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GreyEagleGGreyEagle Posts: 350
edited 06/11/2012 - 8:26 AM in Health Insurance Issues
Hi everyone:

I was recently accepted for Long Term Disability through my employer. When I received the acceptance letter it included a brochure on applying for SSDI. The brochure was encouraging me to apply. It said my LTD Insurance Company would apply for me.

I called my Claims Manager and she said that they start the process of applying if its within 3 months of when I'd be fired from my employment and there is no end in sight for my recovery from cervical surgery. I have DDD and am facing cervical surgery (I don't know the extent or which surgery specifically yet).

I don't even know if I'll end up needing SSDI. My doctors and claims manager seem to think its a strong possibility.

My 31 yr old daughter has been on SSDI about a year. She applied because she has Multiple Sclerosis. Even with that disease she got denied once. She hired lawyers and was finally accepted.

So, its just wait and see now. If I need it at least my LTD Company will apply for me with their lawyers.

Ken GreyEagle


  • Paul, by pre-existing, did they say it was pre-existing to when you had the job/insurance? I am wondering, because I have DDD that was not caused by any specific incident. I have had intermittent back pain for many years, but not until the last 2 years has it become chronic. I'm just wondering how they classify pre-existing. I've had this job for 6 years, so the chronic back pain started since I've been here. But genetically, you could say that my condition has probably been in existence for many years.
  • Beats me on that one. I originally started on Short Term Disability. I did not qualify for Workman's Comp because they said my DDD was not work related but genetically caused and by bad posture over the years sitting at computers (at work or at home).

    When my STD ran out after 26 weeks I think I had a 3 month waiting period before my LTD could kick in. Both are from the same Insurance Company through my Employer. If it becomes clear that I will be out for one full year (at that point I get fired) then my LTD Insurance Company will do the applying for SSDI for me (3 months prior to my getting fired).

    But the preexisting part that Paul speaks of, I have no idea in his case what that means.

    Ken GreyEagle
  • Your employers could call DDD pre-exsisting condition because it comes over time.Many refer to it as the 'gray hair of the spine' because it is part of the natural aging process.Also,DDD is considered a pre-exsisting condition when you get life and/or health insurance.

    Ken,I would say that you are very lucky that you got the LTD.In some cases people get approved for their SSDI right away,but in most cases you would have to appeal.Even then it's not a sure thing-though I've heard DDD is on the list of accepted health problems-still,I think each case is different because some people with DDD don't have pain,while others are incapacitated.Some have surgery,while others opt for conservative treatments.Each case is just so individual.

  • I agree Robin. Each case is very individual. In my case I've been in severe pain from my DDD for 2 1/2 years. I couldn't really say if surgery is going to solve the problem enough for me to work again. Some of the health professionals working with me don't think I'll be able to work again. I don't know.

    I do know I'll be having surgery. I'm hoping I'll know exactly which surgery and the extent of it by next week.

    Anyway, I am very thankful I was approved for LTD. They are paying me enough each month we are going to be ok with the bills.

  • Hm, that's what I was afraid of. I am pretty sure that they would say that my DDD is not caused by my work, that it is a pre-existing condition. I probably should NOT expect them to approve LTD based on that.

    Well, hopefully I won't need it. Hopefully, surgery will allow me to come back to work and do all the things that my position requires (because right now, I am not doing everything I was hired to do).

    Ken, that is great that you are getting paid enough to take care of the bills. I know that my boyfriend and I will probably be okay for at least 6 months, but I am worried about finances if I can't return to work after that. I guess that is something I will just have to deal with if it comes along.
  • that happened to Paul has happened to me.. Because my primary reports all talk about my spine and neck pain they have denied me..
    They really look hard to not have to pay... I applied for my ssd the same day I did my LTD.. Metlife told me I had to.... I really am not very fond of MET LIFE
  • The LTD will only consider a condition Pre Existing if you have been treated, advised or medicated for the condition that disables you within 12 months before the effective date of your policy. You can have a condition forever but if you have not been treated, advised or medicated in the 12 months before your policy became effective it is not pre existing. Please do not hesitate to apply if you need it.
  • That is good information. Now I'll have to see if I can remember if I had any kind of treatment back before I started this job. :? Well, of course even if I did, I don't know that there is any way that they would be able to say it was for the same problem. I was not given a diagnosis until this recent (well 2 years ago) episode. Prior to that, I had intermittent pain, which I just treated myself with Advil and heating pads. There was one incident that seemed to start the incidences of pain, when I was shoveling snow. But I don't recall if I even went to a doctor at the time.
  • All I'm just saying is that DDD can be considered pre-exsisting under the right circumstances,and if an employer or insurance carrier looks hard enough and close enough for a loophole...really,we all know that so many employers,etc.,will get out of paying if there is the smallest chance of them getting away with it.
  • Oh yeah! Those Insurance Companies....if there is a chance they can get out of paying they sure will. I wonder if that is part of the reason they have the long waiting periods before the Insurance kicks in. Dunno.

    I know when I got my acceptance letter for LTD it included a brochure encouraging I apply for SSDI and explained how the Insurance Company applies for me and has their own lawyers working on it. It also explained that they have a significanly higher rate of getting their client accepted than if I did it alone.

    I had to call my Claims Manager and ask her if I should apply right away. She told me they would start the process for me 3 months ahead of me getting fired if there was no end in sight to my medical situation. That will be June 3rd I'd get fired because one year of no working at all results in getting fired at my Company.

    So far I was diagnosed end of June last year. I'm only now getting to see a second opinion neuro (referred by my primary neuro). I see this surgeon this coming Tuesday. Usually when making an appointment with my primary neuro it takes a month before the appt happens. I'm thinking Feb or late Feb before I have my surgery.

    I've been in pain 2 1/2 years. In the past few months its gotten significantly worse. At this point I'm thinking permanent nerve damage. We'll see.

    Anyway, thank you all for your valuable input and opinions on this whole matter! :)

    Ken GreyEagle
  • You are probably right. I think that those long waiting periods are to try and starve you out.
  • Thanks, there is a lot of good information and suggestions here. :?

    I have my LTD summary plan description, so I have read some things that are very confusing. 8} Of course the language is typical of insurers. They make the language so vague, such that ordinary people can't make heads or tails of it, and also so that they can pay as little as possible.

    It says that there is a limitation for "subjective conditions". It says that subjective conditions are those that are based on self-reported symptoms and are not verifiable using objective medical tests and procedures. Including: musculoskeletal and connective disorders of the neck and back; any disease or disorder of the cervical, thoracis and lumbosacral back and its surrounding soft tissue; fibromyalgia; and others. X(

    The limitation is for a maximum of 24 months of benefits. It's pretty clear it seems, that I would only have limited benefits, if I needed them. I guess that isn't that bad, if I were disabled for more than 24 months, I would expect to have to switch to SSDI or SSD.

    Geez, it sucks having to think about these things. I mean I was already worried about retirement (I'm 46), and trying as hard as I can to save for that. Now to think that I may have pain and difficulty working, for the rest of my life, it's just overwhelming and sad. :??
  • I know,and understand.I was 35 yrs old,had my 10th surgery,and drew(earned)my last paycheck in 1995-so I feel it's safe to say that I know 'where you are coming from' during this time in your life.You WILL make it through though.We will all survive this somehow,someway ;)
  • I think that you are misunderstanding that statement.
    "not verifiable using objective medical tests and procedures"
    This means that if you can not verify your medical issues with standard tests such as Xrays or MRIs. If your problems can be verified, meaning it shows up on xrays or MRIs then this will NOT apply to you. This is for people that may have pain but it can not be proven with standatd tests. Surely you have had xrays or MRI right?
  • Sounds like you could really use some help understanding your policy. Please check out this forum it will really help you.

  • Yes I have had an mri which shows DDD, and x-rays's, CT-scan, and the discogram which showed conclusively that my pain is being generated by the discs. And actually the more I thought about it, the more I thought that particularly the discogram should be irrefutable.

    Thanks so much. I will check out that link too.

    Insurance issues have always confused me, and I'm a pretty smart person. ;)
  • I have had more experience with LTD claims than I care to think about. But, I am sure that I am right. That sentence is for people that claim to have pain or illness but it can not be proven by any medical testing. You have plenty of medical tests to back up your condition. Good luck.
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