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Appealing STD and LTD policies


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My last place of employment has both STD and LTD policies. These policies pay 60% of my salary(less SSDI) in I win the case.  I was turned down after about 4 months of payments. I talked to an attorney about appealing, but when she saw the policies only paid for 24 months, she would not take the case.

 

So, I am going to have to put together an appeal of my own.

 

Has anyone had to do this before?

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I applied for LTD, and my LTD insurance company turned me down at first, so I appealled, and they turned me down without looking at the subsequent info that I sent in when appealing. I had to take my LTD provider to court.

 

I found an attorney by googling for ERISA lawyers.  I had no recommendations.  We did some initial fact gathering at the beginning, and I heard from him off and on for a few months, and then I didn't hear anything for over a year  I contacted him, because I was going to terminate things, but he told me that the process can take a long time.  We didn't go to court, we went through a mediator.  This was laid out in my LTD policy.  The mediator would come in and talk to me and my attorney in one room and my attorney would put forth a proposal and then the mediator went to the LTD attorneys room.

 

I ended up getting some money, but it wasn't a lot, and the attorney got 40%.  That's probably why they won't represent you because the 40% of your eventual decision isn't enough to cover their expenses.

 

I don't know what I would have done without an attorney as I haven't' a clue about the law behind what they did, and how to negotiate an amount.  We must have gone back and forth on the amount at least a dozen times.

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I was on STD then LTD when I first got sick.  I too got turned down after about 4 months, but I thought my illness (physical, not my MI) was getting  better as I was feeling pretty good at that time.  I went to school and planned on living as a student, taking out student loans, and working part time.  When it became clear that wasn't working out and I wasn't better, I contacted a disability lawyer who also refused to take my case.  I didn't pursue things any further.  I just applied for SSDI at that point.  I eventually won my SSDI, but that took a couple years and at the time of the trial, my SSDI lawyer asked why I never used my LTD plan.  Looking back, it probably would have been useful to have fought it, but I wasn't well enough to do it on my own.  Heck, I had to fight with the STD and LTD people every 2 weeks when I was receiving it, and I wasn't well enough to do that either. 

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It didn't seem like much was required for STD (about 10 years ago now), but for LTD, I had to fight, and it took a really long time (several months).  I have a technical job so closely reading through the insurance policy wasn't a big issue for me, I didn't use a lawyer.  I had to request the written evaluation by the insurance doctors, and then did a point-by-point response in my appeal.  In order to do that, I had to be able to write a letter that said "Per policy term x, paragraph 3b, provide all records of my case to me, including xxx..." 

 

I also had to get complete records from both my pdoc and tdoc.  Because my tdoc was a self-centered asshole and only really worried about his liability, I had to have a lawyer request my records as my designated agent.  Which was stupid, because I paid the lawyer $35 to write a letter that said, "I am Catnapper's agent, per state code xxx release her records to me."  Then I went and picked them up from the lawyer. 

 

It was a stressful pain in the ass, but I eventually got my money.  They don't make it easy, and they want you to quit trying, but don't.  Also, do everything in writing, and even if you do have to have a phone call, immediately after you hang up write up a record of the call, "On date x at time y, I spoke with Jane Doe about...."

 

It's helpful to get your medical team on your side, and expect to pay your doctor to release your records, most state laws allow them to charge for making copies.  Lots of doctors also charge to fill out forms, but it's worth it in the long run.  Good luck to you.

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My std ltd issues were many years ago. It seems like i was paid std whille under fmla. When that time ran out i was transfered to ltd and a different insurrance co handled that claim. They gave me one month of pay and then denied me saying i was all better.

I found an attorney to appeal. He was nice and capable...ii met with him several times. He had his own mi issues and nothing ever happened.

At the time i did not feel competent to even begin my own appeal so i dropped it.

A year later i got ssdi on my first try!

Good luck,

db

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When I appealled my SSDI, the attorney had me get an evaluation by a Psychologist he works with.

 

I spoke with him yesterday and he agreed to do another consult and write the correct type of evaluation for STD and LTD. Of course I have to pay for a whole new evaluation and report, but I think this is the right move.

 

Thanks for everyone who posted. They were some good ideas!

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