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Long Term Disability Help

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  • Long Term Disability Help

    I was just wondering if anyone has any experience/advice (negative or positive) concerning receiving Long Term Disability through an insurance policy of your company. I will have an answer in about one-month as to if I am approved. My policy if approved will pay 70% of my salary through age 65. My feeling is they are not going to approve me without a fight. Below is my case - Does anyone see any negatives to my case or how in any way it could get denied.

    1. Can't sit more then 10 minutes without severe pain
    2. Can't walk or stand more then 15 minutes without severe pain.
    3. Having major hip surgery June 30 (LTD decison to be made by July 1st)
    4. I have documented proof of permanent nerve damage.
    5. My doctor agrees that I most likely will not be able to do any occupation now or in the future.
    6. I have a history of back problems dating back to 1998.
    7. I am showing a history of getting progressivly worse after my last surgery in April. I have an appointment at the end of the month which will mark almost 3 months since my surgery. I would have thought if there was going to be improvement It would have started showing. I have had heart surgery in October with a pacemaker/defiberlator implanted, Back surgery in December and April and scheduled for hip surgery in June and July. I would think on my next appointment the doctor will record that most likely I will not be getting better. I have had 4 major back surgeries and every surgery seems to make me worse. I'm not letting anyone touch me again to do any more back surgeries.

    I have to use a walker at times just to walk.

    I do not see how in any way I could be denied. I'm hoping someone out there can look at my case and tell me if you see a negative. I had someone tell me in December to file for Social Security Disability because everyone first gets denied. I told them no because I had hopes of getting better and if I were someone looking at my case before my last back surgeries I would deny me too. However now I have gone through my surgeries and there is no chance of me getting better. I believe I have a case in which there is no way SS or LTD can deny me.

    Anyone have any thoughts?


  • #2
    Where do I begin.....job one is to try and deny you.

    I have been on LTD from my company's policies for four years now and have actually been approved to receive 70% pay until age 65.

    Now, your case manager for your plan (pray it is not Metlife) is not your friend. They will use every trick in the book to try and say you can work. Everything you and your physician write about your medical condition is subject to scrutiny. My case manager at the time tried to set me up by backdooring my physician and speaking with his assistant who was clueless about the condition. Based on his lack of knowledge I was set up for an independent medical evaluation with a Metlife neurologist. Long story short, their own neurologist certified me as permanently jacked up and unable to work gainfully. End of story. Metlife case manager was piiiissssssed, but that's what she gets. They can receive bonuses for keeping those approvals down.

    They will look at your education level and determine that there may be a job you can performing sitting down--pain and all ("isn't that why they give you medication?" they say). Their nurses are will go over your paperwork with a fine toothed comb looking for an opening.

    DO NOT assume your approval will be automatic because more than likely you will have to fight to show just how disabled you really are. You will more than likely have to endure the LTD provider's IMR for full benefits. Good luck.


    • #3
      c6 sci in 1988. worked until 2001. went out on std, then progressed to ltd. must go through the process. current on ssdi in addition. total remuneration equals 66.66% until age 65. use aetna life insurance. needed to have 3 yrs at co. to be eligible, 10 yrs (40 qtrs) for ssdi eligibility.

      had a little push back at first. tried to deny based on a payroll technicality. good thing i kept payroll stubs and benefit selection application copies. had to prove that disability progressed to the point where FT or PT was not an option. couldn't just say i'm sci. they'd say, big deal, you worked with sci for 13 yrs. had to show progression.

      word of advice. keep a spreadsheet with date, provider, service rec, etc. maintain this forever because govt and db provider all req updates. this way your hx is available. keep your recs together. be attentive to recordskeeping.

      i worry when i hit 65. my situation will become bad. until then i hope ss or the ins co won't go bankrupt.