STD/LTD insurance denied, but SSD approved??
 

So, as many of you already know, I have RSD/CRPS throughout most of my body, including both hands. I stopped working at the end of December 2012 and was denied short-term/long-term disability through my employers insurance carrier. This was an employer paid benefit!! I applied for Social Security Disabillity in April and was approved in about three months, on the first try.

I filed my appeal with the STD/LTD insurance carrier and just received the second denial today, 6 pages of bull. I am soooo angry!!!:mad: I just don't get it! Obviously I am in bad shape because SSD approved me right away and I am so thankful for that! My husband told me not to worry about it because it will stress me out and make me hurt worse. He is absolutely correct and we will make it with SSD. I can't help but worry about it because it is a good amount of money that I should be receiving. UGH!

I just had to vent! Thanks for "listening" :)
Nanc

Do you have an attorney?

No. I had a hard time finding one that handles this type of disability claim. Majority handle SSD and not STD/LTD. I tried to find one the during the 6 months between the first denial and the appeal. One that would take my case, charged $4,000 up front. We would have to pay the fee before he would even look at the any paperwork. Another atty charged $2,000 to just look at the case to determine if he would take it or not, if he took it then his fee was 1/3 of the 6-month benefits. Others I talked to just kept referring me to someone else.

I'm sorry Nanc...that really stinks. Why do they make it so hard to get what you are entitled to? Very frustrating. And I swear the insurance companies know how hard it is to get an attorney for this sort of case...giving them more freedom to deny deny deny. So sad.

Take care of yourself. I'm glad at least that SSD went smoothly for you.

Thanks Catra. It is amazing and frustrating how these insurance companies work! So thankful for SSD, expecting my first payment in October :)

I hope you are doing well!
Nanc

I went through the same ordeal. It boils down to deep pockets. Most law offices do not have the resources to go up against these for-profit insurance companies but in your case it is obvious that the insurance company needs their collective *** sued. Im my wife's case she did receive short term disability while only one doctor treated her, but when her short term was up and long term was to kick in, that doctor was removed, replaced with another doctor who stated that she was just fine and dandy. She was terminated from her employment because she was crippled from RSD, relieving the large corporation of any responsibility. She did receive SSDI. We went to two firms who stated that, yes they are pulling a fast one but we would need about $75,000 just for it to see the light of day. One other firm stated that my Wife's employer's attorneys would eat them alive. She worked for the largest defense contractor in the world in their Benefits department. It seems you guys have given a good effort to find a law firm. All I can say is either keep searching for a motivated firm who will sue pro bono or for stress reasons, give it up, which is understandable for sure.

Thanks for your reply and input! The odd thing is that they paid for one week of STD...one week?? And they determined this was all I was eligible to receive. I talked to firms all over the place and the only ones that would even think about taking it would charge up front. This is a problem for us because I haven't been paid since I got that check for one week of STD in January. My husband works for the Dept of Defense and has been going thru furloughs, which JUST ended. I am thankful that SSD was approved, especially because we will not have to pay the 10% penalty for taking my 401k money (we put it towards refinacing our house so we could stay here). But I will not begin receiving SSD payments until Oct and there is no backpay.
I had one atty look at my case and he said he couldn't understand their denial and said I should persue the appeal. He couldn't take the case because it is not his area he is actually a litigator on the defense side...his clients are employers and insurance carriers. He referred me to many others, who referred me to many others, and so on. This is how I got to the $4,000 up front guy.
My husband thinks, for stress reasons, we should let it go. I get so stressed out with this whole thing, and well, we know what stress does to someone suffering from RSD/CRPS. In filing another appeal, I am not sure what else could be done...I sent them all the medical records and letters from my primary dr, PM and counselor. They pulled out things from the medical records to help them, not looking at the majority of what most of the records state. I guess that is what they do....I dunno, I hate that they get away with this. And my employer, treated me like total crap at the end. Maybe I should listen to my husband and let it go and close that entire chapter.
Sorry, got to rambling there!
Nanc
:hug:

Nanc, all insurance is, is a racket, nothing more nothing less. That is why the delivery of health care can not be carried out by for-profit insurance. As a supplement perhaps. In my wife's case I truly believe her employer and the full time health Insurance executives who reside at their corporate HQ are in business together in some shape or manner. And part of their business together is ridding itself of those who are no good to them any longer. One way they do that is deny care through the insurance company. Making the patient's life miserable and above all making it so complicated in getting treatment. That was my wife's issue that it took too long for doctors to treat and diagnose her. She knew that she had RSD before any doctor would treat her for it. She only received decent treatment when she was terminated and added to my employer's insurance. My Wife's treatment was immediate after her termination. To me it was by design. It took her 3 years after to receive SSDI and did receive back pay. She also was able to use her medicare because it took over 2 years to receive the SSDI.

Nanc, I wonder if there are any class action suits?

I think you are correct...it is a racket. I really think that they contacted my employer for more than just my job description. I say this because when I worked there, I was the one who took care of this type of thing. I filed all the WC and disability claims, the adjusters contacted me and asked me questions with every claim. As everyone suffering with RSD knows, people don't get the condition at all. My employer said to me, "you'll be fine after a month off relaxing, you'll be ready to com back to work" They thought I was fine! That whole situation is a long story that I will not get into right now. I went on my husband's insurance about 2 yrs before I stopped working. A better plan to allow me to go to more drs and cover more with less co-pays.
I am sorry that your wife went through what she did, it is awful! Thankfully she has you and she is receiving SSDI (with backpay) and Medicare. The support that you obviously give her is wonderful and it makes all the difference in the world! My husband is like that too :)

I will check into the class action suits...good idea!

Thanks again,
Nanc
:hug:

So sorry you're going through this frustrating mess! I'm sure you paid into having the benefit of STD/LTD so it's not like it welfare! Did you go through the FMLA process through HR.....STD etc.?
I'm going through something similar but thankfully I got my STD and it transitioned into LTD but they hound me every week or two to check on my application process (they require) for S.S.D. It's still only a fraction of my regular pay but It helps.
Depending on how much money you could get the $4000 up front atty. may be well worth it in the end.
It's hard for me to write long replies because my RSD/CRPS is in my hand and I can only use one finger for a short time on that side. So sorry for lack of more details right now. :hug: