LTD vs SSI ???

Discussion in 'Fibromyalgia Main Forum' started by Sekoya, Jun 30, 2003.

  1. Sekoya

    Sekoya New Member

    I can't take this anymore.

    I'm hanging onto my job by a thread. I recently received a poor performance review. Every year there are more and more layoffs. I know I'm next.

    Meanwhile I keep *trying* to do my job and I just can't. I work in IT and the pain and brain challenges are too much.

    SSI is not an option for me. I'm the main means of support for my household. I have "LTD" insurance deducted from my paychecks every month, but I'm not sure what that means.

    I was on STD from Nov2002 to Feb2003, and then forced myself to come back to work. I was out due to complications after surgery (big surprise for us FMS'ers ... NOT).

    I can't fake it anymore. I'm tired. I hurt. I can't think straight. I can't do this work. It's too hard.

    I don't know anything about company paid LTD except that you get paid 75% of your salary (which would be GREAT), but I don't know for how long, and I don't know how to go about getting it. I know that claiming "FMS" would probably be difficult.

    Should I see a psychologist and try to go for the "stress leave" thing?

    How long will the LTD last? How do I find out?

    Anyone out there know anything about this stuff?

  2. elaine_p

    elaine_p New Member

    Sekoya, you should have gotten something at some time which explains your LTD benefits. That will tell you how much you get (I only get 66%, 75% is great!), if there's a limitation on your benefits, etc. If you can't find it, ask your HR department.

    If your policy is anything like mine, I looked it over and most of it didn't make sense. The information is there, it's just that 'til it applies to you, it kinda goes in one ear and out the other (bad metaphor, but you get the point).

    Unfortunately, many LTD policies now have a 2-year limitation on CFS, and probably FMS. That means they'll only pay you for 2 years. The *possible* upside to that is they may actually approve your claim relatively quickly. (My policy thankfully doesn't have the limitation. They kept denying my claim for over 2 years.)

    Also, if they only pay you for 2 years, you may not have to apply for SSDI (I'm *required* to, since it will reduce the insurance company's payments). But you should probably apply for SSDI right away anyway, since it takes at least 18 months to go through the whole process, and you might be denied even then. (You can reapply.)

    Another factor in LTD approval is whether your LTD is a "group" policy. If *not*, they have more incentive to approve, because if they deny you you can sue for pain and suffering, or whatever. If they *are* a group policy, ERISA protects them from having to pay damages. But again, this might not apply if you have a 2-year limitation.

    You could contact a disability attorney to see what they recommend about what to base the claim on (mine wanted to file it for both CFS and depression, which I was adamant about NOT doing, since I'd only ever missed 1 day of work due to depression, and there were several factors).

    Seeing a psychologist can't hurt. If nothing else, they could perhaps document that what you're suffering is real.

    Maybe someone else will have more input about what to base a claim on.
  3. Sekoya

    Sekoya New Member

    You sure know alot more about this than I do. And you've given me hope that maye there IS an answer for me.

    I looked at your profile and we have some things in common. I am one year older than you and also the mother of 2 cats.

    I am a writer at heart, and always wanted to write technical manuals, but wound up as a programmer instead. People love my documentation (even the geeks)!


  4. kadywill

    kadywill New Member

    I was put out of work by my doctor in November due to my MRI results which showed severe spinal stenosis with nerve impingement and other stuff. I received STD, which I pay the premiums for out of my check) for about six months and then I was reevaluated for LTD by the same company and.....I was denied! I appealed and was still denied. I think it is because I refused a series of epidural injections for my back, but I only refused them for them time being, due to lack of funds. Yes, we have insurance that would've covered a large part of the cost, but we have to eat and pay our bills and my husband has missed a LOT of work, himself, lately due to autoimmune thyroiditis and depression. So, at the same time, I was denied SSD, but I thought I could appeal that decision while receiving LTD, but when that was denied, too, I had to return to work. My fellow employees and my bosses thought I was never going to be well enough to return to work and I'd just about accepted that to be true, myself, but here I am, seven months later and NO better, doing the very job that was killing me. I'm taking opiod pain meds to achieve this level of comfort, which is not the level it should be. My level of pain right now is an 8 and I've been home today, resting, and taking my meds.
    I wish I'd been taken out of work due to FMS, but my Rheumatologist and Neurologist didn't help too much with the back diagnosis, so I don't think they'd be any better help with that one. I wish I could sound more optimistic, but I really thought the LTD was "in the bag" for me due to my severe diagnosis, which was diagnosed by the MRI. It shocked me to death when it was denied. Insurance companies do NOT want to pay out their money on a long-term basis, so you'd better make sure your diagnosis is written in stone and that you visit your doctors VERY often and do all that they suggest. Many on this site will attest that you have to really look and act sick all the time, stop driving, stop buying your own groceries, use a cane, etc. This is too sad.
    Good luck to you.
  5. Sekoya

    Sekoya New Member

    Thanks for the input Kady, that sounds a lot closer to what I've been hearing.

    But I have to do *something*!! And soon!!

  6. teach6

    teach6 New Member

    When I left work I had no idea what was wrong with me. In fact I originally thought that if I stayed home and took it easy for a few days I would be able to go back with no problem. That was almost two years ago.

    I had a bit of a problem getting my STD because of the lack of a dx and because at the time my docs were pursuing a red herring, which was an extremely low white count that later turned out to be caused by a med I had taken.

    I finally got STD for depression. When I was dx'd with CFS and FMS it was switched to those dx's. I had no trouble at all moving from STD to LTD. My policy reads that I get paid as long as I am unable to do the duties of my job (teacher) until I am 65.

    My LTD company required me to file for SSDI, which by that time I realized was going to be necessary since I was not seeing any improvement, despite being treated by a doc who is experienced with CFIDS and FMS and who doesn't give up. He just told me last week that he still has more tricks up his sleeve.

    I would suggest that you contact your HR department and get the details on your plan. That will enable you to make plans for what you should do next. For me working is not an option, even though I am single.

    Good luck to you!

  7. elaine_p

    elaine_p New Member

    Sekoya, in looking at other posts, some people were approved for SSDI sooner than 18 months, but you should still apply soon. There's a 6-month waiting period before you're eligible.

    I went to school for programming and ended up a writer! :)

    One option that may be open to you is computer consulting. I tried starting a business last year and it's too hard for me. Software I can explain, but since I got out of school 15 years ago I pretty much ignored hardware and operating system stuff and left it to the programing and hardware geeks. ;-) Do you know how much things have changed in 17 years??? Or you could consider web page development or something. Or you could MAYbe see about working part-time and telecommuting.

    But part-time work could be bad. If you start that right now, you might lose benefits, including your LTD. And even though Social Security says we can earn up to $700/month (I think that's the limit now) and not lose SSDI benefits, I think if we do that they figure we're just lazy and don't want to work more.

    And to learn how to cut your living expenses, do a message search for "tightwad" and click on j-bearmama's post. The thread is somewhat long but lots of people have good suggestions (including mine on what NOT to do).

    There was something else I meant to say, but I don't remember what.... Oh! Someone else (I think racwhite) said their disability had run out (I think it was the 2-year deal) and they were now appealing the insurance company's decision to stop paying on the claim. So, even if your policy has a limitation it's possible you won't be screwed for the rest of your life. Of course, their denial could be because of something else.
  8. zggygirl

    zggygirl New Member

    I recently read on article on here under the disability tab, by a lawyer (can't think of his name right now) but he has lots of articles on here.
    My point being that he was able to win a case even though there wasn't very good doctor support due to the fact that they employee had missed a lot of work- due to illness.
    And it was all in the employees records.
    Perhaps this is the case for you- missing work due to your pain?
    Anwyay, just a thought. You can find that article by looking for- the title which has "employee records" in it.
  9. Dara

    Dara New Member

    post to you, then I went to edit it after I found a mistake, I hit the delete button instead. Right now I'm too upset with myself to try and re-do the whole thing. I will reply soon. I have just received my LTD & SSD within the last couple of months and I was relaying my experience to you.

  10. Dara

    Dara New Member

    I have a question about the LTD. You said that if the policy is for 24 months, and at the end of 24 months you are still disabled, that it would continue?? I don't know if I took this wrong, but I thought that the 24 months meant just that. That at the end of 24 months you no longer would get any LTD benefits. My LTD ends at 24 months, so I am curious if what you said applies to all LTD policies, or just some??

  11. Sekoya

    Sekoya New Member

    Everyone here is being so terrific. Thank you so much. And don't stop replying! I need as much info as I can get.

    It just took me 30 minutes to walk from the train station to my office - what used to take me 10 minutes.

    I could go on but I'll spare you. You know the deal.

    I've been thinking about alternative income for a long time, and if I *do* get some LTD, I will definitely start a home biz of some sort. Maybe a combination of Web Designer and Wellness Product Distributor.

    Right now it all seems like a fairy tale. But I know that if I don't take steps I'll get laid off for incompetency. That should say alot right there. Yikes.

    I'll keep you all updated. Meanwhle, please keep sharing your knowledge.

  12. elaine_p

    elaine_p New Member

    Wow Skeesix sure said a lot of stuff I wish I'd said. Of course, my posts were long enough and I'm not perfect.

    Dara--I think your question to Skeesix regards "own occupation" vs. "any occupation". Own occupation means the job you were doing. I was a technical writer and I was unable to do that when I got sick. Well, actually they denied me for that whole period anyway, but theoretically they should have paid me because I couldn't do my job.

    If I were able to work at another job at the 2-year mark (say, receptionist), I would no longer be considered disabled.

    I hope Skeesix comes back and explains better. (I'm brain dead due to insomnia/lack of sleep.)

    Skeesix--Standard Insurance isn't much better than Unum, though I don't know if anyone can beat Unum--I think they only approved me when they did because they were under investigation by the US Dept of Labor. And they didn't like my lawyer. :)

    Sekoya--I hope you can do a home-based business. Couple more things: they may deduct 1/2 your work income from your monthly benefit payment. (For example, if you earn $1000, they will deduct $500 from your benefit check. This will be in your policy and may not apply the first 2 years. I remember the phrase "Return to work Incentive".)

    The other thing is, if you can't do your business, you could maybe do data entry (unless you're a 2-fingered-typing programmer :). I did that for 3 hours a week. My ego hated it--since it figures any trained monkey could do it--but it still helped my self-esteem.
  13. Sekoya

    Sekoya New Member

    I would *love* to switch occupations and do data entry or something like that.

    Unfortunately those kinds of changes can't happen overnight cuz I make good money as a programmer and it will take some time to change lifestyles -- you know, there's a mortgage and other costly things to consider.

    I am a good writer, a good web designer an excellent document formatter, and a touch typist. In fact I supervised a word processing center from 1980 to 1986.

    I have been thinking about a 3-year plan for awhile now. Time to get moving!

  14. Dara

    Dara New Member

    I have a copy of my plan summary so I'll have to get it out and re-read it. I think my plan is one of those that says I have to be unable to do any type of work, and still ends in 24 months. Not sure, but I'll check it out.

  15. Sekoya

    Sekoya New Member

    I still haven't found the Summary Plan Description, but I found my employee benefits booklet and it's not good news.

    LTD only pays 50% of salary MINUS any SSDI. No way I can live on that.

    This is getting really hard.

  16. Sekoya

    Sekoya New Member

    Another bad pain day.

    Also yesterday my doc said she doesn't think disability is a good idea.

    She thinks if I got a "better job" that my pain would subside. I tried to explain that I already have a great job but I'm having trouble doing the work and we went round and round and back and forth.

    She hasn't said so but I think she's another one who believes my pain is psychosomatic. There is only ONE doc in my state who has a good rep as an FMS doc, and he's too far away for me to see on a semi-regular basis.

    *heavy sigh*
  17. Jen F

    Jen F New Member

    If you are sick/disabled and have been paying into a LTD plan you deserve it and it's probably a better deal than SSDI. Usually it's 50 - 75 % of your income.

    Get the medical supports you need.

    document your symptoms and illness, including any medical tests necessary, and start the application process.

    expect a fight, there's almost always a fight for benefits unless you've just lost both legs and an arm.

    Don't let them fire you cause you are sick like what happened to me. Your poor performance reviews are because of your health problems right? so, get that established...

    Good luck.