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Life With Lupus

Denied LTD


#1

Would like to get some advise from anyone that has been thru this scenario.

I have LTD that I purchased in 2012.
I was stupid and did not purchase when I started my job in 2011 so this has come up to bite me in the booty.
Because of this you have a year wait time before you become eligible under this policy.
No problems medically for me in 2012 then in 2013 I began showing signs of high liver function so we began looking for why. In August of 2013 I went to my dermatologist to have him look at some red dots coming up on my arms and he asked if I had been checked for autoimmune. I said no but told him about my liver, he suggested to have my PCP run tests. We did this and I came up with a positive ANA so she made an appointment with a Rheumy for me as she could not say whether it was lupus or not.
By the time I was able to get into a Rheumy I was now in my "eligible" time frame for LTD.
That doctor saw me and wrote that although I had a positive ANA he did not believe I had lupus but rather it was due to osteoarthritis.
Because of this my doctor and I just continued monitoring my labs, etc., until Nov. 2014 when they became so high that she sent me to a new doctor and he gave me the actual diagnosis of SLE.

I have been on STD since May as I had been calling in sick and/or coming in late to work way too much and I believe they are trying to find a way to get rid of me.
I applied for LTD a few weeks ago and yesterday they called stating it was denied with the reasoning that I was showing widespread pain prior to my eligibility date. There was not a diagnosis of Lupus/SLE before my eligibility date so I am wondering if I have a good case to fight this.

I had been speaking with a disability attorney already for SSDI but he doesn't really do LTD (not enough money to be made) so he suggested I just write a letter of appeal stating the fact that widespread pain is too general, etc.
Any suggestions?
I really need the LTD in order to manage the wait time for SSDI.
Would you drop the attorney I have and get a different one for LTD, try to appeal it on your own with the new letter from my doctor that states prior to the eligibility time frame the doctor was trying to determine a diagnosis but it can be assumed no clear cut medical evidence was found until 2014
OR my financial advisors do help with this but I'm not sure how much legal advise they have especially with ERISA(?).

Thoughts?
I need help!


#2

I have found that LTD insurance provided from your job is useless. I had it and they found a way to dump me off it in 3 months time. I've heard a lot of people say that, too.

A good friend of mine became disabled and got dumped off his LTD and took out $5,000 to pay a lawyer to handle the case. 2-3 years down the pike and he still doesn't have any $ from the LTD. And he's out the $5,000.

So my opinion would ve to concentrate on getting the Federal SSDI. Those lawyers only charge if you win your case, then they take 1/4 of what you win as back pay. I would contact an atty whose only work or majority of work is in SSDI. I used ALLSUP and I won my case the first time it was heard. I don't know how typical that is with them but they told me the chance of winning the case was 50-50 the first time it was heard and they represented me. By the third time, the odds were 80-20 in my favor. I thought the odds were pretty good and went with them.


#3

Thanks for the info Petunia
I would think that your own Insurance that we have been paying for would step up but it doesn't sound like that will be the case.
I was wondering which way to go regarding attorneys and it looks like I'm wasting money trying to get LTD.


#4

HI I am a non working nurse as off 6years ago.I was salary but I had stdisability and Ltd. my husband did all my paper work also my rheumatologist nurse helped.I am64 I got my std right away and I am still getting ltd.When I turn 65 they will basically take most of my Ltd away in place of insurance policy.So it is6 years of Ltd We also used also I only waited for 2 weeks for disability to kick in on my first time.I managed an outpatient facility.I also had fibromyalgia . My husband is very organized so when claim came up again they copied all the same papers.I. feel bad for people that can't do the paperwork because they are too sick.I have been in hospital 4 times for biopsies.Now as of this week they started me on morphine for my in creased pain Also now my bone scan came back with bones of a 94 year old.I couldn't think of doing all that paper work but use your Dr staff and also Good luck They know people can't work.It's not right


#5

I do believe that Insurance companies are trying to find ways to deny most claims now. I can understand if you're not eligible under the policy, etc - but for her to tell me it was because I had widespread pain prior to being diagnosed is crazy. A good attorney could fight this but youre right - they know a person is either not in a mentally good place to fight it or don't have the $$ to hire an attorney.
I did write a letter to them expressing my disappointment and I will appeal the decision but I'm not holding my breath
Sorry to hear about your bones.
Its crazy to think that this is an illness that stress increases the symptoms and we have to deal with road blocks that cause more stress.
Prayers to you


#6

If you weren't missing work during your first year from the pain and hadn't been being tested for the problem then they really don't have a case. Can you find an attorney that will take on the case for a percentage of back pay?


#7

Hi Doggie -
I found an attorney that will try to get it for me and if he wins then takes his cut.
Not a lot attorney's do that for LTD but he wants to look at everything.
My doctor is writing a note (went today).
The only thing we see that might stop it is that we did "testing" for autoimmune 2 months prior to my eligibility for the Insurance and it came up positive but the Rheumy she sent me to said no so we moved on to other options as to what was going on. A year later I was diagnosed with SLE.
I could see where the Insurance company may try to wiggle out of this one but hopefully the letter the doctor writes will help??
It's hard to walk away from a good paying job (especially now-a-days) and being single this will cost me all my savings if it takes 3+ years to hopefully get SSDI.
I wish I could say I could go back to work but just the 2 hours I was out today for dr. visit did me in.
If I went back to work they would just try to find a way to fire me.
This is a large company where people come and go all the time so I'm just another pawn.
Keep prayers up


#8

I guess the short version (ha) is that I was tested for it but then the specialist came back saying no it wasn't SLE or any connective tissue disorders and thought it was osteoarthritis.
That lab test 2 months before I became eligible could cost me.
Who knew what my future would bring me 2 yrs later!

Doggie said:

If you weren't missing work during your first year from the pain and hadn't been being tested for the problem then they really don't have a case. Can you find an attorney that will take on the case for a percentage of back pay?