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Old 10-21-2011, 12:46 PM   #1
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Appeal of erisa ltd extended by ins co need suggestions

I am a little cautious about putting in too many details because this ins co us known for trolling forums. However, I hope you full might have some knowledge to help my situation. I was diagnosed with stroke and on std and ltd for about a year before ltd denied with a vague "couldnt prove disability from any occupation". I am seeing a psych who specializes in brain injuries and on a cocktail of medications that often change, as I have adhd- ike symptoms (definitely no sign of adhd before so it's not a case of late life diagnosis). I appealed the denial and they extended the 45 days to do more review. Now I find out they are calling doctors I'm no longer seeing, telling them "they are trying to close out the file" and asking about functional capabilities with no more detail. The main argument send to be that there is no mri that shows a scar in my brain, yet my doctors have seen me fall (when I wasn't aware they were present), have problems with speech, etc. I am on SSDI. I think the ltd co is trying to make this mental not organic since my policy doesn't cover mental unless caused from an organic issue like stroke.

Sorry that was long - thats part of the brain problem.
1 Is Adhd typically considered mental?
2 Any ideas on brain damage without a cat or mri showing? Silly me I was happy that my mri was clear so I didnt require surgery.
3 I was at the top level in performance reviews but I know about the pip mentioned by others and suspect we are probably talking about the same employer and ltd provider, so I know there won't be a job to come back to. Thanks for any ideas, and oh yeah I do have an attorney.

 
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Old 10-21-2011, 02:12 PM   #2
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Re: Appeal of erisa ltd extended by ins co need suggestions

Is the LTD company trying to put your disability in the M/N (mental/nervous) category because most group LTD policies will only payout for a max. 2 years for mental health unless you can prove a physical cause for your disability. Did they just terminate you after 1 year, nscagal? The 1st two years are usually for own OCC and then you must prove any occ after that to continuing receiving benefits. When you initially went on LTD, how did they categorize your illness/disability?

I have read where where Spine AZ said you should appeal the 1st denial yourself before seeking professional help from an attorney who specializes in LTD. My situation is a little different than yours. I am on LTD for severe anxiety, panic, and depression but I have one of the rare group policies that does not limit mental health payouts to 2 years max. My policy will pay until age 65 as long as I remain disabled.

Personally, I would seek out the help of a professional. I had 3 free consultations with LTD attorneys before I ever went out on LTD. I knew in my heart I was truly disabled but I wanted to make sure that I was going to be treated fairly now that I was sick and could no longer continue working. I have found two LTD attorneys that IMO are especially good and extremely well versed in ERISA and would use one of them if I ever run into a problem in the future.

How much even after the SSDI offset is your LTD had they not terminated your claim? Perhaps, SpineAZ will see your post and might respond if she is not in too much pain.

Last edited by BlueSkies14; 10-21-2011 at 02:25 PM.

 
Old 10-21-2011, 02:26 PM   #3
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Re: Appeal of erisa ltd extended by ins co need suggestions

ADHD is considered a mental impairment. Have you ssen a Neuroligist for the brain injury? If not that might help you.

 
Old 10-21-2011, 02:31 PM   #4
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Re: Appeal of erisa ltd extended by ins co need suggestions

I just re-read your post. You said your policy will not pay period for mental unless cause by something physical like a stroke. What is your attorney suggesting you do? Are you in the process of appealing their decision? I would say say ADHD is mental as far as disability impairments go.

Last edited by BlueSkies14; 10-21-2011 at 02:32 PM.

 
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