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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 164 opinions so far. Add your comment below.


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:


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.


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:


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:


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:


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.


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

Attorney Stephen Jessup:


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.


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:


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.


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:


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.


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:


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


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:


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.


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:


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.


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

Attorney Stephen Jessup:


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.


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.


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.


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.


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.


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.


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.


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.


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.


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


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.


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.


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.


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.


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.


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.


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.


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.


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.


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.


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.


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.


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.


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.


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.


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).


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


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.


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.


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.


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.


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.


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.


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.


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?


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.


My ltd dropped me on oct. 7, 2017. On oct. 10 I was approved by the ssi. I got paid 26 months back pay. Do I owe my ltd any money?

Attorney Stephen Jessup:

Dwight, the LTD carrier would still have legal rights to recover any overpayment. Additionally, you would have rights to appeal the denial to secure the benefit. If you would like to discuss how we can assist you appealing the LTD denial please feel free to contact our office.


I went through the process with Cigna when I went on FMLA for my personal health. They denied me twice I applied for Social Security disability insurance and was approved right away. I did get a lawyer but he only usually does Social Security disability insurance. I had a lot of documentation for my Dr and my mental health professional. No help for my employer and how to file a claim. And when I called Cigna I got a different person every time. And the nurse practitioner that denied me the final time did it on what was already put in and not any of the new stuff. That was almost 2 years ago. Which put me in a position to lose my job because I couldn’t go back to work. Is it too late to sue Cigna for my short-term disability period and or my long term disability? I didn’t get to apply for long term disability because they took so long denying my short-term disability. I was wondering if there was anything else I could do? Or if there any class action lawsuits against Cigna? For how they’ve denied claims?

Attorney Stephen Jessup:

Kristy, most ERISA disability policies will have a three year statute of limitations to file a lawsuit. If your STD policy has the same period of time then you would still have the ability to file for STD benefits, but may be barred from pursuing the LTD benefit as you never filed a claim for benefits under the LTD plan.



I was DENIED STD benefits by my employer on a self-funded policy, but APPROVED for LTD benefits by my insurer who is governed by ERISA. I want to get my decision in the STD context reversed because it impacts my health benefits AS WELL AS my retirement benefits. I have searched but can’t find any guidance on this specific situation. What would you advise?

Attorney Stephen Jessup:

Sharon, I have had this exact situation occur with Cigna on multiple occasions. I recommend that you forward a copy of your LTD award letter to the STD claims manager and advise them you received your LTD benefit (which requires being disabled during the Elimination Period- aka STD period) and if benefits are not paid then you will take legal action.


Hi, I’ve been on long term disability up until October. I started long term due to my left shoulder been messed up my surgery. Dr. put me on a permanent 5 pound weight restriction due to no mussle in the left shoulder, Cigna sent me to one of there dr.s and there dr. says I’m able to lift 10 pounds push and pull up to 50 pounds. Cigna reviewed my case and sent me a letter stating there is 2 jobs available for me where I live but never mentioned what jobs they were. I also have issues with my lower back and neck I’m wondering if and when appealed if I will get my checks back. I went on long term in 2013 and always ask how long I would receive LTD and they said as long as I’m dissabled. I’m really confused.

Attorney Stephen Jessup:

Steve, have you filed your appeal yet? If so, Cigna will have statutory deadlines with which to render a decision. If you have not appealed the denial please contact our office to discuss how we may be able to assist you. Cigna is right – you will continue to receive the benefit until retirement age – but with the caveat – if they think you’re disabled.

Brian C.:

I’ve been on short term disability for 7 years. Originall with Aflac. My company switched to Boston Mutual 3 months. I’m signed up for 6 months for short term. It looks like I’m not going back to work. I may need a liver transplant. Question is, can they kick me and my wife and kids off short term if I go past the 6 months? I was advised to apply for social security.

But back to my question can they kick me off being that I’m only signed up for 6 months? Please contact me ASAP, I’d really appreciate it.

Attorney Stephen Jessup:

Brian, if your policy only covers six months of benefits, then there is nothing that can be done to secure benefits beyond that maximum benefit period. If you have coverage through an employer long term disability policy you can explore filing a claim under same. If the STD policy is the only private disability policy you have then your only other option may very well be filing for Social Security disability.


Do I have to pay back the long term disability if there was no overlap in payment? I applied for ss disability 4-15 and was approved 8-16. There was a 5 month waiting period and my back pay didn’t start till Feb.2017. My long term disability was stopped in December of 2016. No overlap, do I have to pay back?

Attorney Stephen Jessup:

Randy, if there is no overlap, then there is no repayment to be concerned about.


I am receiving ltd from Unum. Unum requested that I file for SSDI and I did.

I was approved for SSDI and received my back pay. I know I will have to pay Unum back with the money I received from SSDI. Can I deduct any or all attorney fees before payment to Unum?


How much weight does a SSDI Judge ruling hold. In another words, if a Judge deems you to be totally disabled. Is his ruling “gospel”. If I want my life insurer to start paying my premiums and they want proof that I’m disabled, shouldn’t a copy of the Judge’s ruling suffice? If the DMV wants proof that I’m disabled so I can get a parking pass, shouldn’t a copy of the ruling suffice? I waited 5 years to get a hearing, I provided volumes of medical records, underwent 3 IME’s, etc. I AM DISABLED. I feel like I have to keep proving myself. Why doesn’t the Judge’s ruling trump all. Is there any statute or law I can refer these boneheads to to shut them up!


Attorney Jay Symonds:

Deadra, Unum should not offset for the amount of Attorney Fees you incurred pursuing your SSDI benefits. Be sure to send Unum the SSDI award reflecting the Attorney Fee payment.

Attorney Jay Symonds:

Claudia, I assume you are referring to a Waiver of Life Premium claim. If so, having an SSDI award in your favor, including an ALJ ruling, is certainly evidence in support of your claim and should be submitted to the carrier for consideration during the claim review process. However, it is not “gospel” and the carrier is not required to reach the same conclusion/determination as the SSA. Consequently, you should be sure to submit all medical evidence you have in support of your inability to continue working.


A little over 3 years ago I was denied LTD from Metlife. I moved out of state during the claim because I needed to be under my father’s care, unable to care for myself at the time. After the claim was denied I appealed with Metlife and then filed for SSI. I lost the appeal. After talking to my HR dept they said I needed to move back to the state where my job was located and return to work. They said if not I would lose my job or my other option was to resign and leave on good terms. I unwillingly resigned via email.

Shortly after I was approved for SSDI and have not had a corporate job since.

If I was approved for LTD is it possible that I would had qualified for a pension plan with the company since I was put on SSDI? My retirement plan was through Fidelity at the time. Is there any recourse if you feel that you were forced to resign a job when you weren’t in the right frame of mind to make such a major decision?

For starters…

Attorney Stephen Jessup:

Sam, LTD through your employer and an employer provided pension are two separate entities that are not necessarily related. You would need to speak to an employment attorney to determine any potential recourse you would have regarding your rights to the retirement.

Paul C.:

I applied for SSDI in Dec 2017 my long term disability insurance has been paying me for 6 mos at 1496 per month. (This is less that what I will receive) I just received my initial denial from SSDI March 2018 and I received a call from my LTD insurer offering to settle with a 1 yr payment lump sum, which is 18k. Since SSDI is about a 2yr process I’m struggling. I can take the payment and draw interest. I owe no debt and my wife is a nurse. The LTD from my understanding would likely refuse my claim after a year anyway and since my payment from SSDI would be higher per month than the LTD payment the insurer wouldn’t have any monthly difference to make up. I’m struggling with this. I’m leaning towards settling.

Attorney Rachel Alters:

Paul, this is a tough call. The issue you may run into is that once you are approved for SSDI your LTD benefit with be reduced to the minimum which can be $100 a month. You will also be required to pay the insurance company back any back pay you get from social security that would be considered an overpayment. It is hard for me to tell you whether or not to take the buyout, but these are the things you need to consider.


The LTD company would like me to apply for SSD. However, I do not meet the 40 credit (10 year) requirement on first glance.

If I started employment in the US in 2015 and got my green card in Fall 2017, how many work credits have I accrued 4 or 12? I have citizenship from a country with a totalization agreement with the USA. The SSA can totalize U.S. and foreign coverage credits only if the worker has at least six quarters of U.S. coverage.

I prefer not to apply for SSD. Will my situation be under the 6 quarter requirement making me ineligible?

If I am eligible and refuse to apply for SSD, can the LTD company still permanently offset my LTD payment by the amount they estimate I would receive from SSD? Or is not allowed because I don’t initially meet eligibility in the first place?

Attorney Stephen Jessup:

Ren, I do not know how the SSA determines work credits, so I unfortunately cannot provide any insight. However, as it relates to an LTD policy/claim – your duty is to apply. If it comes back you are not eligible because of work credits provide that to the carrier. There can be no offset at that point if you are not eligible – you would have essentially satisfied the requirement to apply and seek SSDI to the fullest.


I have been approved for SSDI and have been on it for about a year, my long term disability Lincoln financial group continues to send me paperwork to be filled out and signed by all of my doctors which is getting to be very frustrating for me and them. Why are they doing this when they know I have SSDI?


I don’t understand why if I have SSDI that’s my disability company from work can’t use that information to deem me disabled. They are continually sending forms for me and my doctors to fill out. This is getting to be a hassle for me and my providers. Do I have to continue to provide medical information to my disability insurance company once I am deemed disabled permanently. I am on the list for a double long transplant.

Attorney Rachel Alters:

Mel, yes, unfortunately your insurance company is not required to follow the SSDI determination declaring you disabled. They can and will continue to require ongoing updated paperwork as long as you are on claim. If you would like assistance managing your claim you can contact my office and ask for Rachel Alters.



I worked for my company for 14 years and never took Std or Ltd on their group policy. So in August 2017 I was diagnosed with cancer but did not go on std till September 2017. Will this be considered pre existing conditions for Ltd? I am worried because it is June 2018 and insurance told me they had to send in eligibility paperwork to employer before approval.

Thank you

Attorney Rachel Alters:

Shawn, I do not think that your condition will be considered preexisting since you have been with your company for 14 years. Preexisting issues usually don’t come into question if you have been covered by your Std and Ltd policy for at least a year prior to filing a claim. If you would like a free consultation with an attorney feel free to contact our office.


Hi. I was approved by Metlife for bipolar disorder until 2036 when I retire. I was denied for SSDI and my appeal was denied as well due to the fact that my bipolar disorder was overlooked. I was wondering if Metlife can stop paying me since I was denied SSDI. I look at my paper work from Metlife and they only required me to apply but it doesn’t say that they will cut me off if I get denied. I am very stressed because it was really hard to get approved for Ltd .

Victor Pena:

Faith, the SSDI decision alone will not warrant a denial but MetLife will likely consider the Social Security Administration’s review in evaluating your continued eligibility for benefits under your LTD policy. MetLife can cut you off at any time if they find the evidence no longer supports your claim for disability.


I have been on LTD with MetLife for over 3 years and have had nothing but problems. The claims rep has used sneaky tactics on several occasions to try to close my claim, once actually doing so. Now that I’ve had my SSDI hearing and hope it’s favorable, I know that I’m required to pay them the offset. I suspect they will drop me. Here’s the million dollar question – I have a huge tax debt that will be paid out of that backpay, actually garnished – so I’ll never receive it. That means MetLife won’t be getting but about a quarter of the backpay… what can they do to me?

Attorney Jay Symonds:

Deneen, under the terms of the Policy the carrier is generally entitled to recover any overpayments that result from retroactive award of “other sources of income.” I suspect you may have also executed a reimbursement agreement, which further strengthens the carrier’s right to recovery. If, as you say, a large portion of the retroactive award will be garnished to satisfy a tax obligation you will likely still be obligated to reimburse the carrier. It is likely MetLife will deduct the monthly SSDI payment you receive as well as an additional amount from the balance until the overpayment is satisfied. Depending on the amounts, you may be able to negotiate a repayment schedule. You may also be entitled to the “guaranteed monthly minimum” set forth in the Policy, though that is usually negated by recouping an overpayment.


I have been on LTD for 3 years for severe degenerative disc disease.

SSDI recently awarded me a fully favorable decision based on the same diagnosis of degenerative disc disease and they also added diabetes.
I don’t suffer with symptoms of diabeties and only suffer from the degenerative disc disease which goes into detail about it in my award letter.

Since diabetes was not on my LTD claim, can the LTD company say diabetes was preecisting and cancel me?

Thank you!

Attorney Stephen Jessup:

Tara, I don’t think you have anything to worry about. If your LTD has determined your disability to be due to your degenerative disc disease then your disability claim is based on that. Even if they found diabetes to be pre-existing, all the insurance carrier would do is not “approve” your claim based on that. It wouldn’t nullify your disability due to DDD.


Can my disability carrier decide to calculate an estimate of my SSDI benefits and subtract that from my LTD benefits? I signed a reimbursement form. There’s more to the story but right now, I really need to know the answer. The claim rep said they could’ve done it anytime they wanted. It’s metlife. I might need an attorney. Do y’all help people in Florida?

Attorney Jay Symonds:

Susan, under most Group LTD policies the insurer is allowed to estimate an offset for purposes of SSDI but usually will not do so if you submit proof that you have applied for SSDI and are in the process. The reimbursement agreement alone would likely not be enough if you haven’t actually applied for the benefit. I suggest you contact our office and speak with one of the attorneys to address any additional questions you have regarding your specific situation.


I’ve been on short term disability with my employer for almost 3 months. My leave specialist called me and said that I am required to file for social security disability and if I don’t, my benefit can be lowered to 50% instead of the 70% I am being paid now. I’m confused as to why I need to apply for social security benefits.

Attorney Stephen Jessup:

Betty, employer provided policies have requirements to pursue sources of “Other Income” with SSDI benefits being the most common. If you fail to pursue the SSDI benefits they are allowed under the policy to offset what you would get from SSDI.


I recieved LTD benefits from Cigna from july 2015 thru july 2017. I applied for SSD in March of 2017 and recieved my reward letter in jan 2019. Will I have to pay Cigna any of my back payment?

Attorney Cesar Gavidia:

Phoebe, yes, you will most likely be required to refund CIGNA any amount of LTD benefits that were overpaid to you on account of award of SSDI benefit dating back to 2015. However, there are other options available to resolve the overpayment of benefits.


I collected STD in 2017. Started LTD in 2018. I applied for SSDI and was accepted in 4 months. I have never been denied any benefits. Now 18 months later my LTD company feels I can do some type of work. I only see a doctor every couple of months now as there is little he can do for me. My injury was bilateral calcaneal fractures with numerous complications and deformity of 1 foot.

Does the LTD company need to show improvement in condition in order to discontinue my benefits? I am 62 years old. I have had no improvement and the deformed foot is actually worse with use of a brace.

Attorney Cesar Gavidia:

Jeanine, no, the long-term disability insurer does not need to show that your condition has improved in order to question or challenge your long-term disability claim. It is the insured’s responsibility to continue providing on-going proof of loss to satisfy the definition of disability.

Meisha S.:

I am not on Disability. I teach school for a public school system as Inclusion/Resource Instructor. I have not discussed details of having Diabetes nor BiPolar Disorder with my principal. While in a hospital out of town for a week, the doctor there faxed information to my principal about my stay. When I came back to work, the principal started making statements to call me out. One incident was my psychiatrist had me on new sleeping medication and I had taken the medication in the morning. Yes, I went to sleep on the job. In reading on the medication I discovered it was my sleeping medication. I now take it at night.

However, my principal, knowing I have health problems, has been picking on me, harassing me, talking out loud when she should make comments between the two of us. She has a multitude of ill will against me. Where she tries to make me look bad with work associates, the students and parents love me.

Metlife has been on me to get my disability claim forms to them. In speaking with Debbie Kennedy, Leave Specialist of Human Resources Department for Longview Independent School District, she told me that I must get the doctors to fill out the Metlife forms first before she would sign. HIPPA Laws prohibit my employer from seeing what my doctors have to say about my health, am I not correct? What documentation is there about when the employer signs disability forms? My mother Sheryl took the papers to Debbie Kennedy’s office yesterday when Debbie was off. She refused to call my mother. What she told me was interpreted as refusal to sign. I need to file with Metlife Insurance as they are waiting for the documents and have waited.

Attorney Rachel Alters:

Meisha, you can take the forms directly to your doctor and then send it to Metlife. Your employer does not need to be involved.

Darry D.:

Cigna stated that they will evaluate me for any occupation, and must be able to find a job that will pay me 80% of my pre injury pay. If I stay in an area that have little to no job does that play a factor in their decision? Do they require you to Commute, if so how far they will require you to commute?

Attorney Stephen Jessup:

Darry, it depends. If you moved to a remote area after disability started, some policies state that they can look in the labor market where you resided when disability benefits started. In some cases where there is a requirement that the “any occupation” pay 80% of pre-disability earnings the policy can almost become a de facto “own occupation” policy as the only job that would meet the requirements is your pre-disability occupation. So, yes, geography does play a role in the decision, but it is dependent on policy language. Please feel free to contact our office if you would like to discuss your situation further.


Hi. I am a legal secretary for the state and have been on LTD for 5 months for migraines, cognitive problems and neck pain due to osteoarthritis. I have a couple of questions. I also have long-standing problems with my lower back, which have grown much worse while off. I need any and all reasons to support my continued disability.

Can the back problems be factored in, or are they irrelevant seeing as they were not on the claim? It does seem relevant though that if I have osteoarthritis in my neck it’s not a big stretch to find it in my back.

Also, when I get to 24 months, the “any gainful employment” stage, do they assist with finding a job for me or am I just denied. I have no idea what “gainful” means as far as $$ or %, policy is vague except they have to consider my education and line of work. Legal secretary is all I know. It’s York Risk Services and I live in Michigan. Thank you.

Attorney Alex Palamara:

Kristine, your other issues should certainly also be considered by the disability insurance company. It is likely best to submit all supportive medical documentation for any conditions that give any restrictions or limitations. Regarding Any Gainful Occupation, no, the insurance company will not assist in finding you a job. The policy will govern the claim, but typically it is an occupation that can provide you with 60% of your prior monthly earnings.

K. Temple:

I started receiving Ltd with my employwr and after 2 years was required to apply for Ssdi. After 3 years, I was awarded full benefits and repaid 34k to the insurance co. So I collected both with the Ltd Being adjusted. After 11 years, the employer requested an IME …i gladly went knowing it was a setup. 2 months prior, social security did a review and approved continued disability, however, the insurance company said I wasn’t disabled anymore and terminated my benefits. I’m not having to file a lawsuit against the insurance company because all medical reports state I’m severely disabled. My functional capacity evaluation states the same. The insurance company stated in their denial letter that they disagree completely with social security, however, they are the ones who made me apply for it! How likely can I win my case on court appeal and possibly get back the money paid to the insurance company as well as the adjustments they took each month.

Attorney Rachel Alters:

K. Temple, if you email me your denial letter I can go over it with you and let you know what I think. My email is Attorney Rachel Alters.


I am on LTD I never signed a form allowing CIGNA to recoup back pay benefits from SSDI. I did apply and was approved 5 months after I applied. My application for Social Security was sent before CIGNA sent the form stating that was a requirement. Am I still required to pay them?

Attorney Alex Palamara:

Annie, congratulations on the approval of both LTD and SSDI benefits. Your policy will govern when and what benefits are considered offsets to your LTD claim, but in all likelihood your SSDI benefits will be an offset and an overpayment will likely be owed.

Torri T:

I have been on LTD said since 2016. I have radiculapathy, neuropathy, degenerative disk disease, occipital neuralgia – have had 6 surgeries (my cervical spine is all metal and three vertibrae in my lower lumbar is as well) I also have a spinal cord stimulator. I suffer muscle spasms as well as pain. On Aug 1, 2019 my LTD carrier called me and said “effective today, your benefits are closed. We feel you can find employment”.

My doctor’s (to include surgeons) have provided my records to show my limitations prevent me from ever maintaining meaningful employment. How can my LTD carrier decide I can work after three years? They state they know I cannot do what I was doing but should be able to find something. Without any notice, I no longer have income except my SSDI.

Would a letter from my husband and other family members (who have to see me struggle) help with my appeal?

Attorney Cesar Gavidia:

Torri, if you have been denied LTD benefits and the disability insurer has informed you that you could appeal the decision, you should not attempt to appeal on your own. In an employee benefit case, you may only have one bite at the apple in terms of appeals and it is the most important aspect of the case. Although a letter from your husband explaining what he has seen you struggle with can be helpful there is much more than will need to go into your appeal in order for it to potentially succeed in overturning the claim denial. Please feel free to contact our office to obtain a free consultation regarding your claim denial.


Just diagnosed with stage 4 lung cancer with a 1″ golf ball sized brain tumor metastasized to my left lobe which is causing all kinds of cognitive issues. I cant do simple tasks, have memory loss; i cant even drive a car. The motion is causing me dizziness. I applied for FMLA leave but with every day/multiple doctor appointments with multiple specialists and two different hospitals to determine the diagnoses, and now I’ve started the lung cancer chemo treatments (3 days a week every 3 weeks for 6 treatments) and 1 gamma radiation treatment for the brain tumor. Had an allergic reaction to one of the chemo drugs so doctors are reassessing my treatment. I requested STD through my company insurance (BCBS) who referred me to Aetna who sent me to The Hartford who is pushing me to connect with Allsup for LTD/SSDI (?) ill finish with chemo before the end of the year, so ive been out of work from late July 2019 and should be ready to return by year end. Why is my company leapfrogging me from STD (through The Hartford) to LTD through Allsup if im only going to be out for 5.5 months?!! The Hartford has been paying me STD since i took the leave.

Attorney Stephen Jessup:

Adriana, first and foremost, we are wishing you the absolute best in your treatment. As it relates to your disability claim. Aetna (specifically its disability and life insurance divisions were bought by Hartford. Most Aetna policies are still in place showing Aetna as the insuring company, but since Hartford owns the policy all back and forth is with them. Hartford will be responsible for reviewing and managing your long term disability claim through your employer’s policy. Under employer provided disability policies you have a duty to pursue sources of “other income” with the most common being Social Security disability. If you don’t apply for the benefit Hartford would be allowed to estimate what you would receive from SSDI and offset your benefit.

That is where Allsup comes in. Allsup is a third party vendor that many insurance companies use to assist their insureds with the filing of SSDI benefits with the government. So they are not handling your LTD (that is Hartford), but will assist in getting federal disability through SSDI. You are under no obligation to use them and can apply on your own. Your main obligation under the policy is to apply and pursue the benefit so we would recommend you do so if Hartford is requiring (to avoid them offsetting your benefit prematurely), but if you return to work before a decision is made by the SSA, so be it. If you have any other questions please feel free to contact our office.


I have been on LTD (ERISA) since 2012. I was also rewarded SSDI in 2012 for a physical disability. I continue to regularly see my doctor. A few months ago, I received a letter from Hartford, the LTD company, requesting for me to be evaluated by a neuro psychologist. My doctor received the letter along with the results of the neuro psych evaluation. In it, the IME stated that my mental state is good. The IME does not that I have obvious medical disability. Hartford states that I should be able to turning to a full time position. I see my doctor for treatments once a week. It looks like I will be loosing my LTD. How will impact my SSDI benefits? My doctor sees that I may be able to work a few hours a day but not full time. Seven years of not having work experience I am at a disadvantage. Is Hartford obligated provide job re-training or job placement?

Attorney Alex Palamara:

Jen, I am sorry to hear that your LTD might be denied. The good news is that it should have no effect on your SSDI claim. However, any return to work could impact your SSDI claim. Also, it is doubtful that Hartford has any obligation to provide you with job retraining or job placement. The policy governing your claim will provide any information regarding this, but I would doubt that they would have any obligation. That being said, if your LTD claim is denied, all is not lost. If you receive a denial letter, please contact us for a free consultation. We would love to review your denial letter and assist you any way we can.


I am currently receiving SSDI and is interested in trying to see if I can work 30 to 40 hours a month and earning about $1000. Will this have an impact my SSDI status?


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