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Can my disability insurance benefits be denied if I am approved for Social Security Disability Benefits?



Disability Insurance Attorneys Gregory Dell and Cesar Gavidia discuss the misconception that a claimant will be approved for long term disability insurance benefits if social security disability benefits are approved.

In most cases this is a true statement, but we have been seeing a lot of people approved for SSDI benefits and then denied Long Term Disability benefits. This trend is frustrating and inconsistent as it is the disability insurance companies that often make a claimant apply for SSDI benefits.

Approximatley 72% of the people receiving LTD benefits are also approved for social security disability benefits.

There are 106 opinions so far. Add your comment now.

Renee:

I have been on LTD since 2008 and in 2012 was awarded SSDI back-pay as well as ongoing. My LTD has not been easy to deal with and were about to drop me right before I was awarded SSDI. After receiving SSDI they stopped demanding paperwork from me every month and harassing me. I thought things were going to be better with them going forward since everything they demanded I do, I did. Now they are demanding I see one of their physicians. Through all the reading I’ve done on the internet and passed experience dealing with them, I figure unless I’m on my death bed they are probably going to claim I am no longer disabled. Can you give me some advice as to what I should do or not do? Thank you.

Attorney Stephen Jessup:

Renee,

It would appear that your carrier might be setting you up for a claim denial. At this point in your claim history it is somewhat unusual that they would have you submit to an IME. Please feel free to contact our office if you would like to discuss your claim further.

Tony:

I was approve for SSDI, now my WC attorney is telling me to withdraw my app. Why would they tell me this, they haven’t gave me a reason? Early on I was told by them it was OK, I was told about the SSDI offset. I also get TTD, so what will happen?

Attorney Stephen Jessup:

Tony,

You will need to consult with your worker’s compensation attorney as to why you are being told to withdraw your application.

Shiva Sharma:

I had a stroke in 2003 while I was working and got hospitalized for 6 months. I had Prudential for LTD and got it for a few months and then I applied for SSI benefits and started getting benefit. Suddenly Prudential stopped paying benefits and asking me to pay back some of the money paid, but after explaining my situation and unable to pay back, they stop paying any more benefits and ask for more documents from doctors, but still I am getting SSI benefits. Can I still appeal Prudential for getting LTD benefits?

Attorney Stephen Jessup:

Shiva,

How long ago was the denial of your claim? If it was in 2003 you would have exceed the 180 days allotted to file an appeal and the Statute of Limitations to bring a lawsuit would have most likely run. Please advise.

Jason K.:

If SSDI denies my claim, can my LTD company deny my claim with them?

Attorney Stephen Jessup:

Jason,

Your LTD carrier could use a denial of SSDI benefits as a factor in its determination as to your entitlement to continued benefits. That being said, just as receipt of SSDI does not guarantee your LTD carrier will approve benefits, denial of SSDI does not mean your LTD carrier will deny your claim. The LTD carrier has to review your claim in light of the provisions applicable to its policy.

Vanessa:

Was approved, received one month’s benefits then I was denied. I don’t understand why they would do this.

Attorney Stephen Jessup:

Vanessa,

If your disability benefit is from an employer provided disability policy you would have the right to appeal the denial of benefits. Please feel free to contact our office to discuss how we may be able to assist you with same.

Al:

Hi, I’m on currently on LTD and have a question.

In late 2011 I had some issues requiring surgery. At the time, I went out on “short-term” disability and in early 2012 I had 2 surgeries to resolve my problem. I went back to work and after a few months all of my problems came back. Due to this I applied for LTD (through my company which had it’s premiums paid by me weekly).

After a long trek through the muddy waters of LTD, I was eventually granted said LTD in mid 2013. (Yeah, a year and a half) It worked out okay though and I was once again awarded for another 24 months at the 2 year review.

Now for SSDI… Although I applied a year+ earlier, I eventually got my court date for SSDI just a few months ago. I was awarded a “capped” benefit up until the day of my next surgery which was planned to hopefully put things to rest. I haven’t received my SSDI check yet which I need to pay back to my LTD company, but when I get it… I will.

I just had my surgery mentioned above and it’s a 60/40 result basically. So I honestly don’t know how I’ll be in a couple months. Since my SSDI award was “capped” until the day of my surgery, does that leave room for my LTD company to stop payments after that capped date, or could they as well bring my monthly amount to half of what it’s supposed to be even though SSDI isn’t paying me post surgery? No matter what, I need a few months to get back into shape after being bed-ridden for 3 years.

So I’m a little concerned about this and any help would be appreciated. Thank you in advance.

Attorney Stephen Jessup:

Al,

our LTD carrier will review your entitlement to benefits based on the criteria set forth in the policy and although they will consider a SSA decision as part of its review, the fact that the SSA capped your benefit until the time of your next surgery does not mean the insurance carrier will follow suit. Additionally, insurance carriers typically will at a minimum continue to provide benefits following a surgery for what I considers a reasonable recovery period. Please feel free to contact our office if you would like to discuss your claim further.

Lisa:

If the LTD carrier denies any further benefits (after successfully having someone apply for and be awarded SSDI), can you request that they give you their full administrative record and any surveillance video they have used in their decision?

Attorney Stephen Jessup:

Lisa,

If your claim has been denied you are entitled to a full copy of the claim file upon written request. Please feel free to contact our office to discuss how we may be able to assist you in appealing the denial.

Barb:

I have been receiving LTD and SSDI for around 5 years. Just had a review with SSDI and benefits continue. Now The Standard is reviewing with activities and capabilities questionnaire. For some reason I feel uncomfortable (gut feeling) knowing another person in my shoes was recently offered a settlement. Should I call your office before proceeding with the questionnaire? Also my current doctor is on a LOA.

I like the approach to cover my basis first or do you discuss claims that are not denied yet?

Attorney Stephen Jessup:

Barb,

Please feel free to contact our office to discuss the specifics of your claim and your policy.

Danny:

I have been approved for ssdi but my ltd says there’s not enough proof for ltd and is sending me to ime. What are the chances that I will be approved or denied my ltd?

Attorney Stephen Jessup:

Danny,

The chances of denial are very specific to each case. Although receipt of SSDI is evidence of disability, receipt of same does not guarantee continued benefits under a private disability insurance policy. Sending you to an IME at this point sounds like an attempt by your insurance carrier to obtain “new” information that was not available to the SSA and that can justify a denial of benefits. Please feel free to contact our office to discuss your situation further.

Cindy:

I was out on Short term disability due to pregnancy related medical issues. My STD was approved but was only approved for 26 weeks. After that, I was told I would now have to apply for LTD. No problem ,I thought since it is the same company administering the benefits. Plus I also work for them. Anyway, they denied me for LTD stating my medical notes do not indicate enough of a disability. My Dr notes were provided every month and my diagnosis never changed. Neither did my symptoms and limitations. If amything, my condition worsened. They claim they sent my medical notes to an in house RN who made th is decision.

Attorney Stephen Jessup:

Cindy,

Have you already filed your appeal of the denial? Please feel free to contact our office to discuss how we can assist you in appealing the denial.

Shelly:

Can Unum force me to appeal a Social Security Disability denial?

Attorney Stephen Jessup:

Shelly,

Most policies require you pursue SSDI benefits through the entire process, to include court. It is more than likely that your policy requires the same.

Dave:

Hello, I am on Ltd through work policy. They wanted me to file for social security, I did and was turned down. Can Ltd stop paying me since as was denied? I have been on Ltd a lil over 2 years. Thank you for any help and information.

Attorney Stephen Jessup:

Dave, they cannot deny you based solely on the Social Security ruling. However, it can be used as evidence to support a potential position that you are no longer/will no longer be disabled under an “any occupation” definition of disability.

Debi:

I have been receiving Ltd benefits from Cigna through a work policy because I am unable to perform the duties of my regular occupation. They have required me to apply for SS Disability, which I did but was denied because Social Security believes based on evidence in file, that I can adjust to other work. Can my LTD benefits be denied based on Social Security ruling? I am approaching my 2 year period with LTD, they are working on reaching a decision of permanent disability.

Attorney Stephen Jessup:

Debi, denial of SSDI benefits alone is not a basis for Hartford to be able to deny the claim, but would be used as part of any review for “any occupation” benefits. Please feel free to contact our office to discuss your claim further.

Thomas P.:

How about short term disability? My insurance company Etna is trying everything to deny my Std claim saying my spine that has bulging disks and Mri backing up my spinal degeneration does not qualify. I am an aircraft mechanic who as you can imagine has to change heavy brakes and tires and climb all over a jet to which my doctors say I can not do this. I have a history of bad health due to my military service so when back in October I applied for SSDI when I had my torn rotator cuff (slap tear and labrum tear) just in case I could not return to work. I have had 15 surgeries 2 heart attacks bypass surgery among them. I was not surprised when in just 4 months I was told I was approved for SSDI. Can I use this as proof of my poor health that I can not return to work ever and that they should pay out Std. Thank you

Attorney Stephen Jessup:

Thomas, receipt of SSDI is certainly evidence of disability that it would be important for Aetna to know as part of the review for your STD benefits. Please feel free to contact our office should you have additional questions.

Mark:

I turned 61 on March 1 2016
May 2015 I had a stroke which caused extensive loss of vision in my left eye and less in the right
I purchase ltd coverage through my employer from Matrix
When applying for ltd matrix told me that if approved for ltd I would have to apply for ssd. They would pay Allsup to represent me and if approved for ssd I would have to pay back the ltd benefits they gave me. I agreed
They finally approved me after jumping through hoops until March 1 2016 and said at that time it would be reviewed again. During that process matrix stated that they were using federal guidelines to determine if I was eligible for ltd benefits
My benefit was $3425 per month which was 60% of my base salary
On March 16Matrix denied to continue ltd benefits. They stated the doctors determined I was not totally disabled so they denied. The eye sight did not improve nor is expected to due to brain damage from the stroke
I had the vision retested in February showing no improvement
On March 16, 2 hours later I found I was approved for ssd!The benefit amount is $2143 per month. I am very grateful for the decision. How ever the amount is almost $1200 less than the ltd benefit
It’s my understanding that if matrix would have paid the $1200 difference if they had approved continuation of Ltd benefit
My question is now that I have been approved for ssd benefits,which I’m assuming is the federal guidelines matrix was referring to, does matrix have to approve the ltd benefits to make up the $1200 difference. Matrix did say when I was denied I could appeal their decision. Do I have a leg to stand on?

Attorney Stephen Jessup:

Mark, receipt of Social Security benefits is evidence of disability that the carrier has to consider as part of your claim, but receipt of SSDI in and of itself does not require the carrier to automatically approve your benefit. They would responsible for the $1200 difference and you do have rights to appeal- so yes, you very much have a leg to stand on. Please feel free to contact our office to discuss how we can assist you.

Conrad:

I’m have been receiving LTD for the past 3 yrs stating I’m unable to do any occupation. LTD started on 4/23/13. I was finally approved for SSDI on 7/1/15 .My employment was terminated on 4/23/15, due to
my employer only had to hold my job for 30 months which I surpassed.
I was injured on10/23/12, driving to work and was rear ended totaling the company car and my back was injured-Herniated Disk L4-L5, Spinal Stenosis which was a 24 year career ending injury.
I been receiving LTD , but have never received any kind of Wokers Comp Benefits. NO TTD payments and no medical bills paid. My 3rd Party claim against the person who rear ended me, their insurance company states the will not pay my bills because this is a workers comp case.
My 3rd Party case I had a Deposition on 5/6/15 and around end of 2015 they admitted negligence which I know now is only half the battle.
I been seeing my own Orthopedic Spine Surgeon since the beginning of my accident. I’ve had prior back problems in the past. My company sent me to an IME on 12/9/13 which the IME doctor stated that I could return light duty lifting 15-20lbs with no stooping or repetitive bending. My company could not accommodate these restrictions. My Dr. says no work with restrictions limited sitting, standing, walking
10-15lbs no repetitive bending. LTD continues to pay, but now my attorney handling Workers Comp sent me another appointment to do another IME with the same doctor 2 and a half years later. I had no changes in my condition nor have I had any more MRI which was done 11/2012. I’m on SSDI and have no job to go back to. I feel I should have to do another IME with this doctor. Is this reasonable because they are still in arbitration and They haven’t paid me anything, they have created financial hardship and its very aggravating to me which does help my current back problems. Both doctors recommended surgery by I do not want it. I know this is long and complicated, but at this point I’m fed up. What to do??????

Attorney Stephen Jessup:

Conrad, you will need to consult with your Worker’s Compensation and injury attorney as to what steps you will have to take for those claims. As the IME is not in furtherance of your LTD claim there is little we can offer in advice, and would have to defer to the attorneys that currently represent you.

Susan:

I was approved for std. I called my job to help someone who had a question.
Could I now be denied std, for making that call to help someone who works for me?
I work retail. So my employees had a question .

Attorney Stephen Jessup:

Susan, in a situation like that I do not see an insurance carrier claiming you are no longer disabled.

Diane:

I am on short term disability because of back problems and just found out I have 2 bulging disks, osteoarthritis and degenerative disk disease. I filed for SSDI a month ago. Do I have to inform short term disability of this fact? I have not been approved for SSDI and it may take 4-6 months. I will be 63 in July.

Attorney Stephen Jessup:

Diane, your carrier will likely inquire as to the status of any SSDI application so you can certainly advise them.

Robin:

I have been out of work since Dec 2012. I have had no problem with short or Ltd up until now. I was told to apply for SSDI which will all go to my Ltd carrier when I receive the retro backpay. Around the same time my hearing I got mysterious attending physicians statements from my carrier. I was confused so I called because they hadn’t stated which doctor they were seeking information from and they knew I didn’t have an appointment the time frame they were requesting the return of the papers. I first called and asked to speak to my case manager. I didn’t receive a call from her so I called back the next day. I was told no worries just take it to my next appt on June 30. Yesterday I received a letter stating I wasn’t cooperating with them and they had tried to call me twice which is untrue. I have an answering machine on home phone and voice mail on cell. They may have called but they certainly left no message. I feel they are trying to set me up to stop paying me as soon as they recover their backpay. Any advice?

Attorney Stephen Jessup:

Robin, first and foremost I would get the APS to your doctor to complete as soon as possible. Please feel free to give us a call to discuss the status of your claim.

Tina:

I was approved for SSDI in April 2016 (first payment due in August) for severe C-spine and L-spine issues. I’m just now starting he application process for LTD through my group policy. My employer refused to give me a copy of the LTD policy prior to the 6 month waiting period, meanwhile they changed carriers. I finally sent a request with return receipt and received the policy. I suspect they will deny based upon pre-existing condition, but we will see. My main question is this: If I’m denied LTD, will it affect my SSDI?

Attorney Stephen Jessup:

Tina, a denial of LTD through a private carrier has no impact on the SSA review of your claim for SSDI.

Robbie S.:

I was approved long term disability by Pridential to the year 2032. The year my Social security will take over. I was approved by Social Security also after a couple of appeals. After I was approved by SS Prudential decided to discontinue my long term disability. They decided I was able to go back to work. Which I have had no improvement on my condition and all the treatments did nothing to help. I don’t understand how they can originally approve me than decide to deny me 4 years after my disability by Pridential was approved to the year 2032. I have appealed it twice. The second time they sent the records out to a independent medical firm for evaluation. Which of course they hired and paid. Do I have any rights as to litigation against Prudential ?

Attorney Stephen Jessup:

Robbie, unfortunately, your situation is all too common. Before you can bring a suit you have to go through the administrative appeal process. Please feel free to contact our office to discuss how we may be able to assist you with same.

D:

I was just awarded SSD and am transitioning from STD to LTD at my workplace. How can I find out if my workplace policy will pay me in full, offset, or deny me jist because I was approved for SSD? What actions do you suggest I take? Thanks, D

Ann:

My LTD carrier, Cigna, declined to continue payments after 6 months of coverage, that was in May. 2 months went by with no income. In July, I was approved for SSDI and received 4 months back payments. Will I owe any back payments to Cigna even though they dropped me? I am 61 years old and cannot return to work.

Attorney Stephen Jessup:

D, you will need to request a formal copy of your policies form your employer. That being said it is almost certain they will contain offset language as it relates to your SSDI award.

Attorney Stephen Jessup:

Ann, Cigna would have a right to seek repayment for the overlapping period of time. That being said, you have the right to appeal this denial to try to get your benefits back. Have you appealed? Please feel free to contact our office to discuss your claim in greater detail.

Barbara:

I had been on short-term disability from March 2015 till June 2015 then was placed on long term disability was advised to sign up for SSDI which I did in September 2015 was denied April 2016 hired hdisability Justice they were able to get SSDI to do a reconsideration I was awarded my SSDI I contacted my case manager at Cigna faxed over my award letter told her I was making a cashier’s check for the amount of back pay they sent I was told not to do so because I might not owe it to them call the every day up until last Friday she told me they will contact me and let me know if I owe them anything I hadn’t heard anything so I’ve looked on my account with Cigna my case has been closed my policy is supposed to pay the difference till my retirement age I called them today and got nowhere please advise

Attorney Stephen Jessup:

Barbara, if your case is closed that typically means there was a denial, which would trigger Cigna having to send you a formal denial letter. That being said, I have heard of system “glitches” in which the information on the site is not an accurate reflection of the current status of the claim. At this point I could only recommend that you continue to contact your claims manager or their supervisor to find out exactly what is going on.

Melissa:

I was just denied disability through the state. I have been on disability through my old employer for 6 years. Can they end my benefits now that the state turned me down? It says I’m approved through Metlife till 2048.

Kim:

I started having surgeries for a pelvic mesh sling erosion back in July, 2014 and RTW for as long as I could after about 4-5 additional surgeries. I then was placed out of work completely on 9/18/15 and was awarded LTD benefits and was asked to apply for SSDI. On July 22, 2016 (out of the blue) my employer of 26 years ( who also carriers there own LTD benefits) denied my LTD. I have been in the process of gathering all medical needed for my appeal ( after an additional 4 surgeries- 9 total to date). Today, 9/22/16 I received a call stating I was awarded SSDI benefits. I want to wait until I receive the SSDI benefits in writing as I am a single mother of three children and am in a bad way right now should I continue with my appeal once I receive the award letter from SSDI? Should I continue to fill out my medical benefits through the state or if I am approved LTD benefits again through my employer do I I have to keep my medical through them in which they take additional money out for or once I notify the state of my LTD benefits ( if I get them back) and SSDI do I lose the medical and food stamps being offered to me and my children right now? I need to do what is best for me and my children as I am told I will never be able to return to work again. The pelvic mesh lawsuit is a joke and what is being offered will not help especially since there is no past, present or future medical or wages to assist us women in this situation. The money will barely cover my medical expenses- forget about the pain and suffering that will continue to grow as my quality of life will surely continue to decline!! Any advice…

Attorney Stephen Jessup:

Melissa, a denial of SSDI benefits is not in and of itself a basis for MetLife to terminate your claim, but they can use the information as a basis to conduct a review to determine continued eligibility under their plan. Please feel free to contact our office to discuss your case in detail.

Attorney Stephen Jessup:

Kim, please contact our office to discuss everything in detail. Depending on your LTD plan, the award of SSDI benefits would likely trigger an overpayment owed back to the LTD plan. The award is also evidence of continued disability that you would want to make part of any administrative appeal.

Craig:

Good afternoon-

I have MS and on STD which was supposed to turn into LTD at the end of Oct. In the meantime, I filed for social security disability. My employer has offered me a new job and I was told that if I do not accept, my STD/LTD benefits will cease. I accepted the job because I figured SS would deny me if I did not take the job. If I take the job,SS will now deny me because I make over the SGA. Is that correct what my employer told me about my LTD benefits? Should I be concerned about SS denying me if I DO NOT take the position? Thank you.

Attorney Stephen Jessup:

Craig, without seeing the policy we would not be able to comment as to the veracity of your employer’s statement. Some policies do contain language that if you are offered a workplace accommodation or new position and do not pursue benefits can be cancelled. As we do not handle SSDI claims I would not be able to speak as to same.

Harper Lee:

Hello! My husband has been on LTD and is now approved SSDI. When we were going to a hearing, the LTD representative if he was awarded SSDI benefits, he will receive the difference from LTD to make it whole. He was getting paid $1500 LTD, is now receiving $1100. We were told that LTD is “generously” giving him $150/ month (not the $400 we originally thought) because our daughter may start receiving benefits for $500. She hasn’t received them yet and do they usually include the dependents amount? Thank you

Attorney Stephen Jessup:

Harper Lee, yes, the policies allow for reduction due to dependent SSDI; however, that offset doesn’t usually occur until it is received. If you have proof of filing for the DSSDI for your daughter, I suggest you provide to Unum and ask that they lift the extra offset until such time your daughter’s DSSDI benefits is approved/paid.

Debbie:

I got approved and was paid STD for 6 months and then approved for LTD. I had injured my l knee at work and was denied workmen’s compensation a year later I won my case and understood I would have to pay the overpayment back. They want me to pay back the entire amount of the STD which is several thousand more then what I recieved in back pay. They said they denied my claim because they do not pay for injuries that are job related. They had all the information and the denial letter from the court when they approved the STD. Can they do this. Is there anything I can do since I am unable to pay the amount back.

Attorney Stephen Jessup:

Debbie, there are policies written that state they will not cover claims covered by worker’s compensation. The initial denial of worker’s compensation may have been the reason why the STD benefit was paid. Furthermore, when dealing with overpayments policies typically state that amounts paid to your attorney are not to be considered part of the overpayment.

Rachel:

I went out on std in April 2013, had bad surgery had other severe health issues arise, then in Oct 2014 told to switch over to ltd and made to apply for ssd. Which I did. I finally had my appeal hearing 10/16 and have been approved. Reliance has informed me I need to pay them back.
Do I also pay them back the std I received from their other side Matrix? The judge awarded back to beginning.

Attorney Stephen Jessup:

Rachel, Matrix administers claims for RSL – but both policies would indicate offset language due to the SSDI – so most likely yes, you would have to pay back the STD for any period of time the benefits overlap.

Pella:

I have been receiving Ltd for over a year and in August was awarded ssdi and back pay. I told allsup (for Aetna) I won and they said they’d advise Aetna to see if I “had to do anything”. That was 3 months ago and they are still paying me Ltd. I’ve received no notices or anything about reimbursement. What’s going on? Can I collect ssdi and Ltd at same time and am I required by law to give them my back pay? Alternately can soc sec reduce my benefits due to getting Ltd too? I’m very confused.

Attorney Stephen Jessup:

Pella, have you advised Aetna you received the SSDI? You will be required to repay Aetna for any overlapping months they paid and you receive SSDI benefits. The SSA will not reduce your benefit on account of what you receive from Aetna.

Joaovictor:

Hi, reliance standard ended my claim back on december2015, due to surveillance, and to a third party dr based on his information I dont qualify for been disable, which I disagree, im still taking meds and injections in my back to deal with pain and also terapy. Im still waiting for ssdi aproval , my question is lets say if I get approval for ssdi, will reliance collect any benefits from ssdi, although they have closed the claim, they still owe me 12 months of benefits, or what if receive workers comp benefits which Im still waiting to solve the claim. do I have any right to use the past twelve months that reliance have not paid me to subtract from any benefits that I may collect from ssdi or workers comp.

Kimberly:

I have been out of work since 09/29/3016 My STD through Prudential my Employer pays for denied my benifits so I have to Appeal. I also have been paying for LTD. I applied for SSDI and SSI and just got approved for both. I have not received an approval letter yet because they needed more imformation from me to calculate my benifits.
My question is, My employer has been paying my share of health Insurance benefits and I have not yet filed my appeal, I have 180 days. I’ve asked my employer for my STD booklet certificate and contract imformation they have with prudential and have yet to receive it. When I get my approval letter and tell my employer will they have to continue my health insurance while I file and wait for a decision on my appeal?

Attorney Stephen Jessup:

Hi Joaovictor, did you appeal the denial within the 180 day deadline? If not you may not have any further rights to seek benefits under the policy. Technically, any overlapping periods of payment between the LTD carrier and SSDI or Work Comp would result in an overpayment, but your carrier may not be aware or ever know if no action has been taken on your claim since December 2015.

Attorney Stephen Jessup:

Kimberly, your employer will not likely reinstate your health benefits unless your Prudential claim is approved. If you would like assistance in appealing the Prudential denial please feel free to contact our office to discuss same.

Necee:

I have been awarded backpay and benefits for ssdi, I am a 60 year old divorced widow. In August 2016 I began receiving reduced survivors until my ssdi decision was approved December 2016). Because my income was higher than my deceased spouse the letter says I only recieve 12 months disability backpay and 1360 monthly. The alj decision was dared back to 12.2014 and payback to May 2016.

In all this I have been informed by a few people that I could have been using my Prudential LTD insurance, can I file now?

Attorney Stephen Jessup:

Necee, if you never made an application for benefits at the time of employment you likely do not have active coverage. You can certainly attempt to file a claim with them but there will be issues with respect to late notice of claim.

Glenn:

I have been disabled due to complications from rectal cancer. I was receiving std then Ltd from Cigna. My employer sent letter that they will no longer pay after 2 years so I no longer receive any pay. I have filed with ssdi and had hearing after first being denied. They want to know why employer will noonger pay. My question is if I receive a reward of disability from ssdi will I have to pay back Cigna for the two years of payment?

Attorney Stephen Jessup:

Glenn, your carrier would still have a right to seek repayment for any overlapping period of time they paid you. That being said, you indicated your claim was terminated at the 24 month mark- was that due to your condition being limited to 24 months under the policy (such as mental health claims) or because the carrier says you can return to some other type of occupation? If it is the latter you should have rights to appeal the denial. Please feel free to contact our office to discuss your claim further.

Coop:

I received STD than I was denied, I appealed it and was awarded payment for the remaining term of my std coverage. While I was waiting on the appeal I filed for Ssdi and was awarded. Can I file for Ltd to cover me up to the date I received my ssdi? Can I receive Ltd and ssdi at the same time? My ssdi is 1000 less than my std payment which would be the same for my ltd payments if I am approved. Will my ltd pay me that 1000 or pay me my full amount? I have my plan with Cigna.

Attorney Stephen Jessup:

Coop, certainly continue the process into LTD. Cigna will pay you a benefit less what SSDI is paying you.

Sharon A.:

I was approved over a year ago for LTD with Cigna. I work in a specialized field and an accident caused permanent injury to my dominant hand. My coverage is provided if I am unable to work in my field. I was also diagnosed with depression and PTSD. I also have a home business which is unrelated to my profession. I can receive commissions from my home business based in the activity of my team, even if I don’t work. They often exceed the SSDI monthly limit. If approved for SSDI, Cigna will cut my payment in half and with SSDI benefit, I will receive about 330 less per month. I would also not be able to make more than 1100 per month. Can I be forced to continue the application?

Cigna hired the Advantage 2k company to assist with application. The person who assisted with the application put in that I received 99,999.00 since I last worked. Even though I told her that my W2 from work totaled 106,000 I got a call from SS accusing me of falsifying get the information. I expressed this to the agent from Advantage 2K. She admitted to putting down the lower number in order to file the claim . I don’t want to apply for this.

Can Cigna legally force me to do this?

Attorney Stephen Jessup:

Sharon, Cigna cannot legally force you to continue your application; but they would have rights under your policy to reduce your benefit by the amount they estimate SSDI would pay. If you’d like to discuss your situation further, please feel free to contact our office to discuss.

Dusam:

I applied for SSDI in Sept. 2014, collected STD in Sept. 2014 for 90 days, was denied LTD in early 2015, and my SSDI was approved in December 2016. Do I have any repercussions against Cigna for the LTD deniel?

Attorney Stephen Jessup:

Dusam, did you ever appeal the denial of benefits on the LTD? If not, then you could be precluded from bringing a federal lawsuit against them. If you did appeal the claim please feel free to contact our office to discuss what options you may have.

Dani:

I am approaching 24 months of LTD with met life. I have been approved for ssdi. Our union contract states first 24 months you must be unable to perform your usual occupation and after 24 months for LTD to continue you must be unable to perform any occupation and earn 80% or more of pre-disability earnings.

What are the standards or requirements to determine if you are able to work in any occupation and make 80% of your pre-injury earnings? Met life will only say that a panel of experts looks at your medical records and reviews the claim to determine continued payment.

My work restrictions are:no repetitive twisting,lifting, grip, grasp, pinch left and right arms/hands and no repetitive neck twist, turn, flex, extend motion.

Thank you for your time

Attorney Stephen Jessup:

Dani, what they have advised you is pretty much the extent of a review. They will have medical staff review the medical records to determine applicable restrictions and limitations and based on those restrictions send the file for a vocational review to determine if there are jobs that would meet the requirement of the policy. Please feel free to contact our office to discuss your claim in further detail to determine the best ways to avoid a potential denial.

Christa:

I was denied STD through my employer and have appealed and was denied and appealed again and again was denied. I am currently filing suit against Lincoln Financial for my STD benefits as well as I have submitted a LTD claim to them as I was told that when/if STD was approved through the appeals process LTD would kick in, I gave up waiting on approval, filed suit and claim for LTD. While all this was going on my claim for SSDI was approved by the ALJ. Are chances improved that my suit for STD as well as my claim for LTD will be approved since the ALJ approved me? If the LTD is approved do they normally go back to the date they should have began paying me,which would have been December 2015, and pay back pay for that entire time minus the benefits I receive from SSDI for backpay?

Attorney Stephen Jessup:

Christa, if your suit for STD is already filed and your policy is governed by ERISA, which I assume it is, the court would not know be able to consider the SSDI as it was not part of the claim file before the final denial. However, receipt of the SSDI could help with your LTD claim being approved. If the LTD claim is approve then Lincoln would also likely approve the STD. Benefits payable would be your gross monthly benefit from Lincoln less any applicable offsets (SSDI).

Matt:

I am on LTD since 2/2016. I have submitted all paperwork that has been asked for. In April of this year they requested I see an IME. The examine went just as described by others that have gone through it. 2 weeks ago they called me and said the IME agreed that I was unable to work my current roll but could be able to do a job with that is sedentary. Then my LTD provider said that means my policy is only good till August of 2018. The LTD provider offered me a buyout through that time frame which amounted to $115,000. I had 10 days to decide. I just turned her down with 1 day left. Her tone totally changed and made a comment that i was guaranteed to be payed out till next year now. My question is can they deny me after i have turned down a buyout?

Attorney Stephen Jessup:

Matt, as they had an IME that indicated you wouldn’t be able to work in your occupation, a denial would be less likely, but that does not mean the carrier won’t become problematic.

Shawna V:

My ltd was just terminated due to the any occupation clause. Of course three months before my ss hearing. I have RA, Lupus and was just diagnosed with fibromyalgia while all this was going on the past week. My condition has not improved during the two years I have been on ltd. I am planning on appealing this. What are any tips or help? Thank you

Peter:

I had been on STD from 10/15 – 03/2016 and then converted to LTD in 03/2016. My LTD benefits were changed from Physical to Mental in 01/2017 and I was told that Mental benefits would only carry me for 2 years. Then in May 2017, my disability benefits were cut off because it was stated in their letter that they tried to reach my doctor on 3 separate dates in May within a week of each other and he did not respond. I asked my doctor about this and he stated that no one from my disability provider had tried to contact him. I am in the appeal process with a person letter written from me, my wife, and my sister-in-law, plus a personal letter written by my doctor along with a copy of my current office medical records stating that I am physically unable to work. My disability is primarily physical and the mental part being associated with the drastic change in lifestyle I was accustomed to prior to my physical disability. I have severe chronic back pain and numbness down my right leg making it very difficult for me to walk. They changed my status because my doctor failed to not that I have to get around with a walker or cane. I rarely leave the house with the exception of going to doctor appointments and I use the assistance of a walker or cane to get around. For the most part, I am mostly bedridden because I cannot stand or sit for long periods of time and my bed is the most comfortable place for me.

I have applied for SSDI back in late March in which I am awaiting a decision. I am currently without any income with the exception of my wife’s SSDI of $1260 per month which does not even cover my mortgage payment, not to mention all of the other bills that we have. I have had to surrender two of my vehicles and almost went into foreclosure while my disability company took 3 months to make a decision on my physical disability. I have a house in my name, but I have very little equity in it.

I am not sure if my appeal with my disability company will reinstate my benefits, nor do I know whether or not I will be approved for SSDI. If I am approved for SSDI and receive back pay from the time I became disabled, how does my insurance carrier know if I have been approved and what back pay that I have received? Are they informed by SSA, which I don’t believe they know who my disability carrier is, or do they have other means of knowing? My disability carrier is provided by a company sponsored plan, but I’d rather not disclose as this being a public forum that they can search online. With all the hoops that I have been forced to jump through to keep my benefits, they have done so many things to cause me extreme anxiety and furthering my depression, I am thinking that if I do get approved for SSDI and a lump-sum back pay check, I am not going to pay my disability carrier a penny. I did sign a form stating that I would pay back pay, but at the time, I was in a poor state of mental health and just signed whateverr they sent to me without understanding what I was signing.

I live in SC and only the house is in my name. I have no automobiles in my name and very few possessions that would amount to any significant amount of money. I live in a state where pay cannot be garnished, which I know social security pay is off limits. I know that they can file a lawsuit against me and obtain a judgment against me which expires in 7 years and is not renewable. Is there anything else that they can do? I already have a couple of judgments against me for defaulting on two credit cards because of my lowered income and likely more coming for surrendering two cars. There really isn’t anything that I think that they can do except if I try to sell my house. The judgments would have to be paid first, but I don’t plan to do that in the next 7 years. Also, my wife owns a property and has two cars in her name. Can they go after her for the back pay, or just me? She is not on my mortgage, but is on my deed. My name is not on any of the property that she owns.

Any advice that you can offer would be appreciated!

Attorney Stephen Jessup:

Shawna V, please feel free to contact our office if you would like to discuss how we can assist you in appealing the denial of benefits. Based on your insurance carrier you may only have one opportunity to appeal, so it is imperative to make your appeal as strong as possible.

Attorney Stephen Jessup:

Peter, please feel free to contact our office to speak to one of the disability attorneys about your claim denial and what can be done to appeal the decision to get your benefit reinstated and readjusted back to the physical medical conditions.

James F.:

My wife had her disability claim approved by The Hartford two years ago. They then urged her to apply for SSDI and that was approved without any problems. Now The Hartford has suddenly denied her claim after two years. Can we expect that SSDI will now also be denied or will it continue in spite of The Hartford’s action ?

Attorney Stephen Jessup:

James, the SSA will not terminate a SSDI claim because of Hartford’s actions. Your wife has rights to appeal the Hartford denial of benefits. Please feel free to contact our office to discuss how we may be able to assist her in filing same.

Renee:

I recently received a letter from Social Security that my disability benefits were approved. In March of this year after having been on LTD for a year and a half my benefits were denied. I still have time to appeal, and was planning to, but my question for you is the following:

If I have been approved for disability benefits, do I still need to submit all the same information (doctors, illness symptoms etc.) or do I simply need to inform them that Social Security approved me for disability? It seems to me that would be enough.

Secondly, in the LTD agreement they said I would have to pay back any retro pay I receive from Social Security. How does that work? If they approve my disability appeal, then they owe me money….so would they work the numbers so they are paid and I still receive what would lost since March?

If they still deny me, how will they request their money from Social Security, can they do that legally since they took away my money in March?

My backpay won’t be much; only about 8 months.

Terri:

Hi, I was just recently approved for SSDI. I just came off my STD. Can I now apply for and receive my LTD or will they deny me because I was approved for SSDI?

Attorney Stephen Jessup:

Renee, (1) I would recommend that you certainly advise your carrier that SSDI was awarded but you will still need to provide any and all updated medical information to support continued disability. Receipt of the SSDI, in and of itself, is not a guarantee your carrier will approve your claim. (2) Any period of time that your carrier paid benefits that overlaps with the SSDI back benefit check would result in you owing the carrier money. If there is no overlapping period and your claim is approved on appeal the back benefit computed by the carrier would be adjusted accordingly. (3) If they deny your appeal they can send you to collections or file a civil suit in an attempt to secure any overpayment amount.

Attorney Stephen Jessup:

Terri, if you have LTD coverage you should certainly make application for benefits under same. They will not deny you because you receive SSDI, but your LTD carrier will likely be able to reduce the amount they have to pay you by the amount you receive from SSDI.

Heather:

I was on LTD since Nov of 2013 and the LTD co. , Sunlife, suddenly denied LTD as they felt I was no longer disabled effective Dec. 2016. I was recently awarded SSDI in August 2017. Sun life no wants all backpay, including child benefits, which some how is greater than my actual backpay. I know they have a right to most of this money but I have been without income for 9 months and bills are bad. Will ltd take a lesser lump sum payment? I am past the appeal date but feel ltd was wrong in denial. Can I still go after them?

Attorney Stephen Jessup:

Heather, if you did not appeal the denial within the 180 day deadline you could be barred from appealing and likely from brining any civil lawsuit against them. That being said, I would certainly suggest you attempt to submit an appeal to the denial to at the very least preserve any potential legal rights you have. If they do reinstate your claim you could request that they apply back benefits owed to date to the overpayment amount. Additionally, as you have been off claim for some time it does not seem right that the overpayment would be greater than the sum of the dependent and primary SSDI benefit awards. If Sun Life has not already provided you with a detailed breakdown of the overpayment you should request one from them. If you have any additional questions please feel free to contact our office to speak with one of our disability attorneys.

Thomas:

Hello
I’ve been on LTD with SS and Aetna for 2 years. Aetna is set to expire in a few months unless I can prove that I can’t work (ANY JOB) for 25 hours a week. I have stage III Congestive Heart Failure and my Cardiologist is behind me 100% of the way. Aetna is going to make theire decision in the next couple of months as to whether or not to extend me to 65 (I am currently 52).

Does Aetna deny on the first round as a rule? Will I need to appeal and or sue them?

Like I said, My Cardio Dr said and wrote in my file that I should be completely disabled but I know Aetna wants to have their specialist see me.

Thx
Th

Attorney Stephen Jessup:

Thomas, Aetna does not always deny a claim as a matter of course. Each claim is dependent on the specific medical and vocational facts. If they were to deny your claim you would have to first go through the administrative appeal process before being able to file any lawsuit. Administrative Appeals under ERISA governed disability insurance policies are very important and must be as thorough as possible. Please feel free to contact our office to discuss your claim in greater detail.

Chris D:

Dear Mr. Jessup:

I have been approved effective March 2016 by two of my LTD policies (both upon appeal). One policy is a flat amount per month thru Prudential. This policy is offered thru the AICPA and is what I would call “private and unrelated to my employment.

The second policy is thru “The Principal” and relates to my former employment. As indicated above, I was approved upon appeal very quickly once they sent me to two independent Doctors for evaluation.

This second policy has asked me to file for SSDI which I immediately did and was rejected. I was asked to appeal, which I have done and is currently pending. I understand that this second policy is entitled to any benefits I am awarded. However, if I am denied again by SSDI, can/will this second “The Principal” LTD carrier likely, now, after a year and a half, try to deny my claim? This LTD carrier has told me I should get an attorney involved on my appeal to SSDI should it be denied again. I have no problem in doing so but am I obligated to do so at my expense? After all, any proceeds will go to the insurance company.

As indicated by all the people requested your advice, all of these insurances, public and private are very difficult to deal with and it is quite clear to me they will spare nothing in finding a way to dishonor a legitimate claim. So disappointing when one has earnestly and timely paid these premiums for well in excess of 20 years.

Thank you Sir,

Chris D

Attorney Stephen Jessup:

Chris, denials from SSDI will not as a default result in a denial under a private policy. Principal would still have to conduct an independent review of all your records before terminating a claim. With respect to SSDI appeals – yes, having an attorney is in your best interest. We do not handle SSDI claims but please feel free to contact our office and we can assist you in getting in touch with a SSDI attorney. SSDI attorney fees are paid by the SSA from your back benefit check – 25% of the back benefit capped at $6,000.00. As such you are not out of pocket any money. Additionally, when it comes time to compute your overpayment, Principal will credit you the attorney fee award. For example if your award was $40,000 and $6,000 is going to the attorney, you are only liable for the $34,000 actually received.

DeeDee:

My STD through my employer appeal was turned down. Meanwhile I had applied for and was approved and now collect SSDI. The start date for STD and SSDI are the same.

What are my chances of being retroactively re-imbursed and moving forward with LTD through civil action.

Attorney Stephen Jessup:

DeeDee, if you have a second appeal available you can exercise that right and in doing so advise the carrier of the SSDI award. In the alternative, you may have the ability to make an application for LTD (despite the STD denial) and include the SSDI award letter along with additional medical information. Please feel free to contact our office to discuss your claim in greater detail and to better advise you of your rights and options at this point.

Bret:

I have been approved for LTD. Then denied, then reapproved after jumping through hoops and several months of doctor visits and letters.

Can the insurance company force me to apply for Social Security Benefits? I am only in my mid 50’s and don’t want to be approved for Social Security at reduce benefits.

Will SS reduce the benefits, if it is due to a disabling condition?

Thank you.

Attorney Stephen Jessup:

Bret, if you have an employer provided policy, then yes – they can require you to apply for SSDI as it is an offset to your monthly benefit. If you do not apply the carrier can estimate what you would receive and reduce your benefit by that amount.

Angela S.:

First I was on FMLA then STD through guardian which I paid for monthly out of my check. They went on LT D through Guardian. Guardian is who my employer at the time used. Spoke to SSDI rep yesterday seems like it may go through so my question is I bacame disabled nov 2016 after STD ran out started LTD march 2017, they Guardian made me apply for SSDI in Aug 2017 which I know why. So if get approved do they get all retro money since November or is it just when I started with the LTD?

Edwin:

I was approved by Prudential for Long Term Disability in 2015. It was a not easy as they of course denied by claim. I was forced to hire an attorney and fortunately I won. I have had two hear attack, triple by pass, two separate stent procedures. I also had a stroke while during my by-pass surgery which has resulted in diagnosis of epilepsy which short term memory loss. Around the same time, in 2015 I applied for Social Security Disability. I was denied but applied for a hearing. I had my hearing in May and received an unfavorable decision last week, October 2017. My doctors can’t believe the SSD decision. Question: When Prudential finds out I received an unfavorable decision by SSD will they use this a leverage to cancel my Long Term Disability Payments?

Attorney Stephen Jessup:

Angela, they would be entitled to seek a repayment of any funds for the period of time that overlaps with when Guardian paid you and the SSA issues a check. In your situation, potentially back to 2016 when STD started.

Attorney Stephen Jessup:

Edwin, it could potentially way into their evaluation of the claim, but the denial, in and of itself, would not be grounds for them to terminate your benefit. SSDI denials are so common that it is not often that a carrier really uses it as a weapon to deny benefits. I would strongly urge you to discuss any other options available to you with your SSDI attorney.

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