PLEASE.....Anyone who has dealt with a work LTD

Discussion in 'Fibromyalgia Main Forum' started by lin21, May 1, 2003.

  1. lin21

    lin21 New Member

    I am so desperate and disgusted, I need input from any and all who could give me suport.
    I applied for LTD in Dec. (I was eligible in Oct), the first time I applied my paperwork was all screwed up by an ill-meaning person in my ortho's office.
    I was denied.
    I appealed and once again I was denied because of statements this person wrote (capable of doing sedetary work)
    I am now in my second appeal and am waiting to hear anyday. This time I had a strong letter from the ortho stating I had weakness and numbness in all extremities.
    I had a letter from the neuro (the first denial they said it was because all my MRI's wwere negative)
    Also, the rheumie sent a strong letter stating my case was severe in nature. He ordered exercise and meds because it is standard textbook treatment. (they also denied me because he ordered light aerobics).
    I have myself in a terrible flare and I can't stop crying because I received my denial letter from SSDI today (which I expected) but I'm so nervous that the LTD will deny me again and I truely don't know what I will do.
    This has started tension in my marriage and I just don't know how much I can take .
    If anyone out there has experience with LTD please let me know what you think .
  2. Susan07

    Susan07 New Member

    Goodness, what a crock - I have no experience with this, just wanted to BUMP.
  3. lin21

    lin21 New Member

    Hi Sue,

    Just wanted to say "thanks".
  4. COOKIEMONSTER

    COOKIEMONSTER New Member

    The first thing that you have to do is "NOT GIVE UP."

    First of all, I also received just recently a letter for SS stating that I was denied benefits. I was fuming so I called them up and asked them what the heck was going on? They informed me that I was not eligible for SSI for which I never applied for. SSI, according to the rep, was just to notify me that I did not qualify for welfare benefits at this time due to my husband's income. I informed them that I did not apply for welfare benefits, but for SSDI. They told me that it was just a standard letter that goes out during the review process of my application for SSDI. That made me feel a little better. So take a look at your letter and see if it reads that you do not qualify for SSI or for SSDI benefits.

    Second of all, LTD. I also received a notice from Standard Insurance informing me that I did not qualify for LTD benefits because,as they told you, I can do "sedatary work." I called them up and told them they must be crazy if they think that I can hold a job, without doing anything but sit there and look pretty and if they had a job to please offer it to me. They don't want to hear what you have to say about what your limitations are. What they want to see is what is on paper from a doctor. So without putting himself in any predicament, he in little words due to the conversation possibly being recorded, informed me that what people and doctors don't understand is that they want to know what your limitations are, not so much what your diagnoses is.

    So first of all for both parties noted above, I personally requested all medical copies from my primary physican, cost me $15.00, so I can review them personally, to see if what I had been telling my doctor all these years, was actually on the reports. You'd be surprised to know that the only things noted was the date, diagnoses and treatment! I would recommend to anyone reading this post that from this point forward, always ask your doctor for a copy of your results at your visit so you can review them with him/her while it's still fresh in your mind. Not 10 years later!

    Anyhoot, I was able to provide SSDI will all my doctors reports to review which is still in the review process, but I asked Standard Insurance, (LTD) to forward what they had in their possesion that lead them to deny my claim, so that I could review it myself to make sure that they had all the reports so I could decide if I wanted to appeal. Have you requested your file so you can personally review it? What I was really doing is killing time because as you know, there is a certain time frame to appeal.

    I then went back to my chiroprator who is currently treating me and informed him that the diagnosis is important, but the insurance companies want to see what my limitations are. So he noted on my report that I am not able to sit for more than 15 minutes at a time, not able to stand for more than 20 minutes at a time, not able to walk more than 10 minutes, cannot drive a vehicle for more than 20 minutes, etc. In your posting, all the ortho said was that you had weakness and numbness, the rhuemi said your case was severe, but you have to ask them to write what you can and cannot do.

    I understand that under the LTD rules, Fibromyalgia could be considered a "disease" and the policy should automatically qualify you for this but you know how that goes. Once I received the information from the Chiro and the Rhuemy report listing all of my limitations, I then filed for an appeal, again noting the timeframe, in my case, of 180 days to appeal.

    I for one, don't think that it is in my good nature to pay someone 25% of what belongs to me especially if I'm the one who is suffering. I will continue to appeal, appeal, appeal, until I get my way. Hopefully, or eventually, you will get whats' coming to you with back pay. I've heard that once the claim is approved, it does not take to much time to receive your check with back payments.

    Also, if the appeal gets to the point that you are forever appealing, then write them a note stating if there is anyone else in a higher position that you can forward your information to. Remember, this IS your money and your not taking anything out of anyone's mouth!

    It is my understanding that it is in the nature to deny, deny, deny, until we the applicant, get tired and give up. So don't give up! Fight, Fight, Fight. We can all read and write I'm sure, so why pay someone 25% to complete forms we can do ourselves? Hold off as long as you can before you decide to "give" up your 25% to anyone.

    Please keep in mind to always keep copies of everything that you send to anyone, whether it be an attorney, SSDI, or LTD just in case they "lose" something, and always send everthing to them certified mail with a return receipt.

    I'm probably talking out of my "you know what" hoping that my appeal for LTD will be a favorable one. But you see, sometimes if we think positively, things just may go our way. If not, and I've exhausted all avenues, then and only then will I make a decision to use a third party.

    I hope this helps and good luck to the both of us and anyone else going through this Bull S***.


    Lots of hugs,
    CookieMonster


  5. kellbear

    kellbear New Member

    Who is your dissability through?

    I work in HR and understand a little about LTD. Sometimes the company name alone sets off a red flag as to how easy/difficult it is to get LTD.
  6. lin21

    lin21 New Member

    Hi,

    Well thanks for all this information cookiemonster, and you are right about the 25% but I'm not sure I have any fight left in me, they have drained me of everything and I just thought it would be better to let a lawyer handle it. This damn rheumie, I could kill him, he never sent in the damn file so they made judgement without him, the most important of all!!!
    Anyway, the LTD doesn't have the lastest info on my case. Several weeks ago after I sent in my appeal, I saw my g.p. who has recommended me to see a therapist and who also has increased my pain meds, so I just left a message for their rep so I can update her. I don't think I can handle another denial, it will send me right over the edge which I'm tettering on.
    Kellbear, it begins with a "P".
  7. lin21

    lin21 New Member

    hi Susan,

    Just want to say thanks for being here for me. This thing is a total nightmare. I was diagnosed in early Dec. by a neurologist who sent me to this rheumie. Well , although he said I can't work he has not followed through with sending paperwork to the LTD and SSDI. I just found out yesterday he never submitted my file, although he promised me he would take care of it. I went through hell with his office to get my files for the LTD. My g.p. has recommended I see another rheumie in town but I'm afraid to because I heard from some one that he doesn't believe in fibro. I am in a terrible flare from all the backlash with the SSDI and waiting for this damn LTD. Now I know why depression is so common with this illness, with all the crap we go through, no wonder we get depressed!!!
    Thanks again,
    Lin
  8. kar1953

    kar1953 New Member

    what does LTD stand for?

    Take care.......Kathi
  9. lin21

    lin21 New Member

    Kathi,

    Never feel dumb around here, just ask. LTD stands for Long Term Disability such as a private insurer .

  10. dolsgirl

    dolsgirl New Member

    I'd get a lawyer. It is amazing what some office personnel are capable of doing. I couldn't believe what my sister went through with her surgeons' office. Good luck. dolsgirl
  11. lin21

    lin21 New Member

    Hi,

    I want to change doctors. Right now I've been seeing my g.p. mainly because she's in my town . She has been giving me refills on my pain meds and she suggested a rheumie in town. I'm afraid to go to him though because I heard some bad things about him. I did check the good doctor list and there are two doctors on there that I'm interested in, only problem is they are a little far for me to drive. I don't have anyone who could take me as everyone else works and my husband has exhausted his "sick" days to take me to the rheumie who is also out of town. I can only drive for about 15 - 20 minutes max.
    Believe me he is going to get an ear full on Monday.

    Thanks,
    Lin
  12. lin21

    lin21 New Member

    Hi,

    Thanks for all your information and caring. To get to both of these doctors on the list I have to get on to really busy roads and that's what scares me. But if worse comes to worse I will choose between the two.
    I'm going to call my g.p. this week and set up an early appt., I'm not scheduled until 5/28. She was the one who put me on the duragesic patch and she was also the one that has recommended I see a therapist. She said "you have been sick for so long it's starting to affecting you mentally and that is expected". I have lost all quality of life. I am 43, in great shape , mother of one, went and did everything and now I'm homebound. Today I stayed home while my family went to a family members party. We have never done anything without each. But because of my pain I couldn't push myself to go, besides I didn't want everyone looking at me because I can't even walk today. I get like this when I go into flares which happens quite often these days.
    Thanks again,
    I'll keep you posted.
    Lin