SSDI VS. LTD

I have been on Long Term Disability (LTD) since April 2007, along with SSDI being awarded this past year with a disbility date of from 2007.  SSDI states I am being awarded for CD, Depression.  Since then, I have had a 2 level cervical fusion & chronic pain in hips & legs which a rheumy is treating me for with neurotin & going to physical therapy.  Not sure if the fusion worked will know in a few weeks after xrays.  Anyway, LTD reviews your claim after 2 years, the 1st 2 years is on your own job, then after 2 yrs they review for any type of job.  They have determined that they feel I can do a sit down job.  For numerous reasons I cannot.  I don't understand how the government grants me benefits & the LTD can terminate me just like that.  Of course, they informed via phone & they read what the adjuster work, which I believe all info was not looked at.  I am going to appeal.  Has anyone had a similiar situation?  Should a get a lawyer?  The lawyer who did my SSDI only does SSDI and Iam awaiting a referral from them.  In the meantime, I need to appeal but just don't have the physical & mental energy to appeal all this. I only have 60 days.  My last check was to be April 13, 2009, however, they sent it early & closed my claim already.  I live in NW Indiana if anyone has a referral for a lawyer.  Thanks for reading.

From my own experience - my understanding is that you can't have the LTD and the SSDI at the same time. When you were awarded your $ from the gov't, didn't the LTD people try to take most, if not all of your award back as payment? That's what they did to me. My company's policy was that if you get on disability from the gov't then they only pay 10% of what they were paying you before. For example - $1000 a month, then became $100.

You need to find out what your company's policy is. If the policy is not in your favor (and they usually aren't) then it won't be worth it to fight it. Their goal is to NOT pay you anything. They want to keep their money. So, if they think that you are capable in the slightest, you will not get a dime. If you really want to fight it you need to appeal by writing a letter stating all of the reasons why you cannot work a desk job. Show how your illnesses make you disabled in quantifiable terms. For example - "I am so weak I am unable to sit up for more than 5 minutes at a time." or "The side effects from xyz prescription med makes me so shaky that I am unable to hold a pen steady enough to sign my name and I am unable to drive." Whatever it is that you CAN'T do, you need to spell it out for them. You can't just say, "I feel bad" or "I need a bathroom" because they don't give a crap.

It is tedious to go through the process, so I completely understand why you wouldn't want to. I say you should find out what the LTD policy is about payment in conjunction with SSDI. If they don't have to pay you any more, then appealing is a moot point. If they do have to pay, then decide if you want to appeal or not. You'll need medical records to back it all up. Remember they are looking for ANY and EVERY reason not to have to pay you. Good luck!

I'm not sure if this is really "advice" as it is more of an explanation. I know a little about this stuff b/c my husband used to work in LTD claims. Each policy has different coverage set by the contract with the employer. Some have maximum benefit times regardless of whether you are still disabled. Typically any "self-reported" disability has the shortest benefit time. Self-reported does not mean you are making it up. It means there is no concrete proof a doctor could give the company. Good examples are pain and depression. Depression is diagnosed based on symptoms reported to the doctor, not based on a cat scan that sees a tumor. So your CD would probably be covered under the longer provision because it is verifiable by tests. However, CD alone doesn't make one disabled. It is the symptoms, and those are often self-reported. If the part of your CD making you disabled is bathroom trips and pain those can't be "proven" by the doctor. If the part making you disabled was fistula, abcesss, etc. then you would probably fall under the other longer coverage provision.

So assuming your symptoms are mostly self-reported they evaluate you under step two (and since it has been 2 years) to see if with an accomodation you could work any job. They found that you could work a seated job. That is not enough for them to find. There has to be jobs available, in your area, for which you are qualified that provide that accommodation. I believe even if they close your claim they are supposed to transition you. Give you a career coach, help you find the kind of work that you can do, start you with a reduced schedule, etc. I would call the disability company and ask about getting those kinds of benefits if you lose your appeal for full coverage.

I am guessing that if you read your contract there will be a strict time limit on self-reported disabilities. Even verifiable disabilites (ie: cancer) have a time limit on how long one can receive benefits under some plans.

Good luck!

They will also take into account if you could work with accommodations such as frequent bathroom breaks, reduced work schedule, adjusted work station so you can alternate sitting and standing, etc. SSDI may still find you disabled because they don't have a time limit on their coverage. It is a government benefit.

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Edited to add: also look at your contract to see what qualifies as symptoms of the disability.  Under 99% of plans not being able to drive has no bearing on if you are disabled.  I don't know how they expect you to get to work if you live in a rural are but those are just the arbitrary rules.  I guess they want you to carpool or something.  Also, being on a medication that effects your ability to concentrate does not qualify under a lot of plans.  You didn't elaborate on why you can't go back to work so I can't give you my opinion if they are reasons the company will accept. 

Thank you again for everyones advice.  I have gone on the suggested website & they are very informative.  I spoke with a firm this am, just giving info on the claim & I will know in a week if they feel the case is worth pursing.  I do believe it is, but, we'll see.  Its been a week since the LTD called & I have not recd any formal paperwork at all.  After re-reading the policy, I do feel I must appeal.  However, the firm will advise me & I will let all of you know what they suggested.  Take care & thanks again.