Need info/help: anybody that took LTD from work

Discussion in 'Fibromyalgia Main Forum' started by acesk, Aug 22, 2008.

  1. acesk

    acesk New Member

    Hi, I need some help. I'm a sales manager and have been still working full-time. I got fibro over 4 years ago and I'm about ready to stop working from the pain. I'm concerned about taking short term disability and then getting long term disability thru MetLife for a diagnosis of fibro. I read a lot on this board but don't see many posts about stopping work and going on long term disability, not social security disability. I have a rheum and an internist and a pain doctor. I can work another few months while I get my ducks in a row, if I really need to. But I'm physically and mentally exhausted - I sleep all weekend to rest up for my week of travel/work. (I'm divorced and don't have a spouse to rely on for finances.) Any and all replies will be gratefully accepted! Thanks.
  2. proo

    proo New Member


    I'm dealing with Prudential for STD. They okay'd the first month's disability and denied the second (nothing had changed). I have fibro, mps, cf, chronic Lyme, etc. Prudential has been terrible. Now they are requesting pharmacy records even though they had copies of the scripts.
    I've worked for my employer 20+ yrs, yet I'm treated like dirt. The conditions are so complex, they don't begin to understand them. Normal lab work means to them everything is fine. I got hold of the RN case manager's computer notes and found MANY errors. I sent in a response and am waiting to hear from them. My rheum. is light years ahead of their RN. I had to go into the American Fibro Assn. and print out an article about our ability to accurately access an inability to find the correct words, being disorganized, etc.

    I would suggest you get a large notebook and document
    EVERYTHING!!! If they give you grief, get copies of the documentation they used to make their decision.

    Best of luck with your quest,
  3. acesk

    acesk New Member

    Thanks so much! I'm sorry to hear about the aggravation you are having. That is what I was fearful of hearing!
    I appreciate your quick reply and look forward to more replies from other kind readers.
  4. acesk

    acesk New Member

    Thanks so much for telling me what is happening with you. My LTD carrier also says only 2 years for depression and only 2 years for neuromucular disorders (like fibro). I know the pain you are talking about, but we always look so good! I appreciate you taking time to write to me.
  5. acesk

    acesk New Member

    Would anyone else like to share their story. Did it help to talk to your doctors before you went off work? Thanks for your help (including the 2 posters that already shared their stories)
  6. petemora

    petemora Member

    My personal experience:

    I got CFS in 1998 and was diagnosed in 1999. AFTER I got sick my employer (a governmental agency) offered LTD insurance as well as short term disability insurance. I purchased the LTD insurance, which I paid for totally, no contribution from my employer, and disclosed my CFS to the insurance company. There was a 2-year exclusion for pre-existing conditions. I had a remission that started in 2000 and lasted a couple of years. I started getting worse again and was forced to quit work in 2005 after a weekend "crash". This was when I also developed FM. I have not been able to work since.

    If I had it to do over again, I would ask my doctor to run as many tests as he possibly could, to rule out anything else. I would ask for an MRI, I would go to a rheumy, an infectious disease specialist, etc. (You seem to have already covered these bases.)

    I never did that because I didn't know ahead of time that I would be forced to quit work. Duh!

    I "lost" my good medical insurance when I quit work and now rely on my husband's insurance. I have a $150 co-pay for doctor visits so I don't go as often as I would like. But, on the other hand, my condition is stable, for what that's worth.

    Anyway, I applied for my LTD insurance benefits after the 90-day (or 60 days?) waiting period and I was approved right away. My insurance agent has been very good to me, so far, but since I am coming up on their 3-year review period, they are looking more closely at me, especially since I got a vicious denial by Social Security in January. I had an IME (independent medical examination) in May and an FCE (functional capacity evaluation) last week. The FCE practically killed me!

    I fully expect my LTD company to deny my benefits starting next month.

    I have talked to a wonderful attorney, who will represent me, if need be, for both my LTD case and my Social Security case (I have reapplied).

    That's my experience, for what it's worth!

    Good luck to you!
  7. acesk

    acesk New Member

    I'm sorry you got denied from SS. It does give me hope that your LTD carrier paid for 3 years. You have given me good advice - I haven't had a lot of tests and I'm going to ask for them while under insurance! Thanks for the info and good luck!
  8. Malcolm82

    Malcolm82 New Member

    When I got to the point I could no longer work, I applied for STD with a group policy I paid for through my employer through Security Mutual Life Insurance Company of New York (SML), in addition to the New York State mandated disability that runs for the same 6 month duration as the STD. I did not have a specific diagnosis at that time. On the attending physician's statements my doctor said I had irresistable daytime sleepiness, loss of cognitive function, and short term memory loss. He also pointed out that the above was so severe I could no longer drive (my wife drove me to and from work on my last week).

    I was approved for both after about 2 weeks, however they both required I see my doctor every 2 weeks and sent a claims inquiry form with each benefit check that my doctor, me, and my employer had to fill out and send back within a very short time frame or they would delay my benefits.

    As a lot of you probably know, it isn't easy to get everybody to fill those things out in a timely manner, especially when you can hardly hold your head up and they only give you about 5 days to get the thing returned.

    Therefore, several of my benefit checks were late. Even when I got the forms back on time, which was actually most of the time, they still did not send them every 2 weeks like they were supposed to. I would always have to call them and ask where my check was. I was afraid, of course, that they had terminated my benefits! I would usually get some lame excuse if there was no good reason, then they would say they would send it right out.

    I finally came to the conclusion that this is probably standard procedure. Delay as much as possible until the person calls. If you are really sick and can't deal with it, you won't get anything.

    Anyway, by the time 6 months rolled around and I wasn't any better, I knew I had to file for LTD, again through Security Mutual. This required, again, forms to be filled out by my employer, me, and my doctor. They require that that the forms filled out by my employer and me be given to my doctor to fill out her part, and then they required her to mail them in. I got the main claim form filled out by the doctor who had done my STD forms, and then had my new doctor, who had actually diagnosed me, fill out an additional attending physicians statement and fax it in to SML.

    Just a heads up here: Nobody is going to tell you your STD is going to end until you get your last check. It takes at least 60 days to approve a LTD claim, and they won't even start to review your claim until you can send them a copy of the STD termination notice you get with your last check. So have your LTD forms filled out and ready to mail before the first six months are up. Even if you do this, expect to be without benefits for 2 months at least.

    By the time I had to apply for LTD, I had been diagnosed with CFIDS, and that is what my doctors put on the attending physician's statement.

    After about 45 days of my claim being received by SML and not hearing anything, I began to worry that there was something wrong with my claim that was delaying it, so I called up SML to find out the status. They told me the claim was being administered for them by Disability RMS and I would have to call them. I called and left messages for my claims handler to call me back every day for 2 weeks, and she never called!

    Finally, I received my first check, showing the claim status as "claim pending". All my subsequent checks, which are paid monthly, have that same claim status, so I guess as long as they keep saying that, I'm alright.

    I'm not really sure what to expect next. SML has not asked me or my doctor for anything else since my claim was approved, but I'm sure they must have to review my status at some point. It has been about 4 months since I got my first check. Maybe someone else out there who has been on LTD longer can enlighten me about what to expect going forward.

    The process does not go very smoothly, and you are going to have delays in getting your checks and get jerked around, especially during the STD phase, but don't give up!! That is what they are hoping you will do, I think, especially when you are so sick you can't even deal with what you are going to have for lunch. Keep at it, and maybe get some help from a caring someone to help fill out the forms and figure things out.

    In my state, New York, you have to be on STD for 6 months to be able to apply for LTD. STD benefits AUTOMATICALLY END after 6 months, so definitely have your forms in hand for LTD when that happens. A lot of people find this stuff out the hard way, because NOBODY is going to tell you what to expect. Get and read copies of your STD and LTD policies before you start this (some help here by someone whose brain is still working is beneficial here too) If you have your insurance through your employer, they have to provide them to you, as well as all the forms you need.

    If I have any other advice for you, it is to DEFINITELY talk to your doctor first. Make sure they are willing to fill out the insurance forms stating you are disabled and can't perform your job duties. You WILL NOT be approved without your doctor's proclaiming that on the insurance forms.
    If your current doctor won't do it, try to find another one who understands these DDs.

    Go for it, and Good Luck!!

    [This Message was Edited on 08/23/2008]
  9. petemora

    petemora Member

    One more thing, I am blessed to have been able to find a wonderful, compassionate, caring, smart doctor. He's really up-to-date on FM and CFS stuff and always takes a lot of time with me...

    Anyway, the sad part is this: While it would be nice to be diagnosed with something that is actually diagnosable, whatever it be, I truly, in my heart, know I have CFS. I have the classic symptoms.

    I live in Minnesota and could have gone to the Mayo Clinic, for goodness sake, but I did not because my doctor and I didn't think they would be able to help me any more than my doctor does.

    My doctor could have ordered lots of tests that he didn't think were necessary. He could have referred me to specialists that he didn't think would be able to help me. It would have cost my medical insurance company thousands of dollars! Had my doctor done this, I might have had better luck with Social Security.

    My point is this: My doctor, all along, has been looking out for MY medical interests, not my Social Security or LTD interests. My doctor has been practicing good medicine! That should have been enough for both Social Security and my LTD carrier. But it wasn't!
  10. Malcolm82

    Malcolm82 New Member

    I am concerned why if you meet the criteria for CFS that your doctor hasn't diagnosed you with it.

    That is generally the key to getting LTD or SSDI.
  11. proo

    proo New Member

    I neglected to remind you to get a copy of your job description and go over this with your doctor. Then you and the doctor can review what you can and cannot do and why. Insurance companies love numbers such as "degrees",
    "percents", etc.

    Best wishes,
  12. petemora

    petemora Member

    My doctor HAS diagnosed me with FM and CFS but there really is no definitive test that will PROVE I am sick. There are no lab tests, no blood is really only my word that I feel pain, that I have fatigue, that I am depressed, etc.

    I have been tested for Lyme Disease twice, both negative. My EBV titers are out of this world! My ANA is negative, which indicates I don't have arthritis. I tested negative for gluten intolerance.

    The bottom line, my ALJ didn't believe me and my LTD carrier would like to drop me.
    [This Message was Edited on 08/23/2008]
  13. acesk

    acesk New Member

    You don't know how much I appreciate your LTD stories. It is helping me greatly and I am very grateful. I only wish the best for both of you.
    At least being a manager, I've had the experience of one of my reps going on STD and then LTD for cancer and know the forms she had to fill out!
  14. ldoty

    ldoty New Member

    I also have Disability RMS as my LTD carrier. So far, my LTD benefits have gone smooth. I am now at the point of filing for SSD which the Social Security Law Group is helping with that. I have FM and depression. I keep asking my case manager about the FM dx because that would keep me on LTD benefits longer than depression dx. So far she keeps telling me they are reviewing my case. I have a feeling that they will deny my FM dx and I will have to get an attorney to appeal that decision. Can't wait to see what they come up with.
    Goodluck to you!
  15. landra

    landra New Member

    It is a yahoo board like this and you can reach them at didinissues at yhoogroups dot com. They specialize in the issues of getting disability both through insurance and through SSA. They are lawyers and people who worked for insurance companies or SSA.

    I would phrase the question as "what suggestions do you have to prpare to get LTD from MetLife with fibro? "
    They also have files that may have information.

    It is not a support group, so just expect to ask your question and wait for answers. But they have LOTS of info on LTD through insurance.
  16. ldoty

    ldoty New Member

    I have been on LTD with them since February 2007. At this point they are telling me my benefits are extended until February 2009. As I stated before, still waiting on the FM dx answer.
  17. susabar

    susabar New Member

    Doesn't it differ from employer to employer or state to state ?? I have STD through my employer and I purchased LTD but that is only good for 2 years. I would never be able to survive on it however at least not if I had to purchase my Rx's etc... It's a terrible position to be in.

  18. proo

    proo New Member

    Hi,I was so excited to learn of this site....HOWEVER, Yahoo wanted to install something on my computer which my virus scanner said could be dangerious. They also want personal information such as name, DOB, etc.
    Did you have to go through all this just to get into the site?
    Many thanks,

  19. landra

    landra New Member

    I was already a member of another yahoogroup, so they already had my info. As i understand it, yahoo gathers that info so no one can pretend to be someone else and cause trouble that way. And i was assured by others much more knowledgeable than I that it would not cause any problems to do it. I have never had a problem because of it. Yahoo does their own virus screening.

    [If there are techies out there, please elaborate! I know I probably did not say it right.]