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SSD Approved, STD Denied ???? Texas

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  • SSD Approved, STD Denied ???? Texas

    In 2006, I went on STD and then LTD. I felt better and went back to work at another job that allowed me to work from home.

    After 3 months, I again had to go out of work and have been receiving STD for the last 5 1/2 months. I was 2 weeks shy of qualifing for LTD.

    I summitted my LTD application, applied for SSD and appealed the STD denial.

    I was approved for SSD but have yet to hear regarding the STD.

    What should I do if they do not approve the STD?

    Will my SSD approval influence their decision in any way?

  • #2
    Originally posted by LMGray74 View Post
    In 2006, I went on STD and then LTD. I felt better and went back to work at another job that allowed me to work from home.

    After 3 months, I again had to go out of work and have been receiving STD for the last 5 1/2 months. I was 2 weeks shy of qualifing for LTD.

    I summitted my LTD application, applied for SSD and appealed the STD denial.

    I was approved for SSD but have yet to hear regarding the STD.

    What should I do if they do not approve the STD?

    Will my SSD approval influence their decision in any way?
    LMGray your post is somewhat confusing as you say for this disability you have been receiving STD fro 5 1/2 months, then at the end you ask about appealing the STD denial. SSDI and private STD or LTD policies uses different criteria for approval so being approved for SSDI wouldn't necessariy make it a given that the STD or LTD would be approved. However, given that the criteria for SSDI approval is so rigrous I am surprised that the STD and/or LTD was not approved without a problem. Any chance the paperwork wasn't filled out correctly or some other snafu that is causing the denial rather than your actual diability? What if any reason did the STD/LTD give for denial?
    Last edited by Kick Me; 09-24-2007, 10:57 AM.
    Information posted by me is my "OPINION". I do NOT give legal advice to anyone as like most here I am NOT an attorney.

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    • #3
      Clarification

      Thanks for responding.

      After receiving the private STD for over 5 months, they suddenly denied it based on me being able to make a fist (I have lupus and spondylitis) and that I talked to my shrink about building a house (I am Bi-Polar).

      After 2 more weeks of being on STD, I would have qualified for LTD. Because they denied the last 2 weeks of STD, I will not be eligible for LTD benefits.

      The denial letter also suggested that they think all my symptoms are subjective.

      I realized after the fact that they had not received any of the bone scans, xrays, etc that were used for the diagnosis. They also had not received the full picture of the Bi-Polar diagnoisis as well. I sent them over 200 pages in documentation.

      Comment


      • #4
        LM, the STD plan will have an internal appeal procedure that you must follow. The most important thing you can do is send them every shred of evidence there is that supports your claim for benefits. If you end up having to go to court the only evidence that can be considered is the stuff that was in the possession of the STD/LTD administrator when they made their decisions. You cannot put new or additional medical evidence into the "administrative record" at court.

        Given the timing, there is a good chance that they denied the STD simply because you were two weeks away from qualifying for LTD. It is well known in the legal community that disability insurance carriers deny almost all claims without any real justification, and that they end up paying many of them after the worker gets a lawyer to push a few buttons. So your next step should be finding a good lawyer with some experience in this area to help you.

        Good luck.
        Bob Bollinger, Attorney
        Board Certified Specialist in NC Workers' Compensation Law
        Charlotte, NC

        Comment


        • #5
          One other thought LM. I have only used my STD/LTD policy once but it was for a 15 month period so I used both. I had NO problems with the payments other than the LTD insisting that I apply for SSDI before they would start paying. This was a total pain in butt however in order to be paid the benefit I went along with it.

          When I finally was released to return to work the LTD company sent me a notice that they had received my release and of course would discontinue benefits. However, in that same notice was a statement that IF I was to become disabled again from the same conditions that had me off the first time within 5 months of returning to work that the LTD policy would automatically pick back up without a waiting period. You might want to ask for the full policy rules from your HR dept or the company that administers your policies and make sure you don't have a continuation from your first disability.

          Also what Bob has told you for the majority of people that I know first hand that have tried to use the STD/LTD policies they pay for is 100% dead on. Delay, Deny, Delay. Sometimes it makes me wonder if they aren't just hoping that the claimant passes away before they have a chance to get legal help, an attorney, and have the court system make them pay the benefits due. Very sad but very true. Following Bob's advice and seeking legal help is a very good idea as well as his other suggestions of getting every shred of evidence into that carrier ASAP.

          At least you have your SSDI for income in the mean time. Good luck to you.

          KM
          Information posted by me is my "OPINION". I do NOT give legal advice to anyone as like most here I am NOT an attorney.

          Comment


          • #6
            With regards to the question about whether the SSD approval will affect the other benefits, you'll need to look in the policies to see if there is an offset for SSD mentioned.
            The above answer, whatever it is, assumes that no legally binding and enforceable contract or CBA says otherwise. If it does, then the terms of the contract or CBA apply.

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            • #7
              Thank you

              Thank you all for your valuable advice!

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              • #8
                In addition... at my old job, the disability is coordinated with Social Security, so if the SS benefits are more than what STD would pay, you would get nothing, so you probably should check your policy.

                Comment

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