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Old 03-07-2012, 02:28 PM   #31
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Wink Re: Getting approval from doctor for disability

Thank you, CVIDMama and thank you, jgrangran.

I will take your advise to heart about the treatment taking 6 months to a year before I feel normal, CVIDMama. Thanks. In the meantime I am preparing for the worst case senario.

I filed for LTD through my place of employment. It is a disability insurance company.
They called today and left a voice mail stating they wanted me to call them back and do a "phone interview" with them. Do I have to do this? does anyone know, who has been through this before, what I should do?

I called PP Legal and asked to speak to a disability lawyer before even talking to them. Should I just have a lawyer deal with this process?
My STD will be over 3/23; no more income. I am praying to be approved.
This is getting scary.

Concerned about my first infusion coming up this Friday morning; the nurse is coming out to administer here at the house. I will drink lots of water ahead and have Gatoraide on hand.

 
Old 03-07-2012, 02:41 PM   #32
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Re: Getting approval from doctor for disability

You must do a phone interview and complete any paperwork they send you for LTD (and have treating doctors complete whatever is necessary).

The LTD interview will ask for the names of ALL conditions that disable you in any way, the names of all treating physicians, the exact reasons you are unable to do your occupation, when you expect to return to work, have you asked for any accommodations to stay at work, etc). Be prepared to tell then specifically what affects your conditions have on your daily functioning at home, what limits you have that you didn't have before, etc.

I went out of work due to spine problems and my employer, a disability insurance company, outsourced STD to a Third Party Vendor and then did the LTD in-house. LTD is always more stressful and required far more from you than STD (STD is kind of like extended sick pay where LTD can be permanent). Although I went out of work for my knee is made sure they knew I was also treating for severe right knee arthritis. And while on LTD they found it had Carpal Tunnel Syndrome so I made sure LTD knew the diagnosis, doctor and his full contact info, dates of surgery, etc. I also have 50% hearing loss which didn't limit me from my occupation, it would limit me from some other types of work.

Best suggestion I received was get a small notebook and write down EVERY medical appointment date, type, and facility. Such as

2/3/12. Dr. T Jones, knee eval
2/5/12 Dr. M Smith (PCP), annual check up
2/7/12 Knee MRI at Coastal Imaging
3/15/12 Spine MRI at Southport Imaging
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Old 03-07-2012, 04:18 PM   #33
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Re: Getting approval from doctor for disability

SpineAZ can help you a lot Greg. She knows everything about the LTD process. I encourage you to post here regularly. It might help to allay some of your fears about the process. The loss of income and the worry afterwards about how am I going to survive now scares the hell out of all of us.

Keep in mind that if approved for LTD, your group LTD policy probably mandates that you apply for SSDI. Now is the time to familiarize yourself completely with your LTD policy and understand how the SSDI process works. I have been on offset LTD for almost 2 years and have been approved for continued LTD under any "occ" clause. I have been on SSDI since Oct. 2011 and was given a 3 year CDR.

Last edited by BlueSkies14; 03-07-2012 at 04:19 PM.

 
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Old 04-04-2012, 07:44 PM   #34
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Re: Getting approval from doctor for disability

Hello All,

Well I finally received my first treatment of Gammagard on March 19th. I had side effects of joint pain all over extreme fatigue and tiredness for about two days; slept for 18 hours straight after the IV treatment. My insurance did not accept the SubQ, but approved me for IVIG.

I was in the ER with pneumonia before the treatment, and then afterwards I had to go back to ER with another bout of pneumonia.

Also, I had applied with Hartford for LTD back early March, but they have not reached a decision yet. I called today and the rep told me she sent my case to the Medical review team to make a decision; she said there was not enough objective proof and too much subjective info from my doctors office. My doctor has been making notes of my recurring infections, symptoms of bronchitis, and I faxed over my ER records (both dates) to the rep for proof of recurring infections. I mentioned I would fax over my pharmacy records with the list of filled antibiotics for 2011 and 2012 currently.

I must say, I hope I am not getting the run around. A month is awhile now and I feel somewhat worried. She told me based on the ERISA law that Hartford has to give me an answer by early July. Also, I will not be able to return to work now my STD and FML is over. My employer will have to be notified I cannot work right now and am unable to return; so therefore, as of next Wednesday I will not have a job nor any income. I have some saving to last me awhile, but I wish I could get this over with, "accepted or denied".

Has any had this experience with insurance companies for LTD? should I get a lawyer at this point to work with Hartford? I just don't want to have them drag this out for months now...and as BlueSkies said before, maybe i should go ahead and apply for SSDI, since I have to anyway per Hartford.

Thanks for the feedback as always.

- G

 
Old 04-04-2012, 07:57 PM   #35
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Re: Getting approval from doctor for disability

Your employer is the one that makes the decision as to your employment. Is your employer administering your FMLA or is The Hartford administering both STD and FMLA.

If your STD is not approved, then the employer may wait for the decision before making an employment decision.

Many employers have extended leave provisions that retain people as employees on disabiltiy until LTD is approved. So when STD lasts 6 months, many employers hold off on terminating employment until STD is over and LTD begins.

However, once FMLA is exhausted the employer can make a decision at any time to terminate employment. If an employer does so they'll notify you in writing and provide you COBRA information for continuation of health insurance and also continuation information on other benefits.

Contact your HR/Benefits department and tell them The Hartford has not yet made a decision, confirm what date FMLA ends, and ask what the employers policies are for employment status after FMLA is exhausted. Employers should have a Employee Handbook that outlines all types of leave available.

STD and LTD are based on objective medical evidence to support why someone can not do the essential duties of his/her occupation. Recurring infections are considered, but if they can be treated while you remain at work then the insurance company would want to know what it is that led you to remain out of work between infections and while treating if no doctor has detailed why you are unable to work.

Be sure you have spoken to The Hartford about, objectively, what your key job duties are and why you are unable to do those continually. Also make sure they are aware of ANY AND ALL medical or psychological conditions that impact you in any way. For example, someone who is diabetic and has infections may have difficulty with diabetes control while fighting an infection. Or possibly someone has bone and joint problems being treated by a specialist that has compounded his/her incapacity. So be sure The Hartford knows every diagnosis, every doctor you see, every medication you are on, and every limitation you have from all these conditions.

It's amazing what people forget, when I did claims I'd have someone with a recurrent pneumonia and no where in the records did it say he lost a lung years ago thus has only one lung and it's compromised, and that's becuase the doctor was so experienced in treating the patient that he doesn't think to mention the missing lung in records. I had someone with dwarfism who kept saying return to work was hard, he couldn't even walk far, and eventually in talking to him he mentioned he had acondroplasia dwarfism and was under 4 feet tall, with many joint issues (hip replacements, ongoing back issues, etc) He had never mentioned it, and none of the medical records mentioned it, but it made it more obvious as to why recovery from back surgery was very tough and the impact on the spine and overall functioning of the claimant.
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Old 04-05-2012, 07:33 AM   #36
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Re: Getting approval from doctor for disability

Excellent Spine! I have to say I had a very good employer. They treated me fairly and tried to help me all they could. They allowed me several UWA's even after my FMLA was exhausted. This company treated all employees like you were a part of a larger family. That was why it was so hard for me to let go.

Spine is right. After you have exhausted your 12 weeks of FMLA, you have no more job protection and the employer could terminate employment. Here is basically how it worked for the company I use to work for. They never terminated after FMLA. You had one year of STD to basically get better and return to work. If after one year you were still sick, you were retained as an active employee for 2 years on disability leave. LTD insurance was an option where I worked and you paid for the coverage entirely if elected, altho I know some employers pay a portion and some pay the entire cost. If you did not have LTD, you were basically retained on the books as an active employee but without pay. In a way, it was like an extended FMLA....2 years instead of 12 weeks. The caveat was the company was under no obligation to let you return during this 2 year leave. They terminate employment after the 2 year disability leave. I actually called up HR and asked them do many people return after being out for 2 years? She said there were a few but the majority never returned. She also told me that the majority who had LTD took it and just stayed on it until age 65 after being approved for SSDI ofc.

I was told by my HR that it would take about 3 months for my LTDI carrier to make a decision. The elimination period for my LTD was 6 months. Remember I had a year of STD. HR got with me in advance and helped me coordinate the filing of my LTD claim. It was timed so after I ran out of STD, LTD would be approved and there would be no lapse in income.

I would not get a lawyer at this point. LTD is scary I know. LTD is one of those things you pray you never need but one that you can't afford not to have. If not for LTD when i became too sick to work, I would have been devastated financially even tho I am now approved for SSDI.

In my case, it took my carrier about 2 months to approve my disability claim. I just looked at my LTD timeline. Hang in there Greg. I know this is a very scary and uncertain period in your life. There are many good ERISA lawyers today who were not available 10 years ago. Hopefully, things will never get to that point and your claim will be approved.

I got approved for a mental illness so I was very concerned since all evidence for mental illness is subjective. Luckily, I had a very long medical history. I had about 24 years of service with my ex employer. 22 of those years, I was able to work with the disorder but it was being managed with meds and psychotherapy. Now, my meds don't really work and I am left with a certain degree of psychological pain which varies from day to day.

Last edited by BlueSkies14; 04-16-2012 at 02:32 AM. Reason: errors corrected after proofreading

 
Old 04-05-2012, 07:56 AM   #37
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Re: Getting approval from doctor for disability

Quote:
Originally Posted by GregBear4you View Post
Also, I had applied with Hartford for LTD back early March, but they have not reached a decision yet. I called today and the rep told me she sent my case to the Medical review team to make a decision; she said there was not enough objective proof and too much subjective info from my doctors office. My doctor has been making notes of my recurring infections, symptoms of bronchitis, and I faxed over my ER records (both dates) to the rep for proof of recurring infections. I mentioned I would fax over my pharmacy records with the list of filled antibiotics for 2011 and 2012 currently.

- G
Sounds like you are doing everything right Greg. It also sounds like you have a very good,supportive, concerned doctor. Give the carrier a little more time. I know it is almost impossible to stop panic and worry from setting in. It is good you have some savings to survive on if they have not reached a decision by next week Wednesday. I also had modest savings but luckily I did not have to touch this. How long is your LTD good for Greg if approved? I think Spine said hers is good until SSNRA. Mine ends at age 65.

Question? Exactly how long have you been on STD? Was the STD administered by Hartford or done in-house by the company you work for?

 
Old 04-10-2012, 04:02 PM   #38
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Re: Getting approval from doctor for disability

Hello BlueSkies and Spine,

Thank you both for the post and support.

The STD was covered by the company itself and was for only 3 months. I was not able to extend it any longer, so needed to apply for LTD through Hartford.
The rep there called today and stated the chances are good they will approve it, but don't want to get too hopeful until I see it in writing.

I think my Hartford policy states I have up until age 65 and then after that they would no longer provide benefits.

- G

 
Old 04-10-2012, 04:05 PM   #39
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Re: Getting approval from doctor for disability

Hello BlueSkies and Spine,

Thank you both for the post and support.

The STD was covered by the company itself and was for only 3 months. I was not able to extend it any longer, so needed to apply for LTD through Hartford.
The rep there called today and stated the chances are good they will approve it, but I don't want to get too hopeful until I see it in writing.

I think my Hartford policy states I have up until age 65 and then after that they would no longer provide benefits.

- G

 
Old 04-10-2012, 04:50 PM   #40
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Re: Getting approval from doctor for disability

Be sure to get a copy of the exactly plan under which you are covered. Most plans allow the first 24 mo of LTD under any Own Occ definition of disability during which you must be unable to do the material and substantial duties of your own occupation. Then after 24 mo the definition of disability becomes Any Occ under which you must be disabled from Any Occupation for which you are reasonably trained by education, experience, and ability and within a reasonable range of prior income. That means if you are a machinist with a HS education who made $41,000/yr, they can't say you can do a minimum wage job. Policies do vary, some rare ones don't have an Any Occ but most do and it's at 24, 36, or 48 mo (etc). And these days most LTD policies max out at your SSNRA (Social Security Normal Retirement Age). Go to www.ssa.gov and search for SSNRA. I was born in 66 so mine is 67 and LTD ends at 67. Some older LTD policies max at 65 but that's becoming more rare.

If you want, let me know, for claim discussion purposes:
-your age
-highest level of education
-type of work you were doing
-what has led you to be out of work

Be sure in applying to Hartford to list each and every medical psychological condition you have and are being treated for, every little bit of information helps your case.

And if you anticipate being out of work permanently be prepared to apply for SSDI. Your LTD policy will likely credit you for any SSDI attorney fees so get an attorney right away. Once Hartford approves your LTD, ask if they provide any Attorney referrals or assistance for SSDI. My LTD did so they coordinated with the SS attorney and forwarded to him all medical information. LTD deducts SSDI from your benefit. So if LTD is $1600/mo and you get $900 in SSDI you will then get $700 from LTD and $900 from SSDI.

I was recently awarded SSDI retro to 10/2009 and thus Medicare started retro to 10/2011.
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Old 05-04-2012, 10:06 AM   #41
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Approval for LTD and Support for SSDI

BlueSkies and Spine - thank you for your previous posts and advise.

Well, I finally got my LTD approved with Hartford. I am very happy about that.
I met with my manager from work and returned my office equipment; he stated I had done a really good job and would want to rehire me if/when I become well enough to work again.


I am not having much luck with the IVIG; I have very bad joint/muscle pain, nausia, and lite headedness. My home nurse stated the IV drip will have to be done slower as a result. They are going to have to extend the IV drip 6 hours a day for 4 days for the Gammagard S/D. I cannot tolerate anything faster than this; the nurse did a baseline on me.

The insurance company sent me a letter that I needed to apply for SSDI now.
They asked if my condition will last 12 months or more and I said yes.
Spine, OWN OC is 24 months, then after that it becomes ANY OC. The SSNRA is age 67.
I asked them for an SSDI attorney who could help me and they referred me to an SSDI advocate who will handle the SSDI process and communicate directly with SSA. They said an attorney will not be involved at this point, unless I had to go see the ALJ, then a lawyer would be assigned to help me.

Does this sound reasonable, that an advocate would help me through the SSDI process and not a lawyer at this point? they were referred to me by the Hartford, so I'm sure it's in their best interest to get me approved for SSDI.

Also, what do you all do when you feel you are being investigated by the insurance company. Right after my approval, I had some guy on a Saturday walking up and down the sidewalk back and forth watching me in my backyard - I was just sitting.
The other day I was well enough to meet a friend for lunch at a restaurant.
There were two men diagonally across from me in a booth, and one of them was looking over at me a lot, playing with his "cell phone" picked it up and faced it toward me like he was recording me or trying to take a picture.
What can you do about this, anything?

There are some days when I feel well enough to leave the house - how do we go about handling the possibility of being investigated?

Thank you.

 
Old 05-04-2012, 10:14 AM   #42
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Re: Getting approval from doctor for disability

Yes, an SS advocacy firm is fine. There are many that contract with LTD insurance companies and the only way an LTD ins co is going to refer you to an advocate or attorney is if the firm is proven to be excellent at getting SS approved.

Surveillance can occur. However it's very expensive. You should call police if at any time someone is observing your home, parked in the street near your home without just cause (if it's the cable TV guy working on a junction box it would not be something to call about). In a restaurant, ask to be repeated elsewhere as you feel the patrons at the other table are making you uncomfortable.

In order for surveillance to work it has to show you substantially deviating from your restrictions and limitations repeatedly. I'll try to add more later to give some examples.
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Old 05-04-2012, 06:32 PM   #43
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Re: Getting approval from doctor for disability

Surveillance can only be used if it can show you consistently do activities above and beyond what you and your doctors have stated.

This is why I say never say "never" on a questionnaire uniless it's truly never.

A few examples of when surveillance fails:

You don't walk much outdoors due to pain. But a neighbor in the hospital asks you to pick up her mail for a week and she lives 6 houses away. Watching you walk to her home and bring back her mail doesn't prove you can work.

If you say that you can occasionally sit and stand and the amount of time is dependent on pain, then lunch with a friend for an hour is reasonable. A three hour lunch observed by surveillance may raise red flags BUT it's once. Only if they can see you doing that regularly can it be used. Maybe your friend drove you and you are highly medicated and fidgeting in your seat due to pain.

People who say they "never" drive but are observed driving 2 miles to the pharmacy and grocery store 3x/week have caused a concern if under surveillance. Because they said "never". If they had said "as needed for pharmacy and basic household needs 2-3x/wk limited locally" then doing so doesn't go against the stated limits.

If you feel you are under surveillance and law enforcement does kick someone off your street (whether they are parked or walking) you can call the insurance company and voice your concern saying "I'm working with the local police as we're concerned about trespassers who may be on my property. Are you aware of any investigators that may be in my area on behalf of your company?"
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Old 05-07-2012, 08:37 PM   #44
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Re: Approval for LTD and Support for SSDI

Surveillance does happen, but it's rare because of the expense. Usually it's because they have reason to believe someone isn't disabled. Being newly approved I would be VERY surprised if you are being investigated. I think it's a little normal to be paranoid when out and about while being on disability. All private LTD companies have fraud units, and now even SSDI has a newly created fraud unit, so it's understandable to be a little paranoid. As long as you know you are unable to work and you aren't outdoing anything that would give the appearance of having any work skills, you should be fine!

 
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