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Just Lost my Employer based Disability Benefit - Lawyer Wanted

CoyoteCCoyote Posts: 120
edited 06/11/2012 - 8:45 AM in Health Insurance Issues
Hi Everyone,

I've been out of action for the past few weeks - my husband is very sick - in the hospital two weeks, in the nursing home three weeks, and then he came home two weeks ago, and we've been battling with/for home care services ever since. I'm the one with the back problem (my husband is sick with other things) and the stress and long hours at the hospital took a great toll on me - I've been taking a LOT more drugs than usual over the past few weeks.

However, I got a whole new agony this week, when I received a letter from my employer based insurance company saying that they have stopped my disability benefit because they don't think I'm really 100% disabled. I am fortunate to still have SSDI, however, this is a huge, sudden cut in our income - AND I AM 100% DISABLED, OTHERWISE I WOULD HAVE GOT A JOB!!!! This is private, employer based disability insurance, and I have been receiving this benefit for three years and now they have cut me off, cold. I worked with my employer for 17 years, paying my dues.

Anyway - I live in New York City, and I presume I need a lawyer, an ERISA lawyer. Any advice/ideas would be greatly appreciated - private messages are good too, for privacy, if anyone has any ideas.

Thanks in advance for any ideas. It's so great to be able to come here and have others who know the many levels of pain we all experience.

Thank you!


  • I'm sorry to hear all that you are going through. I am assuming that you are talking about a long term disability policy since you have been receiving benefits for three years. What did they base their decision on? Did you go for an evaluation recently? Or send them info from your doctors? I would imagine that they have to have a reason to discontinue benefits.

    I would question this first because sometimes there are mistakes made. If they stand by their decision and you feel it is without merit them you will need a lawyer who specializes in disability. I would think that if you have been approved for SSDI that should entitle you to your LTD insurance.
  • As Kris, I am sorry you are having all this dumped on you. Did they give you (I believe they have to) the reason they are cutting off your benefits? Since SSDI is *MUCH* harder to obtain, there has to be something done by error on the LTD - I say LTD like Kris due to 3 years on it. I would see if you could contact the insurer, and if possible get with a supervisor to get to the bottom of this.

    Hopefully it will turn out that some "clerk" made a mistake and it can be fixed. It just seems odd to dump someone...especially if they are on SSDI! Please keep us posted. Supportive *HUG*

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • I am going through the same thing. My LTD benefit is being discontinued as of July 1. I was suddenly given a new case manager with my insurer (Prudential). He based his decision to stop my benefits on information from my surgeon. That info is the release notes I REQUESTED to try going back to work. These were dated February and March 2010. Nothing new was indicated from my surgeon. I explained this to him and asked what weight he was giving my new records from my pain mgt specialist. The idiot was unable to answer me. He stumbled all over his words. Just another bureaucatic moron. I think I too need an attorney. In the meantime I will be returning to work in the next week or 2 and fully intend to seek damages if my condition worsens.

    It's a shame that some idiot in an insurance company cannot come live in my body for a day or 2, I bet he would continue my benefits till the cows come home.

    Good luck Coyote. It seems we will both need it!!
  • The basis for the decision is that they do not believe I am 100% disabled. They say I could work part time. They state they based the decision on the "facts of the case" and policy, but many of the facts are wrong. They state I can stand for two hours in a day, for half an hour at a time, when five minutes is my limit. That I can sit for two hours and then move around a few minutes and sit again, for up to 8 hours a day. I can't! I can't! It was a very lengthy paper of several pages, with many quotes from the files of the doctors I have seen, and they interviewed a couple of Drs over the phone. My pathology is not that bad - just a herniated disc at L4-L5. They also had an independent medical examiner (an IME) - who said I can work part time.

    Thanks for your sympathy! I guess I need a lawyer!
  • I answered your PM with lots of info that will help you. Sorry I was a little late responding but I did not get online yesterday. Good luck.
  • Here is a link to a forum that will answer many of your LTD questions

    Coyote, I sent you a link to a good ERISA attorney in your area.
  • SpineAZSpineAZ WiscPosts: 1,084
    Your denial letter should detail the exact definition of disability and exactly what medical information they used to make their decision. You have to act quickly to appeal any denial of further beneftis and the letter should outline the timeline for this for you. Often you can do the first attempt at appeal IF you know your doctors will provide you all the necessary information to show that you continue to remain fully disabled.

    Some policies have a "change in definition" after one has been on LTD for a period of time (each policy varies). If this is the case, the first few months or years are based on you being unable to do your own occupation. When the change in definition occurs it means they are measuring if you can do any occupation for which you are reasonably trained, educated and could be reasonably compensated. However, some more stringent plans say that if you can return to part time work your LTD may end.

    An ERISA lawyer is not your best source. While many LTD policy procedures/set up is governed by ERISA regulations, ERISA has nothing to do with Disability. So if you choose to get an attorney you want one that SOLELY works in disability law. They may dabble in SSDI, LTD, WC, etc. But make sure they specialize in disability related law. Also know that the state you live in is of some importance but the policy may be based (sitused) in another state. My employer's home base is in Atlanta. I live in Phoenix but my policy is "situed" in Atlanta

    Your denial letter you received is your best best to start with, read it carefully and if you have any questions as to what they based their decision on you can request a copy of "any and all medical and vocational records or information on which your decision was based". Then you can present that letter to your physicians and ask them to write a letter that addresses anything that the insurance company thinks may allow you to return to work. IF your policy ends when you are able to work part time then work with your physicians to substantiate you can't do that either.

    I myself am on LTD right now, but used to work in the STD/LTD industry so let me know if you have any questions.
    2 ACDFs, 2 PCDF, 3 LIFs; Rt TKR; Rt thumb fusion ; Lt thumb arthroplasty; Ehlers Danlos 
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