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LTD - doctors are NOT helping me at all!

candle99ccandle99 Posts: 279
edited 06/11/2012 - 8:38 AM in Health Insurance Issues
I just wanted to vent and you guys are the only ones that will understand. I have decided to file on my long term disability thru my workplace. It's with UNUM (I hope it's okay to post the company name??) There's a 6 month waiting period and I've been out of work since June. I am a computer programmer and have had two ACDF surgeries and am still left with carpal tunnel, C6/7/T1 are still severely degenerated with bulging discs, and my lumbar discs are all bulging, not to mention that I still have a metal cage that is outside the disc space at L4/5. I still have shoulder and upper back pain. Riding in a car makes the next day unbearable and working at a computer for more than 30 mins starts spasms and pain level going up.

I'd asked my neurosurgeon to fill out the doctor's forms and they did put "no work" and everything (didn't mention my lingering problems only the two surgeries) but then they put "will be reevaluated at next appt. on 12/1" which will totally invalidate the LTD. UNUM will ask them to fill out new forms right after I send in my package. ARGH! Why do doctors do this?

Then, I asked my GP to fill out the forms for my severe OA, anemia, and chronic pain and they filled it out just about my neck and two surgeries too. On the physical limitations page, they said this would have to be filled out by the neurosurgeon. ARGH! It's like nobody wanted or cared to help me out with what I needed. And I paid $20 for them to do this!

I've also asked my ortho to fill out forms for my knees and OA, but I haven't received them yet. I had to pay $20 for them to fill out the forms too. They will probably have something totally stupid on them too and not be helpful to my case either.

At this point, I'm thinking I'm going to have to suffer all of this pain and go back to work. It's not like any of these doctor's offices are going to be paying for my LTD and I do have issues that are keeping me from working. It's like nobody cares or wants to help. To top off my frustrations, my manager called last week and said he was going to have make some decisions on my lead position since I'd missed so much work (like I was doing it on purpose!) and I do have my surgeon's letter saying that I'm not to return to work. It was like he was threatening me that I was about to lose my job.


  • Hi Candle,

    It is hard sometimes to get the doctors to understand what it is you need done. Unfortunately, most often times this information the doctor never sees and is completed by his office staff. I think what you need to do is figure out which issue is your worst problem from keeping you off of work. So if the major issue is your back you need to nail down the doctor treating you for it and tell explain the situation to them. You need to explain to them the pain you are having and how if the paper work isn't completed you are in jeopardy of loosing your job. Stating that they will re-evalute at a different time is standard practice. CAll the Ltd carrier and ask them what needs to be done for the initial claim and then what needs to be done to keep it running.

    AS far as your employment goes, depending on the state you in that maybe legal. Also depending on company policy that maybe legal as well. I lost my job while out on work injury. The company policy was that you had to return within 9 months. Not to mention I work in a "employment at will" state. So basically at any point and time your employer can terminate you whenever they would like. You may want to check into your company policy regarding what your rights are as a employee. Good luck and keep us posted.
  • What I have found to be helpful is to bring them a printed "go-bye" of what you need. On some of my work required notes (stating how long I would be out and why), the office staff did the notes and the doctor signed them. Some of them I needed the doctor's to write the statement. I put that in bold on the top of the letter I gave him. So far so good I have found.

    Granted all offices are different, but just maybe something to try? Hope it helps, take care!!! :-)

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
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  • have you tried making an appt with the doc that is filling out your forms and having them fill it out in front of you? it may just be a case of they are busy and not taking the time to include all of the info on the form. that is what i did and my forms were completed successfully. please check out this link. it will help you a great deal

  • I tried to get my NS to fill out the forms while I was there for an appt., but he said they have a process and to give it to the medical records lady. He did put down some medical code on it, which I figure relates to cervialgia (not sure how to spell that?). They filled out it all based on my neck and my two fusions and still have pain. No mention of my lumbar, so they just looked at my last appt. notes and my neck was discussed. I guess I will use this one for my package.

    The ortho doctor with my knees and OA, they have the same process, some clerk fills out the medical info and she said the doctor would fill out the physcial capabilities questions. I got this form yesterday and if he filled it out, he checked 100% on everything. So someone with bilateral grade 3 DJD in their knees can stand for 8 hours? and lift up to 100lbs? I was like what??? Makes me want to take the darn form back in to my next appt. and just confront the doctor. I can't even make it thru the grocery store without limping and pain. He keeps saying I have worn out knees and I will need knee replacements so it's hard to believe that he would check 100% on everything unless he or the clerk just checked it without reading. I mean if the form says it's all about determining disability and I paid for them to fill it out, they would put 50% or something. And I waited for 4 weeks to get nothing that would help me.

    I guess I need to do like TamTam says and just focus on my neck since it's the worst problem. I thought LTD would be like SSD and you would need to put down everything you have and get proof of it all. It's frustrating that none of them want to help. You would think they would want to fill it out for you with you there so they can ask you what you can/can't do. Scares me to death about applying for SSD if they can't even fill out this simple two pages correctly.
  • SpineAZSpineAZ WiscPosts: 1,084
    The fact that they said "will be re-evaluated at next office visit" won't invalidate your application for LTD but would put their decision making process on hold. However, it does mean you need a serious talk with your physicians and/or their staff (sometimes the medical assistant or nurse is more key in this process than the doctor is when it comes to paperwork). At your next office visit make sure the doctor and his staff are aware of what your job requires. If your limitations are such that you can't return to that occupation the doctor needs your help to understand you can't do your job duties.

    If you went out of work in June and have a 6 month waiting period I'm guessing that your 6 month elimination period will be up sometime in December. So the LTD insurance carrier wouldn't likely make a decision before that date so it's actually good that your next office visit is 12/1 as the date is not too far from when your LTD could begin.

    For LTD the insurance company will be looking for extensive medical records and physician statements which indicate your anticipated return to work. But more important are your restrictions and limitations and how long will they last. In preparation for this I did a realistic review of my actual physical job duties and put together a note for my doctor and his staff outlining what my job required. I was VERY realistic as I knew my employer would have to agree with what I said my requirements were. I can see if I can locate what I put together as a reference for you.

    For example, if someone is a nurse and has 3 low back surgeries she may end up with a permanent restriction of no lifting more than 10 pounds. If her job description requires lifting more than 10 pounds then it's likely LTD could be approved if medical evidence supports the restriction.

    LTD is a roller coaster of a ride. I had STD which was approved and then my LTD was approved just when the elimination period ends. With LTD and spinal problems the insurance company may approve you but will continue to actively monitor you after approval to see if/when you may be able to return to work.

    And again, the key here is not always the doctor. My spine surgeon has his staff review all requests for records and has them discuss with the patient the job requirements, etc. Does your spine doctor have a medical assistant or other type of medical person in his office that he relies on for all this?

    If you haven't already guessed I used to work in STD/LTD so please let me know if I can help you in any way.

    2 ACDFs, 2 PCDF, 3 LIFs; Rt TKR; Rt thumb fusion ; Lt thumb arthroplasty; Ehlers Danlos 
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