their necks threatening to cut off benefits if you don't supply X info. by Y date. It can be really aggravating but you must keep your cool. The reality is they want to see you healthy not from a I care about you human standpoint but purely from a business standpoint. Somebody is having to pay you a sum of money and you are not giving them back any productive work for that money. It may seem cruel but some would rather see you back at work not well than out sick and receiving benefits.
Co-operations are good things. They employ ppl, make things, provide services, and sell to mass markets to improve the quality of our lives but there will always be the human greed factor. Somewhere in that chain from the lowest employees in the organizational hierarchy to the CEO of the company and major shareholders, there will always be ppl in that chain who wish to make a lot of money and have devised systems to maximize that bottom line. When you are out sick, they start to see you as a cost rather than a productive entity that is making them money. Some of these things are sad from a human standpoint but make good business sense.
I had a doctor tell me point blank that he use to do disability paperwork for his patients but had to quit b/c the requests for paperwork from some of the carriers got so overwhelming that he just could not tolerate it any longer. This puts many ppl in a really bad place. You are sick and now faced with possibly losing a benefit that you really need at a very critical time in your life. What some of these insurers fail to realize is that all the calling and checking on you and and putting pressure on you to return to work is probably making your health condition worse. I know they have a job to do but many of them go overboard and make ppl feel like saying to hell with all the aggravation. It is not worth it.
Try not to think like this and always keep your cool and be polite even when someone might not be polite back to you. Also, have a heart to heart talk with your doctor so you can get a sense of how he feels about the whole disability status. I actually told my doctors that I really need the disability benefit b/c I can't work but I also told them that I did not want to overburden them with paperwork and medical requests. I told them I know it is frustrating for me and for you but will you support me while you are treating my medical condition? If you can get reassurance from your doctor, it will relieve a lot of the stress you feel even if the disability insurance carrier never changes their claim handling procedures.
Bottom line is you are sick and unable to work. Don't let anyone try and pressure you to return until you can return. I could not return and ended up going on LTD. As long as my insurer treats me fairly, I will comply with all their requests but I am also prepared to fight if I ever have to because I know I can't work now. I don't really care how it affects the company's bottom line. Insurance is nothing more than managed risk. You win (paid premiums) more than you lose (disability claims) but you do lose some.
Last edited by BlueSkies14; 09-13-2011 at 06:43 AM.
Agreed!! The ironic thing is I was put on medical leave for severe depression and anxiety. Dealing with STD benefits just agitates my symptoms even more. (And the only effort I've put in so far is just talking with a few people from the STD company! It won't be until next week that I grease my elbows with faxing medical records and stuff.) I told my husband that I secretly hope my benefits are denied next week, just so I don't have to deal with this anymore. It's just too much....
diznee25
I am out on LTD for severe anxiety/depression diznee25. These things started over 20 years ago and have gotten progressively worse over the years.
