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SSD Denial of course.....shoudl I give SS denial ltr to docs?

SpineAZSpineAZ WiscPosts: 1,084
edited 06/11/2012 - 8:49 AM in Health Insurance Issues
Got the letter from SSA yesterday. It basically says that I'm not impaired even though I have 5 spinal fusions, knee surgeries, etc I can do a light duty job or even my prior job which did not require exertion in their perspective.

Right....flying 2-3 days a week to employers all over the US to spend 8 hours a day in meetings, enrolling employees, doing presentations, lugging crap city to city, etc requires no exertion or stamina :-)

And regardless of that I'm not sure what light duty job I can do that permits me to lay down when needed, take heavy medications, walk around when needed, leave the room, leave the office,etc.

Even though I worked in the STD/LTD industry for 15 years and saw this thousands of time somehow I hoped I'd be one to get approved simply based on all the surgeries, etc. But my attorney rep said the latest stats show AZ has a 95% denial rate at initial app and we'll just move forward with appeal. Luckily this week I have appointments with my spine surgeon, knee surgeon (who is in same practice as orth spine surgeon), and pain med doc so I'll share this information with all of them. Just thought about it, maybe I shoudl take my SS denial letter to each doc?????
2 ACDFs, 2 PCDF, 3 LIFs; Rt TKR; Rt thumb fusion ; Lt thumb arthroplasty; Ehlers Danlos 


  • SpineAZ,

    You might find that your doctors may be even more supportive, or be able to write more supportive documentation for you. What did your lawyer say? I know I would let them know. Plus if it goes to the second stage, you know government, stuff gets lost. This way if they query your doctors for more information, they won't be surprised. Sorry to hear you got denied. *HUGZ*

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • I'd share,make copies,keep your own folder of everything!
    From my dealing in AZ with my Mom and sister,I'd have to say they are a tough state medically speaking as well. Nothing seems to move very fast.
    Good luck with the appeal. I hear most get denied on first try,unless you are severly disabled in multiple ways. Take care and good luck!
  • Hi SpineAZ, sorry to hear about your denial. I found a good website that explains alot of the ins and outs of SS. One of the forms that is really helpful for your doctor to fill out is the Residual Funtional Capacity or Ability to do Work Related Activities Form. You should have your doctors fill these out. Just to also note, as I have somewhat found out. The Lawfirms are not necessarily interested in your getting an on the record decision, as this will get them less money. My case has been moved to the new Virtual Screening Unit, for a possible On the record decision, and I called my LTD provided lawfirm to ask if I needed to supply updated information. They told me not to worry, that even if I did not get an OTR decision I would still have a hearing in front of the ALJ, and they would get all the updated records then. So I asked the lawfirm rep, well why would I not want the VSU unit to have all of the records, she could not answer. A good website is Ultimate Disability Guide, some good recommendations on there. Good Luck, and hang in there!!

  • I'm very sorry to hear this.
    Yes definitely take those papers to your doctor's and have them make a copy for themselves to keep in your files.

    Also any chance the doctor's could resubmit another report, saying your condition has gotten worse.

    Any chance your employer would state there is no light duty that you are qualified for.

    Thats a awful high rate of denials for AZ. with AZ. being known as a retirement state.

    Your doctor hopefully gave you restrictions on lifting and how long you can sit, along with bending and squating.

    Just dont get depressed, or give up, easy to say but hard to do, i know.

    Best of luck, and hoping your lawyer can line up an appeal ASAP.
  • I'm sorry to hear of your denial. I agree to get more forms from them on what you need like FCE on what you can do. How can you work when you lose your train of thought talking to customers because of the meds and not being able to sit or stand? Your attorney rep said 95% are denied so hope your appeal gets accepted.

    Although not from the States I sent in all my test results and Drs evaluations and it all mainly came down to my family Drs evaluations and the EMG test which showed the nerve compression. Praying you'll get accepted friend... Your experience helped me so much I hope you get this! Charry
    DDD of lumbar spine with sciatica to left hip,leg and foot. L4-L5 posterior disc bulge with prominent facets, L5-S1 prominent facets with a posterior osteocartilaginous bar. Mild bilateral foraminal narrowing c-spine c4-c7 RN
  • Karin,

    We don't want to be disabled. If it were only true that we were quite capable of just returning back to work.

    We hear it over and over again. We know they deny just about everyone first time around. Still, we hope just maybe we'll be one of the lucky ones. I was so hoping for you!

    The let down still is hard. I know.

    Hang in there!
  • SpineAZSpineAZ WiscPosts: 1,084
    Luckily for me my LTD insurance company provides me the attorney and the LTD insurance company wants results asap for the people they refer to this SS law group. That's how they choose which atty firms they'll use. The atty rep was great and said they'd start the appeal immediately. Just so happens I see all the important docs this week so I'll give them all the SS letter and I also created a one page letter for my doctors. I've done this before and it basically says "here's what keeps me from being able to work" and I list the physical job requirements of all my prior occupations and why I can not do each one and then now I made a statement that light duty work is not an option given the likelihood that it would be something that requires extended sitting, computer work, etc. I also stated I do some social activities and I pay for it the next day (like today) so I know that a daily work routine would result in rebound increased pain the next day. That makes a 5 work day week impossible. In they eyes of SS they think that if I can work every other day I'd be fine. But luckily LTD doesn't look at it that way. I am disabled under LTD as long as I am unable to earn a similar wage to what I made before due to disability. So they don't expect me to take a minimum wage job and work 4 hours a day whereas SS thinks in those terms.

    Last night was Bunco (dice game with 12 of us). In order to participate I have to take pain meds early in the day and then take excedrin migraine (it has caffeine, tylenol and aspirin) to get myself to the point of being able to attend the evening of eating and socializing. A glass or two of wine actually helps loosen up my neck and back a bit. Then today I woke up at 5 am (after having gone to bed at 1:30 am when I got home) and today's job is to get me ready to face the week ahead. So rest, meds, etc. My husband is friends with the husband of the woman who was hosting this month. So when he came to get me he hung around for a while as my friend's husband had just gotten home with their 5 yr old.

    As a side note I have to add my hubby is fantastic. He drives me to and from the home where Bunco is EACH month for this evening of fun so I can have a little wine and not worry about driving myself home. And the ladies are so wonderful. They know I can't host as I can't spend a day readying my house, cooking, etc and then having 4-6 hours of fun. So I pay the only other non-mom in the group to host at her house. I'm always the earliest to leave due to my pain (and 10 others are moms of young kids and they love their one evening out a month so they make it last until sometimes 3am)
    2 ACDFs, 2 PCDF, 3 LIFs; Rt TKR; Rt thumb fusion ; Lt thumb arthroplasty; Ehlers Danlos 
  • SpineAZSpineAZ WiscPosts: 1,084
    Turns out SS attorney advised me not to give the SS denial letter to the doctors. And she said it's likely that SS disregarded the SS doc's report becuase he contradicted himself by saying I had severe impairments but then checked boxes saying I could sit 6-8 hours a day, etc.
    2 ACDFs, 2 PCDF, 3 LIFs; Rt TKR; Rt thumb fusion ; Lt thumb arthroplasty; Ehlers Danlos 
  • Oh Dandy of him! Is your doctor going to correct that paperwork and have it resubmitted? I would be pissed if mine did that. What does your lawyer say about how this will get corrected?

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • SpineAZSpineAZ WiscPosts: 1,084
    It was the doctor SS sent me to for an examination that did the report with incorrect data and inconsistent opinions. There is no option for me, or the atty, to request a re-examination or re-do of the report directly. The doctor only does what SS requests and my atty said it's not worth requesting a "re-do" since he wasn't paying attention the first time.

    The atty said when inconsistent opinions are seen SS usually tosses the SS doctor's opinion aside and relies solely on my the medical information my attorney has submitted

    According to my atty the two most common problems they see with the doctors SS uses is either they are moving along so quick they aren't really listening nor using all the data SS sent them for the examination report OR they are older semi-retired doctors who find no one disabled and state totally incorrect information.

    I am on LTD from my employer and they just asked for a new Attending Physician Statement (APS) so I will get a copy of that and send it to my atty's office as well.

    The other problem is I may be having neck surgery in early to mid 2011. The atty rep said this mucks up the process sometimes because now SS wonders "are you cured?".

    One of the largest factors is age. Since I am 44 that plays a big part in SS's evaluation of whether I'm disabled. The atty said as I get closer to 50 the more likely I am to be approved so if we go to ALJ hearing that could be in a few years. There's a certain advantage to that as you are then presenting to SS a consistent disability from your first date of disability to the date of the hearing. As long as LTD continues I'm fine and in no hurry for SS. The way my employer works is once I am eligible for Medicare I go off their insurance and can transition to UHC's medicare supplement. So I'd rather stay on my employer's insurance for a bit (though it's expensive as I'm classified as a disability retiree and pay $400/mo) BUT UHC is accepted more readily by doctors than Medicare is so the longer I can stay on it the better.

    My challenge will come Fall 2011 when my LTD changes what they look at. For the first 24 months they evaluate whether I can do my occupation. After 24 mo of LTD the policy changes and I must be unable to do any occupation for which I am reasonably trained, educated, experienced and of income level within reasonable proximity to what I used to make. If they approve me for "any occ" then I know I can just sit back and wait for the SS appeal, reconsideration, ALJ, etc.
    2 ACDFs, 2 PCDF, 3 LIFs; Rt TKR; Rt thumb fusion ; Lt thumb arthroplasty; Ehlers Danlos 
  • Well that's certainly alot of info. I'm just starting on the SS road shortly. The good news is that both the car insurance and the LTD policy will provide help in applying for SS. THat's also the bad news since I don't know how they handle it. Everyone keeps promising that the paperwork is coming......

    Let's hope they continue your LTD. What do they say they will do next? Is there an appeal to file or is that automatic?
  • Wow SpineAZ,

    I didn't realize it was "their" doctor that submitted the fubar! It's good to know that most likely SS will toss his report out, but sad too in that SS thought it so important you see a doctor they wanted and trusted, and yet toss his info due to contradictions. Kind of a slap in the face of what their intent was in the first place.

    "Are you cured yet?" Gotta love that reaction. Isn't that the way! (G) From what you're describing, it might be a blessing to stay on the insurance you are on now, especially given you might be facing revision in the next 12 months or less. I believe things "happen for a reason", so maybe this is the reason. Better insurance for this surgery, then kick back to Medicare once it is out of the way.

    I'm sure this will all work out for your best interests. It's just a pain in the butt when the pot holes keep getting in the way! If you were in Florida, they would be sink holes! :)

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • Oh, so the explainations really mean something?

    I got my denial last week- I need to do something and am not in much of a condition :(

    So hugs from someone walking in your shoes! By the way, mine said that there was no indication of a disability prior to the date I was no longer eligible
  • SpineAZSpineAZ WiscPosts: 1,084
    My attorney will file the appeal and we're waiting to get the most recent LTD form that I had my spine doctor to complete. I called and requested it but will call right after the new year if I haven't received a call back or the form hasn't been mailed to me.
    2 ACDFs, 2 PCDF, 3 LIFs; Rt TKR; Rt thumb fusion ; Lt thumb arthroplasty; Ehlers Danlos 
  • Best of luck with your appeal.
    I truly hope everything works out in your favor.
    You have given a lot of great advice to people here, and now it's your turn for things to go favorably.
  • I could not agree with Jim more...you have been through a great deal health wise; certainly SS can appreciate the evidence you have provided them.

    When applying for SSDI when you are less than 50 yo, what are they looking for to qualify that is different than people of "advancing age"?

  • SpineAZSpineAZ WiscPosts: 1,084
    SS looks at those older than 50 as being of "advanced vocational age" and less likely to be able to get back to work in their own occupation or another occupation. The younger you are when filing the more likley they are to consider you being able to work an alternate job. In my case SS stated in the denial letter that they said my own job didn't require exertion (which is wrong due to travel, etc) BUT even more so I could work a sedentary light job.

    Unlike STD or LTD, SSDI's defines disability as inability to DO any job or occupation. Their perspective is the younger you are the more likely you are to be able to take an alternate job if you are disabled and unable to do what you used to do. They don't even take into account what you may earn doing so. Thus a 42 yr old Lawyer who made $300K a year and applies for SSDI for cardiac limitations, SS may think they are able to do a less stressful job with less stressful hours, etc. So they can, in SS's eyes, sit and work as a clerk at a hospital information desk even though that would earn them minimum wage possibly.

    I saw this when I used to work in STD and LTD. The older the claimant the more likley approval would come on initial appeal. That being said SS's decisions are not predictable. There are very surprising approvals that left us scratching our head while holding a denial of someone with more significant and more progressive disorders.

    My atty rep said in AZ 96% are denied on initial application.

    The stumbling block is do I go forward with neck surgery I'm considering or not as SS may then automatically deny on appeal since they will feel I may be cured after surgery. UGH.
    2 ACDFs, 2 PCDF, 3 LIFs; Rt TKR; Rt thumb fusion ; Lt thumb arthroplasty; Ehlers Danlos 
  • Hope you had a nice holiday. :)

    You're not supposed to be following in my experience with SSD! I was sure you would get approved the first go around, but I tell you... our attorneys are right.

    The first and second denial rates in Arizona, for our ages and education, are sky-high.

    Keep up with your regular doctor appointments, Xrays, all of that lovely stuff and forward it on to your attorney and LTD carrier.

    I was just approved for LTD until age 65. My review was due in February 2011. They started gathering info around September and I received my approval notice in November. I hope and pray this will happen with you, as well. It really does help relieve the stress, until we are both approved for SSD. And, we will be. It's just one long process.

    I am waiting to be scheduled to go before the judge. It can take anywhere from 6 months to 2 years. I will let you know when I get notice of my hearing date.

    Stay confident and keep everyone up-to-date with everything.

    Thinking of you,

    Tammy :)
  • SpineAZSpineAZ WiscPosts: 1,084
    I am hoping that LTD will approve my claim past 11/2011 when I go from "own occ" to "any occ".

    Tammy: Keep in mind they will still monitor you, probably once a year or so, and they'll send you a simple questionnaire about how you are, who you are seeing, etc. They do this to make sure you are still at your address and that you are still disabled. If at any time they believe you are no longer disabled they can terminate the claim. Sometimes people think that once approved at "any occ" that benefits will go to 65 (or retirement age) no matter what but sometimes the LTD company will ask for medical, re-review, etc. If this ever happens let me know and I'll guide you through it.
    2 ACDFs, 2 PCDF, 3 LIFs; Rt TKR; Rt thumb fusion ; Lt thumb arthroplasty; Ehlers Danlos 
  • As always, I appreciate your input. :)

    I'm going to type out what my LTD carrier sent me, as others may be interested and it does confirm what you have stated:

    "We completed our review of your claim for continued LTD benefits. The medical documentation on file substantiates your claim for total disability from any occupation job duties, from February 2011 and continuing forward.

    Your plan states:

    Maximum Benefit Period is the period shown below:

    Age on Date of Your Disability
    *Less than 60*

    Benefits Period
    To age 65

    Disabled or Disability means that, due to Sickness or as a direct result of accidental injury:

    *You are receiving Appropriate Care and Treatment and complying with the requirements of such treatment; and You are unable to earn:
    *during the Elimination Period and the next 24 months of Sickness or accidental injury, more than 80% of Your Predisability Earnings at Your Own Occupation from any employer in Your Local Economy; and
    *after such period, more than 80% of your Predisability Earnings from any employer in Your Local Econony at any gainful occupation for which You are reasonably qualified taking into account Your training, education and experience.

    Appropriate Care and Treatment means medical care and treatment that is:
    *given by a Physician whose medical training and clinical specialty are appropriate for Your Disability;
    *consistent in type, frequency and duration of treatment with relevant guidelines of national medical research, health care coverage organizations and governmental agencies;
    *consistant with a Physician's diagnosis of Your Disability; and
    *intended to maximize Your medical and functional improvement.

    Per the terms of your Plan language, your Maximum Duration Date is December 2031. This means as long as you continue to meet the terms and conditions of your Plan, and any updated medical submitted for review continues to support your disability as outlined above, you will be eligible for Long Term Disability until December 2031. We will continue to review your claim on a periodic basis. Should further reviews support any change in the status of your Long Term Disability benefits, we will advise you."

    I just received another Release Authorization from my LTD carrier, regarding progress on my SSD. Just a couple of pages to sign and fax back to them.

    I have like three, 3 ring binders full of medical stuff just for my LTD stuff. Then a huge folder for my SSD information. It's crazy... LOL!

    I fully expect periodic reviews. A lot of the times they just call me on the phone and we talk about how I am doing. I always let them know when I have been switched to a different medication. When that happens, they mark it on their computer and then send me out a current medication form to fill out.

    Any hoo... whew! Long post here, but I do hope others will find it informative.

    Best wishes to all and HAPPY NEW YEAR!!!!

    Tammy :)

    P.S. Please forgive any errors in my spelling. I just typed away off of the form real quick.
  • SpineAZSpineAZ WiscPosts: 1,084
    Looks good. What they've done is approved your claim for "any occ" and will likely send it to another unit in the insurance company that handles claims with infrequent reviews. For example, a regular LTD Case Manager with active claims may have 150-200 claims. But once a claim becomes "special handling" meaning infrequent reviews and the belief that disability will remain through retirement age, then they often assign it to someone who has up to 1000 claims. But that's not too many as they are only doing a brief check on the claim every 1-2 yr.

    IF something comes up where they think you may be able to return to work then they'd transfer it back (years ago in the 90's with AIDS claims we expected all people with AIDS to die and sent the claims for infrequent review. Then when the new drugs became available we had a task force to re-review and determine who may now be able to work). That was actually a good thing and so many were grateful to be able to get back to work and we helped hook them up with vocational services, etc.

    Special Handling Case Managers do a 5-10 minute call or more usually a form sent to you once a year with 5-15 questions. Don't laugh but the form is also used to prove you are still alive and it's your signature after the 5 simple questions. That's because some families will let the direct deposit of LTD keep going after a persons death for (1) they don't know what it is or if the family is now entitled to it or (2) fraud.

    So you are very fortunate in an odd way. You have the security of LTD behind you and they will not be seeking frequent contact. And of course I know you'd rather be working and not disabled as would we all, but I'm so happy you have piece of mind right now. And don't worry, no matter what happens to your former employer your LTD continues. Companies go under, change hands via sale, change insurance companies, etc. But your claim remains where it is until you reach age 65. If your employer were to close it's business and fire everyone that does NOT affect your benefits. The insurance company is the one to pay you and has reserves to pay claims well into the future.
    2 ACDFs, 2 PCDF, 3 LIFs; Rt TKR; Rt thumb fusion ; Lt thumb arthroplasty; Ehlers Danlos 
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