Settlement in LTD lawsuit

I applied for LTD through employer provided policy. They had no intention of paying. I got denied and then appealed. My appeal was a 35 letter which reviewed my history and basically showed that everything they had in my case (their documentation to support their claim I could work) file about Fibromyalgia was completely bogus. It came down to two paragraphs written on a single sheet of paper with no title and a couple of references.

The paragraphs essentially said that Fibromyalgia is all in your head and if it isn't then you can still work at a sedentary level. I challenged both parts.

My appeal came back with a denial, but someone in their "audit" department called me and told me she felt I should have some specific tests done and then she would make sure the case was reviewed.

They sent me to an Independent Medical Examiner how took his job seriously. He told me to request a copy of his report right away so that I would know his recommendation. He said many insurance companies will send you for an IME and then ignore the result stating "after consideration of Dr X's opinion we have decided to deny your claim." Even the Dr agrees with you. They play semantic trickery. His opinion didn't say you could work, they just said after considering his opinion.

I don't know what you mean by "negotiation phase". Does that mean they have denied you and you got a lawyer and instead of filing suit your lawyer is telling them that you will be filing suit. Is your lawyer "negotiating with them to settle for some amount less than you would get from benefits?

How long have you been out of work? How long would an approval pay? My insurance only lasted for 6 months STD and my LTD 24 months. In the end, I got two checks total. One for 6 months plus 23 months and the second for one month only. Yes, it took almost a year and a half.

Are you aware that your policy stated you are required to file for Social Security Disability and that you will be required to pay them back for any amount up to SSDI benefit? If you have children under 18, they will also claim their benefit as well. Children's benefits can not be used to pay back the insurance company so that will have to come out of your pocket since SSDI expects you to report what the benefits are used for - clothes, medical, etc.

So if you settle for some amount less than your actual benefit, it's likely that after they get paid back for the Social Security benefits they will have paid you nothing.

How long has this been going on? Have you started an application for Social Security?

Feel free to email and I'll share more details with you, especially if you have the same company. My company (the largest for LTD) has a reputation for not paying but usually lose in court because, according to my SSDI lawyer, they don't prepare the local attorney so they look stupid before the judge.

My concern is that if you "settle" and your attorney takes their cut, then you get approved for SSDI during the same period you will end up having to pay back the company for the SSDI and it might be more than you actually collected (settlement minus attorney's fees).

Anything you do pay back the company with SSDI is deductible from your taxes in the year you made the payment to the company.

Sorry if this got confusing. It's a lot to say with out having an actual conversation.

Email me, Kim

Bump