Hello All! I need some help. I have applied for disability through my work's short-term/long-term disability insurance carrier. They have denied my claim even though records document RSD/CRPS in my face and all four extremities. Does anyone with RSD who has gone through this process have any tips or recommendations for me?The medical review staff with the insurance company said that I could do sedentary work and my records did not indicate otherwise.

I had a functional capacity evaluation (FCE), but it only tested my strengths and weaknesses. It did not test anything related to using my hands all day at work, etc.

I am obviously going to appeal, but would appreciate any helpful information.
Thanks!!
Nanc

Nanc,

I'm sorry you are going through this frustrating process. I am not familiar with short term and long term disability, but can support your decision about appealing the decision.

Hi Nanc,

I have not gone through that specific process, but my impression is that it must be somewhat similar to the WC battles and SSDI approval process that I have been through.

What exactly did your FCE say/conclude ?

I'll give the example of one filled out for me (and I forget the exact details, so I am making up these numbers.....) My PCP wrote that I could stand up to 15 min/hour, then multiplied that times an 8 hour shift, for a 2 hour total of standing per 8 hours. He also wrote that I could sit for up to 30 min/hour, then multiplied that times an 8 hour shift, for a 4 hour total of standing per 8 hours. That makes it look like I could do something that involved sitting and standing for 6 hours. Those numbers are my max. That also doesn't account for the 15 minutes each hour (or more) that I usually have to be laying down. Not many jobs can accommodate that. A FCE that just looks like I could sit/stand for 6 hours could and did sink me in my initial SSDI application.

Look closely at what your FCE says/concludes. You may or may not feel comfortable posting that info here....and that's fine either way, as long as you look at it closely. Don't read it as someone KNOWING you and your history. Read it as someone trying to figure out if there is ANY way this person can do ANY work for a few hours a day.

You may need your physician to write up a more specific FCE if he agrees that you are unable to work.

Best of luck. This is such a difficult process and the stress certainly doesn't help our pain issues.

To add.....your FCE should also reflect if you can technically perform an action, but that results in additional pain which must be treated with rest and/or medications that affect your ability to concentrate.

Usually it's required that once you're approved for long term disability insurance, that you then apply for SSDI. They will often provide an attorney at no charge.

There are definitely some similarities between both of these processes as well, and the stickies in the SSDI/SSI NT section should help. The publisher NOLO offers a very thorough guide on applying for SSDI as well.

I am on LTD through my previous employers policy. It was effective after being off work for 6 months before it came into effect. As Lit Love said they require for me to be on SSDI after 36 months. I have started the process and they provide the legal assistance.

I was not diagnosed with RSD yet when my claim with my LTD insurance was filed and approved. At that time it was considered post surgical nerve damage. I have limited use of my hand that started after surgery.

I can try and answer or help you with any questions. The LTD process took a little bit, but my adjuster who worked on the case was pretty helpful in the process.

Hus was on short term then went to long term after company said there was no job he could any longer. He was approved for long term but we had to agree to apply for ssdi, which we did. Got denied. They provide us an atty to go to next step, the ALJ hearing. The rule with most LTD's is first year "you can do your current job". The 2nd year, it's you can't do any job. Read your long term papers and what they say for first, second year, etc.

The insurance companies do rely on what is in your med record per your doctors, etc. You need a doctor in your corner for your diagnosis.

No exp with your disability diagnosis, but do wish you the best....

Thanks Jimking and Ironbutterfly!

My husband went with me yesterday to see my pain doctor. We discussed him writing a letter to describe how the pain of RSD is impacting me and the use of my hands. I went over a list of things with him that he needs to include in the letter, he agreed with it all and his nurse was also taking notes. They are going to email me the letter since I am still waiting for the denial packet (with appeal instructions). I think my doctor is in my corner now. I told him that he was the only one who could help me at this point and he said he would.

That is great news.

That's HUGE !

Obviously, doing extra paperwork is extra work for docs. Unfortunately, that gives them some incentive to not be as thorough as we need them to be. I'd like to offer to do that lecture for them in medical school.....there are MANY ways to help a patient. Making the right diagnosis and ordering the right treatment(s) is just part of the job. Addressing psychosocial needs like finding a way to pay for meds and accessing insurance benefits (be it STD, LTD, WC, SSI, SSDI or insurance approval for a treatment) is also a part of a doctor's job.

Sounds like you've got a keeper there !