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LTD Called Today

backpain3bbackpain3 Posts: 45
edited 06/11/2012 - 8:50 AM in Health Insurance Issues
Hi everybody, I hope everyone is doing well. I was recently approved for SSDI with an On The Record decision. I was called today by my LTD company asking several questions. They asked me if I were going to try to find a new neurosurgeon that would attempt another surgery. I told them and they are aware, that 2 neurosurgeons have told me there is not a surgery they can perform to fix my problem(Arachnoiditis and permanent nerve damage). They then asked me if I wanted to go back to work. I told them I would enjoy nothing better if I could find pain releif on a permanent basis and be able to function well enough to work, but that my doctors have me on permanent restrictions which do not allow me to work. Well then the case manager told me I should seek a new doctor that would lift the restrictions so that I could go back to work, or they could send me to one of thier doctors to get approval. This sounds crazy to me, that they would even suggest such a thing. I told the young lady that I have serious problems confirmed by both MRI and EMG tests. Is this normal for them to act this way? It sue is funny that it seems my SSDI approval suddenly made them call me out of the blue. Thanks


  • You should be very careful about how you answer their questions. I know that honesty is important, and I would never suggest otherwise, but they have ways of twisting even the truth in ways that can come back to haunt you. I think I would screen all of my calls from them and only communicate with them in writing, but sadly, that is because I am such a skeptical soul. It happened after being hurt & disillusioned a few times too many.

    Congratulations on the SSDI approval.
    I wonder why they think you would want to go see their Dr., who of course would release you for work...because they have no ball in that game :rolling my eyes:
  • Hi, and congrats on your approval.

    Robin is right, be careful.

    They are up to no good. Meaning it's probably cheaper for them to have you at work. Then you being home and getting paid by them.

    You are getting paid thru a ins.co. and they hate paying money out.
    You might be better off screening your calls, from them and then they will be forced to send you something in the mail.

    jmo and good luck
  • SpineAZSpineAZ WiscPosts: 1,084
    First rule of LTD is be as NICE as you can to the staff at the LTD ins co. It'll go a long way in having them work with you to help you understand the status of your claim.

    I wouldn't avoid them when they call, having worked in that industry I can tell you that when people would not answer or respond to calls it raised red flags. The ins co starts to wonder if you are not home, are working in some capacity, or have something to hide.

    There could be a key reason they are calling: MOST PLANS CHANGE THE 'DEFINITION OF DISABILITY' 12-36 months after benefits begin. The majority of LTD plans have a "own occ" period and an "any occ" period.

    Own occ is when they evaluate the claim to determine if you are disabled from doing your own occupation.

    Any occ is when they evaluate the claim to determine if you are disabled from any occupation for which you are reasonably able, experienced, trained, and within reasonable range of prior salary history.

    My plan has a 24 mo Own Occ. LTD began 11/2009. Any Occ will be 11/2011. I expect 3-6 mo before Any Occ date to have to provide medical, have a phone interview, etc.

    IF THIS IS THE CASE, the case manager may be required to review the claim, interview you and evaluate where the claim stands. The claim examiner has to justify why claim benefits are to continue or why further claim eval is needed.

    When and if they call be straightforward and say that at this point there is no viable surgical option so you continue treating with Dr. X, Dr. Y and you take XYZ medications. Gently state that while you appreciate their concern it's also true that they can not request you seek any certain treatment. If you have any new conditions be sure they know about them. Many times we'd be considering closing a claim and then find out the person has another serious condition that they never mentioned.

    They can ask questions about who you've seen, what you've considered, etc. So if someone didn't have a lot of knowledge and said "I saw the rheumatologist and he couldn't help me" they might carefully ask "have you considered an evaluation with a spine surgeon to discuss all surgical and non-surgical options?" The reason is often people who don't understand medical terminology and lingo don't understand the specialties of the doctors they go to.

    The higher your LTD amount, the more likely they are to continually evaluate your claim. Same with the younger you are.

    A claim for a 59 year old with 3 spine surgeries who gets $500/mo from LTD and $1800/mo from SS and his entire life he was a copper miner, once SSDI was approved claim likely reviewed once per year.

    But a 28 yr old who getting %4000/mo LTD and $2500/mo SSDI, who had a degree in accounting, and had a single level fusion with minimal pain meds may be continually evaluated to see if return to work is an option.

    Often once SSDI is approved they are looking to determine if they should continue to follow you frequently or on an annual/semi annual basis only.

    If it was a Nurse Case Manager who called they can interview you to see what treatment options you may be considering. But they can not dictate who you see, what you do for treatment, etc. So if 12 spine surgeons told you that you must have a cervical ACDF and you refused while your left arm when numb, they can ask if you are going to do surgery but can't send you to a doctor or insist you do so. That decision is yours alone.

    LTD can have you be evaluated by a physician of their choice, and this is likely laid out in the policy, but that is for evaluation only not for treatment.

    If you feel the person was not a Nurse Case Manager and possibly the Claim Case manager you can call the ins co and ask to speak to the person's supervisor. Objectively state you were disturbed by the direction of the call, it seemed as if the person wanted to create a treatment plan for you and you are aware that it is not the role of LTD to do so.

    Key questions:
    Are they paying you a significant amount each month?
    Or minimal now that SSDI is offset?
    Are you over 50?
    How long have you been on LTD?
    How often does LTD contact you?

    Feel free to respond to me via private message if this is information you don't want to share on the boards or if there's lots of details.
    2 ACDFs, 2 PCDF, 3 LIFs; Rt TKR; Rt thumb fusion ; Lt thumb arthroplasty; Ehlers Danlos 
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