Transitioning to Long Term Disability Question

[Rower Michelle]

Hi all-

I’m hoping someone here has been through the employer sponsored disability insurance process.  

I filed for Short Term Disability in September when I was diagnosed with pneumonia. I thought I would take antibiotics rest up & be back at work.  Then the cancer diagnosis came during an inpatient hospitalization.   The PET scan has be at Stage IV with some bone Mets.  Until the insurance company received my medical records they were aggressively managing my STD claim repeatedly asking about my return to work plan.  Really?!  

After my medical records were received in late November, the STD claim was approved in full until March 12th.  

Today I received a call from my “case manager” that the insurance company will begin to transition my claim to the Long Term Disability Department.   I was told this was  standard policy as I’m 2/3 through the STD policy.  I was having a good day up until this call & now I’m stressed. 

Given the rough start I got off to with this particular disability company, I’m wondering if there’s a possibility the LTD could be denied.   

With this diagnosis I couldn’t imagine that there would be any issues but insurance companies worry me in their quest to save money.  

The only reason I have a shred of sanity is that I’ve been able to focus full time on my treatment plan. I don’t see returning to my career as a viable option.  

If anyone has some insight as to what to expect and more importantly what I should be aware of that would be helpful.  

Hoping to shake off the impact of this call before bedtime!   Thanks- 

Michelle

[Barb1260]

In my previous life (married) the ex was in a motorcycle accident and went through STD to LTD. They did start the transition early as I remember thinking back then. I took care of all paperwork in the house and I did call HR to find out the reason for the rush. I was told it’s normal timing. I would call your HR and check with them for a reason. Also make sure the end date of the STD and start date of the LTD are correct. Disability companies are notorious for being a pain in the butt. I remember threatening that if they didn’t stop with the weekly paperwork when the docs said at least another month they would hear from our attorney-that worked and only wanted updates on the docs end dates  

That company was sued by multiple people about a year after that-I think they were no longer allowed to do business in NJ.  Get some sleep it will all work out  

 

[Steff]

Michelle,

I work with homeless folks, many who are disabled but unable to receive benefits at this time. When applying for federal disability, it's more common than not to be denied the first time - I have had clients who are on their 3rd denial.  This may be different when seeking disability through an employee program.  But my thoughts will probably still apply...I have learned through my work with homeless and helping my family with their disability applications is that your application is only as good as your doctor's records.  My parents and aunt had no trouble with their applications - they go to reputable doctors who are actively engaged with seeing the application through to the end.  Not the case for my homeless folks.  So, my advice - let your doctors know if/when you plan to apply for long term disability.  That way they have a heads up that they will likely be contacted.  I also suggest getting a full copy of your medical records regarding the lung cancer diagnosis and treatment so you can send the information yourself - this will hopefully help with any delays on the doctor's part.  Be prepared for at least weekly interactions with the insurance company until the application is resolved.  And if your application is denied, request an appeal immediately, in writing.

Hope this helps a tiny bit.

Steff

[Rower Michelle]

I must have had a premonition yesterday.  I got a phone call from Human Resources this evening advising me the company has shut down my entire division and my position was eliminated (along with 50 of my colleagues).  Oh boy.  Fortunately, I'm on STD and those payments will continue for the remainder of the benefit in March.  I will be eligble to  receive LTD benefits as long as the claim is approved.   I seriously can't imagine given my diagnosis that the LTD will be denied.   Steff, you are on point with the docs and I will have a long conversation with the onc at my next appointment to ensure we have all the appropriate documentation in place.  

I'm not  sad about the position elimination- the job was such a grind I didn't realize how miserable I was until I got sick.  I don't miss it a single tiny bit! 

 Now the big issue will become health insurance.   My company was very good and included COBRA payments into my severance package. I think they felt guilty eliminating my position.     When I have a clear head, I'll have to meet with the hospital social workers to evaluate the Medicare application process.  Has anyone here been through the disability route to Medicare?   

My husband isn't working right now (long story)  and he will have to try find a job that provides decent health insurance.  Going to take this one day at time and know that with my giant prayer posse this will work itself out.  

[BridgetO]

Hi Michelle,

I haven't been through the Medicare disability route myself, but I have been with some of my clients with disabilities. Basically, you have to get on Social Security Disability first, which means establishing that you're unable to do any substantial gainful employment. Then you have to wait 24 months before you get Medicare. 

Bridget O

[Steff]

Michelle,

If you and your husband are on limited income, you may also qualify for Medicaid.  My mom is currently trying to get my dad on Medicaid so he can be placed in a hospice home.  Depending on your assets and income, Medicaid may be a quicker process than filing for federal disability for Medicare and you can use that health care while you are applying for federal disability.  We've never attempted to access any type of government service except for disability, so the process is very new to us and a bit scary.  Your clinic/hospital will have a social worker that specializes in Medicaid applications and can tell you a general idea of what, if anything, you will need to do with assets or income to qualify.  The gal we met with last week was very helpful and encouraging.  

[Tom Galli]

Michelle,

Steff's suggestion is a good one.  The route to Federal disability is applying for disability with Social Security.  For folks with Stage IV cancer, the process is pretty straight forward.  Applications can be submitted on line and like others have said, ensure you alert your doctors to your application because they will be contacted and asked to submit relevant records documenting your condition.  Social Security will pay you disability income but the law requires one to be disabled for 24 months before being eligible for Medicare.

My long term disability insurance required I apply for Social Security disability as a condition to receiving benefits.  In fact, the company actually made the application for me.  Like Steff suggests, my application was denied first time but approved on appeal.  Free treatment, including travel and lodging, is available through the National Institute of Health Intramural cancer treatment program.  I wrote about it here.  

Stay the course.

Tom

[Barb1260]

Sorry to hear this Michelle. Thankfully you have LTD which gives you time to look into the options. 

[Rower Michelle]

Thanks all- I've had a busy day today.  I had to finalize a second appeal to Foundation One because the insurance company has denied the claim twice (for administrative reasons)- Check all done there.    Then I met with my financial planners to set up an appointment to review the severance payment structure.  The best part of my day was the acupuncture visit with the hippie doctor.  He is part doctor part social worker.  He has advised me to retain a disability attorney.  He also thought my husband should look for a job at KU as the insurance is good. In addition the  employees and their dependents receive medical care at virtually no cost.   Hippie doc is willing to help hubby find a job (which can be anything).  

I'll meet with my social worker too to get the ball rolling there.   At least we were not blindsided by this and I just have to be patient to allow some time to work through these issues.   Not having access is health insurance freaked me out.  We believe the COBRA will be available for 36 months (just need HR to confirm).  So not panicking now- just need to work a plan.    I can't stand the days when I become a mental midget.   

[Barb1260]

If it’s not the disease it’s paperwork to treat it. Hang in there, you’ll get through it. 

[PaulaC]

Barbs right you’ve got this! 

[BridgetO]

Hi Michelle, getting a disability lawyer is a good idea, and sooner rather than later. A weill prepared initial application is a really good idea. If you are initially denied, there are levels of appeal, but that process can be really lenghty. A lot of people dont get help until they've lost once.  I've seen stats somewhere (the dreaded stats!) that show that SS disability applicants who had a lawyer or other experienced advocate  at the initial application stage are WAY more likely to be successful.  Best of luck!

[LexieCat]

I AM a lawyer, and if I had to navigate disability, I wouldn't try to do it on my own.  It's too specialized.

So definitely look into finding a lawyer to help with the planning and application process.

[Rower Michelle]

Thanks guys.  Fortunately I row with a couple of attorneys so I have asked them to reach out to their network for a  referral to a disability attorney.  I also found one through KU's holistic center as well.   I've done some research, Medicare has  a compassionate care allowance for Stage IV Non Small Cell as well as some type of fast track process.  I'm trying to be proactive as I know COBRA only lasts 18 months.  If Medicare makes an award during that time, then I learned COBRA continues for another 18 months.  

In a previous life I was a health care compliance officer but there's no way I'm going to DIY something this important.  I know I will feel less stressed when I understand the process and what the options are going forward.