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Thread: Approved SSDI after LTD insurance was stopped, should I continue with appeal?

Created on: 08/08/12 10:21 PM

Replies: 8

PugMomma


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Joined: 08/08/12

Posts: 5

Approved SSDI after LTD insurance was stopped, should I continue with appeal?
08/08/12 10:21 PM

Hi,
I just received notice today that I've been approved for Social Security Disability. March 2012 my LTD company notified me that I was no longer considered disabled under their definition. I have been working on my appeal for the past several months for the LTD claim.

Is their any reason that I should finish up the LTD appeal and send it off and try to get my LTD reinstated?

SS has my disability date almost two weeks earlier than LTD. Will that create any issues?

I used the attorney that LTD provided and I understand when I receive back pay from 7/26/2010 to current that a portion of that will go to the attorney and a portion will go to LTD company. Should I receive the back pay portions for the time periods that I didn't receive any money from LTD company?

I had LTD company withhold taxes on the amounts they paid me. Will I still have to pay gross amounts back to them? Will I need to get special documentation at tax time so I am not retaxed for this money?

I have a minor child and I read a few posts talking about the children getting social security checks because of their parents being on disability. Is this always the case for minor children that live with the parent?

Thanks for any information or help you can provide. I should hear back from my attorney again once they receive the paperwork I received. I really don't understand how this all works and want to make sure especially when I find out the amount to pay to my LTD company that I can verify the number.

PugMomma

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jdcsky


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Joined: 02/08/11

Posts: 47

Approved SSDI after LTD insurance was stopped, should I continue with appeal?
08/08/12 10:54 PM

Hi,

LTD and SSDI are two different things. How long were you on LTD before they no longer paid since you did not meet the definition? Was it the two year mark?

You should appeal the LTD decision only if you can prove you meet the current definition. The definition would be in your policy.

I do not believe the two weeks will be an issue. They are two different programs.

The back pay to the LTD is only for the months the LTD paid you benefits.

Your amount paid back is equal to (months paid disability and included in the back pay) times the SSDI monthly payment. The attorney should be payed by the LTD.

Minor children will collect SSDI. This will affect your back pay and the amount you owe the LTD.

You should receive documentation of the back pay and when you file taxes, you put down the amount you sent back to LTD. You should get tax help to do this as it is confusing.

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PugMomma


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Joined: 08/08/12

Posts: 5

Approved SSDI after LTD insurance was stopped, should I continue with appeal?
08/08/12 11:15 PM

I received STD starting 8/6/10 and it changed to LTD 11/6/10 and I collected LTD until 3/5/12. So, it was a few months shy of the two year mark.

I have the definition of disability from my LTD company. I believe if they had the updated records that SSDI had that they would end up reversing their decision. I just didn't know if it would be worth the trouble of finishing the appeal. What would be the benefits if I could get LTD reinstated? (in general)

Thanks for the heads up on the Taxes. Luckily, I was an accountant and have several friends that are CPAs and should be able to help me figure it out. It's too bad they can't find a way to make it easy.

Thanks for your help.

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jdcsky


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Joined: 02/08/11

Posts: 47

Approved SSDI after LTD insurance was stopped, should I continue with appeal?
08/08/12 11:52 PM

It would really depend on how much LTD pays and how much LTD pays. in my case, LTD paid a lot more than SSDI.

If LTD pays 800 and SSDI pays 600, You would get 600 from SSDI and 200 from LTD.

If SSDI pays more than LTD, then I would not appeal.

If they approved you for LTD in 11/2010, what changed that you no longer meet the definition. Most LTD do not change definition of disability until two years mark. Did your situation change or did the definition change?

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PugMomma


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Joined: 08/08/12

Posts: 5

Approved SSDI after LTD insurance was stopped, should I continue with appeal?
08/09/12 12:42 AM

I only got worse. However, they decided to do a review of my claim starting November 2010. They started collecting medical files from my doctors and then had one of their Physician Advisers review my claim. The physician adviser decided that I no longer met the definition of disability based on my medical records.

A few things that were not in my favor were:

*They misread my Physical Therapist notes from Summer 2011: They said he stated in his notes that I did 3/4 miles on a bike, 20 min of exercise with minimal breaks, and 15 minutes of aqua therapy. Actually, while I did have a one time where I rode 3/4 mile on the bike, I did not meet the PT's goal for me. Almost all of the other exercises were done either holding on to a PT table or laying down on the table and were stretches. I didn't do aqua therapy, it was aqua massage. Also, my PT put in his notes that I went to Disney, which was true, but failed to mention that I didn't drive myself, used a automated wheelchair the entire day, stood no longer than 10 mins and that put me in pain, and he put the wrong day, so it looked like I went to Disney and had no problem going to PT the next day, which wasn't true. I had to rest the day before and day after. I only went to PT on the day I did for the massage.

*They didn't consider all of the conditions I was out on, even though it was filled out on their paperwork and I re-informed them when I found the mistake in May 2010.

*My neurologist took good notes about my overall condition, but made a few errors when the dictation was processed. However, reading the information on the same doctor from SSDI makes me think that the doctor either has fixed it or the LTD overlooked some of the other pertinent information.

*I had ONE visit with my pain management doctor (the last records they received from him) where I did not need to increase my medication. The doctor put down the pain meds allowed me to do activities of daily living. When the doctor and I were discussing this ADL meant I was able to shower without assistance, dress myself, and bring the pain to a more manageable level. I still was not able to do housework, cook, walk to the mailbox, etc. The LTD decided what this term meant for them and applied it. Also, if they had gotten the doctor's notes from my appt at the end of the month, they would have found out that I now required an increase and was less functional than 4 weeks prior.

*In the LTD's opinion they did not see any overwhelming evidence that my conditions were the same or worse from when I went out on disability. What's funny is I was in the hospital from 12/29-1/1/12 because of my conditions and was much worse than in 2010.

**Social Security also received one extra note from a doctor that was filled out until after the review was done for LTD. The note states all my limitations, discuss my pain and my fatigue. I think this is the main component that caused SSDI to approve me.

I had already received the initial denial from SSDI, did the appeal and was denied. I was waiting for a hearing date and instead received a letter saying they reviewed my file and are giving me a fully favorable decision. I was really surprised!

Does SSDI have a set way they determine how much you get? Then I can at least figure out if it would be worth my time and effort to finish up the appeal. It's due the first week of Sept and I don't know how long until I find out how much I will get from SSDI.

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PugMomma


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Joined: 08/08/12

Posts: 5

Approved SSDI after LTD insurance was stopped, should I continue with appeal?
08/09/12 7:06 AM

Oops I meant they started reviewing my claim Nov 2011. My brain malfunctions all the time :-(

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jdcsky


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Joined: 02/08/11

Posts: 47

Approved SSDI after LTD insurance was stopped, should I continue with appeal?
08/09/12 9:17 AM

I suggest you file an appeal with the LTD and submit all the documents that will support your case. Good Luck.

If you are to get back pay from 7/26/2010, multiply the monthly amount by 24. 24 months of back pay at what amount.

I am not an expert in these matters. I have LTD and appealing SSDI.

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LTDquestions


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Joined: 09/28/11

Posts: 39

Approved SSDI after LTD insurance was stopped, should I continue with appeal?
08/09/12 11:40 AM

1. Yes, continue with the appeal. The SSDI award will be enough to win. The LTD company paid a lawyer to argue with SSA that you were disabled. They have been slapped in court when they turn around and try to argue that you aren't disabled. I can't recall the legal term, but they can't argue you are disabled and not disabled at the same time.

You want SSDI and LTD even if you get no money from LTD. If you lose SSDI in the future, you can then collect from LTD if you meet the definition of disability.

2. Onset date won't matter.

3. Yes, you will receive back pay to your onset date + 5 months. If you received the full LTD in any month you received backpay, you will need to pay back your insurer.

4. You will have to pay back the gross amount. The IRS has the money not the LTD carrier.

5. Your child will receive SSDI dependent benefits. Unfortunately, these will be offset against your LTD benefits.

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PugMomma


New Member


Joined: 08/08/12

Posts: 5

Approved SSDI after LTD insurance was stopped, should I continue with appeal?
08/09/12 1:42 PM

Thank you jdcsky and LTDquestions for your help! I feel like this LTD and SSDI stuff is so complicated when it really shouldn't be. I usually have no problem understanding things, but all of this seems absolutely ridiculous. I feel like we are set up to fail. I'm so glad that I found this forum!

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