Thanks for replying, sorry you are having trouble with your hands and typing I understand the difficulty, I have RSD in both hands.
The STD & LTD benefits were 100% employer paid, so no, I did not pay into them. We didn't qualify for FMLA because we were under 50 employees. I was the HR Manager (Financial & HR Manager to be exact). I was a one person department. I was the benefit administrator too. I filled out the disability paperwork and my boss signed it. After that, she was the employer contact on my claim. I made sure everything was covered, all waiting periods met, etc. The benefit was for 60% of my salary. What I will receive from SSD is about 35%. They approved one week of STD? Why only one week, where is the rationale behind that??
We would have paid the $4000 if the atty sounded more promising. My husband asked him the odds in beating the insurance company...he said eh, 50/50...$4000 is an expensive gamble.
Glad you got your STD and it transitioned to LTD. I read our plan documents and our carrier required the applying for SSD as soon as LTD begins. I got SSD right away, so that would cut down the LTD payments and they still deny me.
I started searching online this afternoon about Lincoln Financial Group's disability claims...it appears the denials are the way they do business! So frustrating!
Nanc

Hey Nanc,

Do you know what diagnosis codes your doctor is using? Did you keep a copy of all of your work release letters from your treating physicians from the time you initially went out on STD? When you left your job was it because a new injury caused spread/increase in pain or was it possibly work related repetition that made things suddenly unbearable? ... bare with me on my gazillion questions... just reaching here. Did they give you any reason for the approval and then denial after the initial week? Are you saying that your STD/LTD claims manager is your employer or do you have an actual claims manager outside of your employer?

When I initially applied for STD/LTD I was assigned a claims manager and it was that person alone with whom I had direct contact with. I made sure to gather copies of all of my records and constantly flooded the claims manager with emails and faxes with chart notes, work release letters & additional diagnosis. They also requested formal records about every 12 weeks and before extending benefits again (usually in 3-4 month intervals). When we were approaching the 2 year mark the LTD rules have different guidelines in that you must be unable to do "any" job, not just the job you were currently doing. I believe that is fairly standard language in most LTD contracts but, you would have to read your through to be certain. I was then required to fill out many more forms asking about my limitations etc., as well as provide information on current medications, physicians list etc., It was right about that time that I had undergone a complex hip surgery and this resulted in nerve damage that caused the CRPS II and I immediately phoned my rep and then followed up with a copy of Dr. Hooshmands article on The spread of CRPS. One week later - I received a letter extending my LTD until the age of 65 instead of the normal 3-4 month intervals, I was shocked and relieved. I'm not sharing this with you to make you feel bad because of the way my case was handled but, wondering if your claims manager doesn't understand CRPS? I wonder if your diagnosis codes are accurate? Did you get a return to work request from your employer for your physician to fill out? If so did they properly list your limitations or excuse you from duties?
In your shoes, I would certainly appeal.. something is just not right. I know it is exhausting and stressful but, it seems from what you have shared that something is missing. I would fight!

Hang in there,
Tessa

Hey Tessa,
Sorry but this is a very long reply, but I wanted to address all your questions.
I do not know of any diagnosis codes my dr used. I do not have any work release letters as I was never released to go back to work. My RSD spread and pain got to where I just couldn’t keep up in my job. In other words, I could not bear the pain any longer. The SCS’s were implanted in June 2011 (revision in Nov 2011) and they enabled me to continue working for another year and a half. The RSD kept progressing and the SCS’s effectiveness was wearing off. I was not sleeping because of the pain, doing my job was taking longer because of my hand and arm pain, I was having these additional pain attacks in my head, side and foot that effected everything (including driving). With RSD in my leg and feet, it was hard to sit in one position very long. I had difficulty walking to the copier and workroom at work. I was finding mistakes that I was making in my job, which was not good when you handle all the finances and hr for the organization. The more I used my hands, the more they hurt! I could not take pain meds when I was working. The insurance carrier did not give any reason for covering one week of STD. They sent a check for that period and that is all. The denial letters just stated that I was not approved for benefits beyond that period -?? My claim’s manager was not my employer; my boss was the employer contact on my claim. I was not exactly assigned a “claims manager”. Our claims were processed as follows: the employee completed form, employer completed form and the physician’s statement (form) all sent in with a copy of my outdated job description. On the drs statement, he put “unknown” as the date expected to return to work. I think the thing that did me most harm is that my dr had me do the functional capacity evaluation (FCE) which stated I could do sedentary work. My job was pretty much classified as sedentary. This FCE did not test real working environment, it tested how much weight I could push, pull and lift. Where is that relevant in my type of job?? The girl who did the FCE made mistakes on it. I tried to contact her and she would not return any of my calls. My dr said he could not say I was totally disabled because the FCE said I could do sedentary level. He said he couldn’t make that determination, even when I showed him the letter my PCP wrote stating I was totally disabled and she advised me to apply for disability (she did for the last two years). HE screwed me over on this whole thing, which is why I am looking for a new PM dr. I wanted to have a new FCE done and checked around, all of them are done the same way…they do not test on the computer, etc.
I was initially contacted by a claims analyst. She never returned any of my calls. They received my initial claim 12/6/12 and my last day was 12/28/12. I had to train a temp to do my job since no one else there knew how to do anything I did. They denied my claim 1/18/13. I had to get a claims supervisor involved because the mishandling of my claim. They only requested records from my PM dr for two months…that is two visits! He changed practices 10/1/12, anything prior was at the old practice and I offered over and over to get these records and send them. They didn’t want them. They denied the initial claim based on the FCE and two months of records. Wasn’t surprised there! So in the appeal, I sent all medical records – from all visits to this PM and others I have seen, PCP, foot dr, neurologists, allergist, dermatologist, everything!! ALL of my medical records note RSD/CRPS of upper & lower extremities, trunk and head. Also sent the letter from my PCP and letter my PM wrote. PM would not say I was totally disabled, but he did say that the FCE did not test real working environment, that my RSD is progressing, that I am in the later stages of RSD and we have eliminated all treatment options, etc., it was a decent letter. When I received my SSD award letter, I forwarded it to them. To get SSD, you have to be unable to do any job. In my STD/LTD plan documents, I have to be unable to do any of the duties in my current job.
There was no return to work request from my employer. When I left 12/28/12, they said they would hold my position a max of 90 days. My RSD was progressing and I was getting worse even after the last day worked. I was denied STD and not getting paid. I could not get my 401k until my employment was terminated and needed it in order to keep our house. They would not release me so I resigned effective 3/4/13 due to my medical condition (I did receive confirmation that this would not interfere with my disability claim appeal as they go by disability date).
I do not know what more could be supplied to them in the next appeal to make them overturn their decision ??
Thanks for your reply and help! What a stressful mess this is!
Nanc

"Hey" to you Nanc,

So, first thing I would do is gather all the records from your doctors and also request copies of all documentation provided to your STD/LTD claims department from your physicians. I would also make a written request either through eMail or certified letter for specific reasoning for your denial. I would also look over what you sent to SSD and compare that with what was submitted to LTD to see if there are any obvious discrepancies.

Regarding the return to work letter - this is usually given to the employee and then asking the employee to have the treating physician to fill out whether or not you are ready to return to work or not, it usually asks for specific limitations or restriction and then also includes an area for those that aren't able to return yet (which you would fall under).

Was your initial disability claim filed after your pain increased enough to seek care and treatment that resulted in the SCS? Or did you wait until after this to file your claim? I totally get not being able to tolerate the pain and it affecting performance etc., what I was trying to get at is if anything specifically that you recall caused this increase or was it just a gradual thing. See sometimes work habits (repetitive tasks and such) can cause a "work related injury" even though you had underlying RSD if something you were doing at work provoked the new injury or spread then this would fall under a work comp claim and thus be denied by STD/LTD. If it was just a gradual progression then the timing of filing could still play a roll in the approval or denial but, since I am still not clear on what if anything physically caused the increase in RSD spread/pain/symptoms I cannot comment much more than that right now.

Who initiated the FCE? It is not necessary to be required to have an FCE in order to receive STD or the first 24 months of LTD unless the records are unclear (which is my suspicion). I know you have a PM doctor but, do you also have either a PCP or Internal Medicine doctor, Chiropractor, Physical Therapist etc., treating you regularly? Did your PM place the SCS or was this another doctor, and were those records also included in your claim process?

Do your records reflect all the above limitations that you describe? Not just in that you state you 'can't walk to from the copier' or 'sit for very long' but, also your physician noting this as his/her "impression" also? Usually insurance carriers heavily weigh the "objective findings" and "impression" when looking over doctors chart notes or opinions and overlook much of what the patient verbally states unless those things are "classic hallmark symptoms" etc... sad but true. There should be notes from your doctor regarding medications & cognitive side effects, difficulty with driving etc., these are important in situations such as yours.

You most certainly need to find another PM who is well versed in RSD/CRPS as well as an internal medicine doctor for sure. I personally would also seek out a Physiatrist as they look at the whole body and consider all factors that contribute to physical limitations and often work very well with PM's and PT's for your care. Personally in your shoes I would treat my Physiatrist like a PCP and make sure all records from each physician are copied strait away to the other doctors in your care - including Chiro's, PT and massage therapist. Heck even my Chiro gets copies of every single medical chart note and lab result done in my care. Getting all your records and finding out what your diagnosis codes are is KEY and should be done ASAP before your appeal time runs out.

I would also print out the pertinent highly regarded medical journals regarding CRPS/RSD and it's long term effects and be sure your claims manager gets it and then be sure to include it with your appeal.

Did you ever have written work release notes from your physician that you provided to your employer? I was actually required to keep my employer informed every 2 weeks as part of my duty and requirements during STD/LTD status. I had every treating doctor write one every two weeks for over 2 years :/ a pain yes.. but necessary.

Your employment status does not affect your disability benefits unless you were injured/illness struck after your termination which obviously isn't the case for you. That is why I keep wondering about when and exactly what the original claim form stated as to why you needed the benefits and the timing of it.

You know how horrible I feel for your situation and others who have gone through this but, please don't give up yet.. I think there are enough red flags to consider yet another appeal.

Be strong,
Tessa

See my comments below:

"Hey" to you Nanc,

So, first thing I would do is gather all the records from your doctors and also request copies of all documentation provided to your STD/LTD claims department from your physicians. I would also make a written request either through eMail or certified letter for specific reasoning for your denial. I would also look over what you sent to SSD and compare that with what was submitted to LTD to see if there are any obvious discrepancies.

I have all records and they were all submitted to the STD/LTD carrier with my appeal. The reason for denial is listed in the denial letter, they said the records did not support the fact that I could not do the sedentary job. I provided SSD the same records that STD received, also the same letters from my drs.

Regarding the return to work letter - this is usually given to the employee and then asking the employee to have the treating physician to fill out whether or not you are ready to return to work or not, it usually asks for specific limitations or restriction and then also includes an area for those that aren't able to return yet (which you would fall under).

there was no return to work letter, there probably would have been had I been approved.

Was your initial disability claim filed after your pain increased enough to seek care and treatment that resulted in the SCS? Or did you wait until after this to file your claim? I totally get not being able to tolerate the pain and it affecting performance etc., what I was trying to get at is if anything specifically that you recall caused this increase or was it just a gradual thing. See sometimes work habits (repetitive tasks and such) can cause a "work related injury" even though you had underlying RSD if something you were doing at work provoked the new injury or spread then this would fall under a work comp claim and thus be denied by STD/LTD. If it was just a gradual progression then the timing of filing could still play a roll in the approval or denial but, since I am still not clear on what if anything physically caused the increase in RSD spread/pain/symptoms I cannot comment much more than that right now.

My disability claim was filed 12/6/12 stating that I was going out on STD on 12/31/12 (last day to work 12/28/12). The SCS's were implanted in 2011, but the effectiveness wore off. I gradually got worse and worse. The constant use of my hands made me worse. I injured my hand in 2009 outside of work, this is how I developed RSD in my hand. It spread to my other hand. I got to the point where i could barely use my hands so i got the SCS's. It wasn't a work related injury, but work definitely didn't help it.

Who initiated the FCE? It is not necessary to be required to have an FCE in order to receive STD or the first 24 months of LTD unless the records are unclear (which is my suspicion). I know you have a PM doctor but, do you also have either a PCP or Internal Medicine doctor, Chiropractor, Physical Therapist etc., treating you regularly? Did your PM place the SCS or was this another doctor, and were those records also included in your claim process?

my stupid PM sent me for the FCE, said he couldn't fill out the disability paperwork without it...it was HIS requirement. I do have a PCP as I mentioned in my previous post. She is an internist and manages all of my medications. My PM is a physical pain & rehabilitation dr. He implanted the SCS's. Those records were included in the claim appeal.

Do your records reflect all the above limitations that you describe? Not just in that you state you 'can't walk to from the copier' or 'sit for very long' but, also your physician noting this as his/her "impression" also? Usually insurance carriers heavily weigh the "objective findings" and "impression" when looking over doctors chart notes or opinions and overlook much of what the patient verbally states unless those things are "classic hallmark symptoms" etc... sad but true. There should be notes from your doctor regarding medications & cognitive side effects, difficulty with driving etc., these are important in situations such as yours.

I think this is where my problem lies. There is some "she says" in my records and the different areas that they review or note are bs. Neurological - memory intact, or range of motion good, or gait/balance fine, or no edema....none is correct. If they didn't examine these areas, then it was notated as ok. I would be sitting when they'd come in the room and didn't see me walk - I walked slow, shuffled my feet and limped. Medications - I was allergic to everything, which was noted in my charts. Never knew how to treat because I could not tolerate anything.

You most certainly need to find another PM who is well versed in RSD/CRPS as well as an internal medicine doctor for sure. I personally would also seek out a Physiatrist as they look at the whole body and consider all factors that contribute to physical limitations and often work very well with PM's and PT's for your care. Personally in your shoes I would treat my Physiatrist like a PCP and make sure all records from each physician are copied strait away to the other doctors in your care - including Chiro's, PT and massage therapist. Heck even my Chiro gets copies of every single medical chart note and lab result done in my care. Getting all your records and finding out what your diagnosis codes are is KEY and should be done ASAP before your appeal time runs out.

i am having difficulty finding a new PM, mine is well versed in RSD/CRPS, but he has completely changed since he went to his new practice. He was the 6th one I went to. All others in this area have terrible ratings. What do the diagnosis codes mean to me and how would they help my appeal?

I would also print out the pertinent highly regarded medical journals regarding CRPS/RSD and it's long term effects and be sure your claims manager gets it and then be sure to include it with your appeal.

Did you ever have written work release notes from your physician that you provided to your employer? I was actually required to keep my employer informed every 2 weeks as part of my duty and requirements during STD/LTD status. I had every treating doctor write one every two weeks for over 2 years :/ a pain yes.. but necessary.

there were no work release notes as I was never released to return to work. He wrote "unknown" as the date expected to return to work. My boss visited me twice and we talked about things. I told him I wouldn't be able to return.

Your employment status does not affect your disability benefits unless you were injured/illness struck after your termination which obviously isn't the case for you. That is why I keep wondering about when and exactly what the original claim form stated as to why you needed the benefits and the timing of it.

You know how horrible I feel for your situation and others who have gone through this but, please don't give up yet.. I think there are enough red flags to consider yet another appeal.

Be strong,
Tessa

AHHHH! This This just #@!^% me off! This is ridiculous!! And precisely what I am sure the insurance company knew would happen when they sold you the policy. What a rip off! Playing on people about what their future needs will be, get the premiums, and then bail when it’s needed. It’s your money and benefit and you should have it! Would it be possible to file a small claims case?

Although your husband might be right that it may only cause more pain and suffering. So sorry to hear about this. I am glad that you got SDD though. I am going to try to fight that fight this fall. Because I have been self-employed for so long and the way my taxes were filed, my claim will be complicated. I pray the SDD Gods will have mercy on me.

Hi Nanc,

I should not write a comment because the word "insurance" creates a bad taste in my mouth, stress, etc. The amount of money spent on "insurance", life insurance, health insurance, homeowner's insurance, flood insurance, and on and on...... well, if I had pocketed and saved that money over my lifetime, I would have more than enough money to pay for anything that would be claims. They are in business to collect premiums, NOT pay off claim benefits. I am so sorry about your situation. And they have so many cards stacked in their favor with their corporate lawyers. When you NEED your benefits, they also know you do not have the financial resources to fight them. This applies to ALL types of insurance. Wish I could offer you some advice. Good luck with whatever you decide to do. What makes it even worse is they continually get away with it.

Hi Vrae! Hope you are having a better day today. I would have to file another appeal (or reconsideration), then if it is subject to ERISA I may have some other options like mediation. Then the last thing I could do is file suit against them. It is completely ridiculous!

I wish you much luck with your SSD claim!
Thanks,
Nanc

I think you are exactly right!! They are in the business to collect premiums and not pay any claims. I wish I had the money to really fight them...in court...but I don't.

Funny thing is that I found online that this insurance company (Lincoln Financial) is awful. There are complaints all over the web about how they deny claims over and over again.

Thanks!
Nanc

Small claims? More like grand larceny.