• How Can A Disability Insurance Company Deny My Claim If My Doctor Hasn't  Returned Me To Work?

How can the disability insurance company deny my claim if my doctor has not released me to return to work?

Disability attorney Stephen Jessup discusses a disability insurance companies right to deny a claim even though the claimant has not been released to return to work by their doctor.

We get a lot of calls from people who say their claims have been denied even though their doctors haven’t told them they can go back to work; they haven’t been “released for work.” However, the insurance company, upon receipt of the claim, is going to start doing their own medical investigation. They’re going to send it to their doctors for review; they may send it out to an independent doctor to do a peer review. If one of those doctors come back and say, “Well, I don’t find any restrictions and limitations or medical reasons as to why this person shouldn’t be working,” the insurance company can rely upon those doctors to deny your claim, regardless of what your actual treating physicians are stating.

Comments (121)

  • Amy, your STD insurer should have provided you with a letter explaining why your claim was denied. The letter should also describe the options you have including pursuing an appeal of the decision and the timeframe that you have to submit your appeal.

    Cesar Gavidia Jan 14, 2023  #121

  • I had a mental breakdown after my nephew went on a killing rampage back in November and I called my primary doctor for help but because I was already seeing a psychiatrist for mental health medication she suggested I see him so I did and he said to be out until 3/23 we’ll they don’t keep good notes and they didn’t send in all the paperwork my STD ay work is requesting so they denied me. I was already approved from the state for PFML what happens now ?

    Amy Jan 13, 2023  #120

  • I was denied for my short-term disability been out of work for 4 months my doctor haven’t released me to go back to work still been running test on me and they denied me

    Yovonne Richardson Dec 29, 2021  #119

  • If di in California disqualify my claim even though my physician filled out form can I now apply for unemployment in California or do I need a dr release

    Allison Dec 20, 2021  #118

  • Sadaski, that can be true in certain situations. And it is sad how the insurance companies act at times. If you have been denied disability benefits, please feel free to contact us so that we can assess your claim.

    Alex Palamara Jun 10, 2021  #117

  • Short-term disability claimants, generally speaking, are less likely to push forward and attempt to secure benefits when the insurer has denied a claim, as the claimant is likely attempting to recover as soon as possible from their condition and return to work. It may seem as though it’s more trouble than it’s worth, and the prospect of benefits may seem uncertain.

    Sadaski Jun 9, 2021  #116

  • Cynthia, your rights under your short and long term disability policies will be “time stamped” as of the date of disability, which at that time you were employed and fully insured/covered. It is not uncommon for employers to terminate employment after FMLA time has run out, but this will not affect your ability to pursue/rights under your disability policies as your rights vested as of the date of disability.

    Stephen Jessup Jun 6, 2021  #115

  • My FMLA is done, but I still have short term disability time left. My HR dept. is having me fill out ADA papers. My doctor did not put a return date on it because it is an ongoing permanent disability. My HR said that if my doctor doesn’t put a return date on it they will have to terminate my employment. Will I still be able to collect my short term disability and them go into long term disability?

    Cynthia M. Jun 5, 2021  #114

  • Carla: This sounds like a somewhat convoluted situation. I suggest you contact our office and speak with one of the attorneys to discuss in more detail your circumstances and your options.

    Jay Symonds Mar 10, 2021  #113

  • I have a personal short/long term disability insurance. Allstate approved the short term and paid all claims. My doctor has kept me off work and I applied for long term. In the meantime I had surgery and another doctor had me off for that. I filed for that claim. I appealed the long term disability claim and medical records were sent, from the 1st claim. After that, they came back and denied my short term disability that I first received and was completely paid out. Then they denied the long term. They approved the surgery claim. Now they say I owe them money. They subtracted the money due to me from the surgery, from my first claim that was paid. The said my medical records nullify what I had received. So now I owe them over 2,000 .00 dollars.

    My doctor had initially written me off work secondary to high risk for covid, because of moderate asthma and being on immune suppressant meds for Rheumatoid arthritis. Can they legally reverse their decision and make me pay it back?

    Carla M. Mar 10, 2021  #112

  • Janine, your short-term disability insurer may have conducted a review of your records and determined that the information in your file did not support a claim for disability. Your denial letter should contain information describing how you can appeal the decision and how long you have to appeal. Your Appeal should address all of the reasons they have expressed cause you not to qualify and you should submit all the records and evidence which support your claim for disability.

    Cesar Gavidia Dec 10, 2020  #111

  • I went out on a stress disability due to being diagnosed with ptsd – I got paid for the first 6 weeks but when she (my doctor) extended it for another 6 weeks it was denied. My doctor sent them the paperwork but they said they wanted information from a therapist I hadn’t seen in a long time. All I am asking for is to get paid for the last (2nd) 6 weeks. Can they legally deny my claim?

    Janine C. Dec 10, 2020  #110

  • Michael, unfortunately, the insurance company’s consulting doctors can come up with a different opinion than your treating providers. I am sorry to hear of the trouble that they are giving you. Please contact us at once for a free consultation to discuss your options.

    Alex Palamara Dec 10, 2020  #109

  • I have been on social security disability for two years and also long term disability through an insurance company. I suffer from congestive heart failure, diabetes, spinal stenosis, arthritis in my feet and knees. The insurance company is trying to put me back to work. I walk with a cane, have balance trouble and take 9 pill for blood pressure every day. Can the insurance doctor over rule my personal doctor?

    Michael G. Dec 10, 2020  #108

  • ATT has denied my STD 3 out of the 5 months since surgery, they have disregarded all doctor notes, no peer to peer. I’m in appeals now, my doctor will not change protocol and stated my treatment plan but ATT ignores that and said I should have been back to work not even 30 days after a ruptured Achilles’ tendon surgery.

    Larry P. Nov 23, 2020  #107

  • Wilma, you have to file a claim with the disability carrier.

    Rachel Alters Nov 14, 2020  #106

  • My Doctor told me that I was to quit work due to COPD, I am 63 years old. Its been 3 months still have not gotten a disability payment. They will not answer my calls or emails. My hr dept will say doctor didn’t date something right. My Doctor says I never need to work any longer. After paying 8 years now I can’t use it. Do I have anything I can do to make them pay?

    Wilma D. Nov 13, 2020  #105

  • Angelica, unfortunately if you were seen, treated or took any tests that revealed or should have revealed that you had lung cancer during the look back period Unum has grounds to deny the claim due to a pre-existing condition. You can try to get your doctors to write letters refuting Unum’s position. However, if you did receive treatment, even if it wasn’t technically diagnosed for a few months it will likely be considered pre-exisisting.

    Rachel Alters Nov 13, 2020  #104

  • I was denied short term disability from my insurance carrier UNUM because they determined I had a pre existing condition before my effective date January 1, 2020. I disagree with their decision because I went into a regular office visit to my primary Doctor dated in November 2019 for a cough. She ended up taking an X-ray which should a nodule in my right lung. She suggested for me to go to a specialist to check it out. I did not go seek out a specialist until February 2020. I had several office visits with the pulmonologist and had a breathing test done. The findings from the X-ray did not cause my pulmonary dr to seek immediate treatment or suggestion that it could be cancerous. The nodule found in my right lung was small and he suggested we try treatments for asthma. My pulmonary doctor suggested that I had asthma and I was provided with an inhaler for my cough. My cough continued and the inhaler did not relieve me of my cough.

    It was then suggested I wait for couple more months to get another X-ray to see if the nodule grew bigger or stayed the same. Or go get a biopsy. I decided that biopsy would be best. The pathologist report dated on February 17 2020 indicated I had a form of stage 1 lung cancer. My pulmonary doctor referred my to a Surgeon to have to have the tumor removed. On March 4, 2020 I was admitted to Medical City Plano for surgery to remove the tumor. Unfortunately, my cancer had spread and my Surgeon was unable to remove my tumor. I was then diagnosed with stage 3 lung cancer. My Surgeon referred me to an Oncologist. In late April 2020 I met with my Oncologist to discuss my cancer treatments. I started my chemo and radiation treatments in April 14 2020. I am still undergoing cancer treatments until June 2021. I do not understand why I was denied my Short Term Disability when my actual diagnosis was in late February 2020 and after I was diagnosed with asthma and treated for it.

    I would like to know if I have a case?

    Angelica C. Nov 13, 2020  #103

  • James, unfortunately, no, a doctor is not obligated/required to complete disability claim forms. This does happen more often than one would think given the fact the doctor is the one that has taken you out of work. If the doctor is a specialist we would recommend that you attempt to speak to your primary care physician about completing the form. Otherwise, stress the importance to your doctor of completing the forms or your disability insurance company will not approve your claim. Please feel free to contact our office if you would like to discuss this matter further.

    Stephen Jessup Oct 30, 2020  #102

  • My Doctor removed me from work for 8 weeks but refuses to complete STD forms? Is the Doctor required to fill these forms out if they restrict me from working?

    James Oct 30, 2020  #101

  • Cynthia, with disability claims, the insurance company is going to require Physician Statements to be completed by your treating providers. You will also want to submit as much proof to the insurance company as you can to prove to them that you are disabled. Never let the insurance company prove it to themselves that you are disabled and that they should be paying you money. If they try to prove it to themselves, they may do a terrible job at such. So it is always the claimant’s responsibility (or their attorney’s) to prove the claim.

    Alex Palamara Oct 21, 2020  #100

  • I had hernia. Surgery and my short-term insurance ask the hospital to fill out medical paper for October to December 2019. This is my insurance from my job.

    Cynthia B. Oct 21, 2020  #99

  • Marilyn, please contact us for a free consultation as we need more information to answer your question. However, typically the insurer looks to the medical records and medical opinions rather than a layperson’s opinion. But again, I need more information to answer your inquiry.

    Alex Palamara Oct 10, 2020  #98

  • What if three supervisors say not to return without being released?

    Marilyn F. Oct 10, 2020  #97

  • Judi: This is a difficult but not uncommon situation. Under most Policies as long as you are under the regular care and attendance of a physician, following an acceptable medical treatment plan and your functional restrictions and limitations are supported by the diagnosis/symptoms that should be sufficient to support an ongoing disability (i.e., a disability that has already been recognized). Not every medical condition requires ongoing active treatments if they serve no purpose. I suggest you contact our office and speak with one of the attorneys to discuss in more detail your circumstances and the options you may have moving forward.

    Jay Symonds Sep 16, 2020  #96

  • I have been out of work R/T bilateral VAD. On STD and the doctor approved of returning to work with very limited restrictions which my job has nothing I can do. STD extended the claim a couple more weeks and wants me to see my doctor before the scheduled F/U in November.

    Because of the type of injury (vessels into the brain) there is no PT and no “specific treatment plan” other than a lot of daily restrictions (lifting bending hyperextending or flexing my neck…) and monitoring for s/s of stroke. STD has a hard time because there is “no treatment plan” and may not extend the claim. What can I do?

    Judi Sep 16, 2020  #95

  • Joe, I am sorry to hear of your issues. We will gladly speak with you and assist you any way that we can. Please contact us at your convenience for a free consultation.

    Alex Palamara Aug 29, 2020  #94

  • I have STD and LTD – I have been out of work since 6/19/20. I work from home, I am 63.5 years old. I have been seeing many doctors from about 2011 – my issue is I pass out recently 4 times in 3 months – I was paid till 7/10/20 and wad denied but I sent a reply back to reopen which it has. I have supplied other on going test back but still have not seen a check or an ETA.

    Do I tell the insurance company that I am seeking legal assistance?

    Joe C. Aug 29, 2020  #93

  • Jack, I’m not sure. You would need to straighten that out with Metlife.

    Rachel Alters Aug 17, 2020  #92

  • MetLife approve my STD claim. However, my former employer only paid me for 5 weeks although it was approved for 26. When I email the employer they told me that MetLife has the wrong date in there system. Well, if that’s the issue. Why am I now being paid for LTD?

    Jack Aug 16, 2020  #91

  • My sister was approved for STD but her employer Wayfair are saying she has to go back to work. She broke her hand and works at home using computer as a customer service associate. Can you advise me on what I should tell her?

    Maria S. Aug 14, 2020  #90

  • Laura, without knowing the particular language/definition of disability in your policy we would not be able to fully advise you. That being said, in a general sense, if you are unable to perform the material and substantial duties of your occupation (to include hours regularly scheduled) then your inability to perform a full shift would be disabling. As a strain would be expected to recover with rest rather quickly your STD carrier/administrator may not give you any issues. If you would like to discuss your situation further please feel free to contact our office.

    Stephen Jessup Aug 3, 2020  #89

  • I have just been given restrictions by the doctor for a strained Achilles. As my job requires standing all day and running around in concrete floors my GM told me that she is unable to accommodate my restrictions of standing and walking less than 2.5 hours per shift. Will I be denied for short term disability if I technically was released to work and they just aren’t willing to accommodate? Mind you these restrictions are for the duration of a month.

    Laura J. Aug 3, 2020  #88

  • Kiana, you need to contact a lawyer that specializes in SSDI.

    Rachel Alters Jul 29, 2020  #87

  • I am a transplant patient taking medication that suppresses my immune system. When COVID19 occured earlier this year, I had tried to apply for benefits using an Unemployment claim, but I never was able to talk to anyone physically on the phone. I was recommended to go on SDI because I was losing money and my unemployment claim never processed. I finally receive a letter from my job stating that we would be on unemployment starting June 15 and we would be eligible for UI benefits, including the $600 a week bonus. However when I finally decided to just fax everything over, the notified me that I was potentially qualified for PEUC. I stopped receiving SDI payments since i sent my information over to EDD. But when I was asked to certify, they asked me whether I was still on SDI and if my doctor gave me permission to work. I marked the ‘I Don’t Know’ selection and put she didn’t give me an OK. This is because my unemployment was all due to COVID19 and no fault of my own. However I received a message informing me that i was disqualified from my benefits. I have nearly no money left because SDI paid me little to none, and I never received any help because of this COVID crisis. What are my next steps if I want to fix all of this and get the benefits I thought I was qualified to receive?

    Kiana Jul 29, 2020  #86

  • Maggie: You have a difficult and, unfortunately, not uncommon situation given the current pandemic. I suggest you contact our office and speak with one of the attorneys to discuss the specific questions you have and your options moving forward.

    Jay Symonds Jul 26, 2020  #85

  • I have sarcoidosis that is under control with inhalers. I work as a tech in a hospital. Due to my underlying condition and my diminished lung capacity from damage caused by my underlying condition my doctor does not want me to work in direct patient contact. I applied for accomodation which the hospital cannot do. I applied for STD which was approved for a 3 week span. I applied to extend but it’s being denied because the doctor cannot give them a return to work estimate date. He indicated it was for an extended period of time until the pandemic is over. What do I do now?

    Maggie H. Jul 26, 2020  #84

  • I was diagnosed bi-polar 2 years ago approximately after a hospitalization. Only received 1 month of medication and was never treated. I am currently under the treatment of a psychiatrist and have a treatment plan as well as medication now. My condition is extreme and my medical records do mention the original diagnosis was 2 years ago and that I have just now decided to treat it… honestly was in denial but this is severely impacting my ability to work especially in my current career.

    Julie K. Jul 23, 2020  #83

  • Iris: If this is an employer provided coverage and your claim has been denied you have a right to request the entire claim file and group pol, which would include the opinion(s) of any medical review consultants. The denial letter your received should have explained this to you. If you have any additional questions, you can contact our office and speak with one of the attorneys to discuss the specific circumstances of your situation.

    Jay Symonds Jul 1, 2020  #82

  • I am 7 months pregnant and I can not complete my essential job functions due to severe headaches I am experiencing because of pregnancy. My job requires me to be in the computer all day and headaches are exacerbated because of that. I have gestational diabetes and prior history of preeclampsia in 2 previous pregnancies. The Hartford insurance is denying the claim saying they need a neuro exam with abnormal findings to approve possibly MRI etc which would predispose me and my baby to unknown risks. My MD send them a letter saying that treatment plan they recommended was to be off work and rest. My MD is an obgyn and not a neurologist so they would not do a neuro exam. However they are saying this is not enough and “usually we do not pay pregnancy disability prior to delivery – according to discussion with a manager there.

    I also asked the insurance who was doing the review and coming up with this recommendation. Basically I wanted to know if reviewer is qualified to make a decision for pregnancy (Is it in their specialized area or not?) They said that they could not give me that information… How can I know who is reviewing the claim is competent enough?! Is there a way to force the company to disclose who the reviewer is? In addition, why does it say that they pay for pregnancy related disability on the insurance plan however they come up with reasons to deny claim even though the language stated in their documents is vague and unclear to the consumer? Thank you…

    Iris Jul 1, 2020  #81

  • Jeff: Have you also exhausted your FMLA? Generally speaking your employer may have the right to terminate you if FMLA has been exhausted. You should contact your employer to let them know you have a pending medical visit to be cleared to return to work and ask that they hold off on termination, if that’s what they are planning to do.

    Jay Symonds Jun 19, 2020  #80

  • My STD ends before I go back to My Dr. to be checked and released. Can my company terminate me if I don’t report to work. Even though I’m under my physicians care? Thanks!

    Jeff G. Jun 19, 2020  #79

  • Karen, your doctor would need to write a letter explaining why he has you out of work. Sedgwick is impossible. You may have to appeal.

    Rachel Alters Jun 1, 2020  #78

  • I had surgery on May 30th to repair my Achilles and remove a spur on my heel. The Dr had submitted a return to work date as July 15. The day of my surgery Sedgwick said I needed to return to work on June 10th and would not pay me for being out. I am still in a cask and am not allowed to but any weight on my leg.

    Karen D. Jun 1, 2020  #77

  • Bob: We are in unchartered territory on many of these issues. Was your wife collecting disability through a private insurer or through state disability? You should notify the company of your situation and that it is beyond your control and request that they continue to pay until your wife’s physician resumes his/her practice. Feel free to contact our office and speak with one of the attorneys to discuss any specific questions you may have regarding your situation.

    Jay Symonds May 5, 2020  #76

  • My wife’s doctor has taken a month off without signing her temporary disability form. What can we do as there is no money coming in due to corona virus?

    Bob B. May 5, 2020  #75

  • Mike, there could be a myriad of reasons and I have seen denials from insurance carriers when a person was taken out of work due to underlying medical conditions that increased risk with COVID-19. Insurance companies still require medical support as to why a person can’t work and in the aforementioned situation argued that a potential medical problem was not grounds for disability. That being said, some carriers are handling claims related to COVID-19 under various guidelines that are favorable. Ultimately, the only answer we can give is yes, it is quite possible it could get denied. If you want to discuss your situation in greater detail please feel free to contact our office.

    Stephen Jessup Apr 23, 2020  #74

  • I have type 2 diabetes and my doctor has taken me out of work do to covid 19. I have applied for short term disability. Would there be any reason for my claim to be denied?

    Mike Apr 23, 2020  #73

  • Cheryl: This is an unfortunate situation Unum has put you in. I suggest you contact our office and speak with one of the attorneys to answer any additional specific questions you may have regarding an appeal.

    Jay Symonds Apr 3, 2020  #72

  • I have myasthenia gravis. Have been collecting disability payments from Unum since 2008. This condition worsens. Now they are closing my claim, because they don’t agree with my doctor, and have decided I can now work 8 hours a day. I have no issue with Social Security checks, because they get it. I have several disorders, that make working impossible. I will appeal, but feel this is a no win situation. I live in Texas.

    Cheryl M. Apr 3, 2020  #71

  • Robert, I am sorry to hear of this denial. An appeal needs to be filed to challenge any denial. Please contact us for a free consultation and we will gladly review the denial and assess your claim to assist you anyway that we can.

    Alex Palamara Mar 29, 2020  #70

  • What if your claim was denied for doctor not filling out paperwork correctly or sending in a timely fashion?

    Robert M. Mar 29, 2020  #69

  • Eugene, as your case pertains to worker’s compensation you will need to consult with a worker’s compensation attorney to assess your rights. If you do have a corresponding disability insurance policy/claim and are having issues with that we could assist you. Please feel free to contact our office as it relates to any potential disability insurance claim.

    Stephen Jessup Mar 25, 2020  #68

  • For about 2 years, my treating pain management doctor has requested different treatments from medication, MRI’s and nerve test. All has been denied by workers comp. I had double fusion surgery back in 2017 and the pain continues, same location and same level of pain. I get monthly pain meds paid by my regular insurance. I paid for my own MRI. Reason for all denials: my doctor never returned the peer to peer messages.

    Eugene A. Mar 25, 2020  #67

  • Cherese, I am sorry to hear of your medical conditions and the way the insurance company is treating you. We will gladly review any correspondence the insurance company has sent you and gladly offer a free consultation. Please feel free to contact us at your convenience.

    Alex Palamara Feb 25, 2020  #66

  • Hello. I am currently being denied of my short term benefits since 11-15-2019, I also had to do an extension for an additional 12 weeks. The disability company states they do not see any functional impairments that would limit me from my occupational duties and functionalities. I am not understanding why. I have chronic back pain and lymphedema venous insufficiency which causes swelling, stiffness and pain in both of my legs.

    Cherese Feb 25, 2020  #65

  • Ed, I am sorry to hear of the issues with your claim. Clearly you need to reach out to your doctor and advise him that comments he makes can have significant impacts on your claim for disability benefits. You will need your doctor to revise his opinion should he believe that you are unable to work. If you are disabled and your doctor is unwilling to support your claim, you may need a new provider who is willing to support your valid claim. Please contact us so that we can discuss this further. We offer a free consultation and are always available.

    Alex Palamara Feb 13, 2020  #64

  • I was approved for short term for ddd and herniated disc. I’ve received 2 injections and scheduled for a 3rd. I am due to transition to long term in a couple weeks. However the my insurance co called and told me my doctor said it was up to me if I wanted to return to work and they think I can go back. Before they called I had told my doctor that the injections weren’t really working and the pain had gotten worse so he scheduled the 3rd injection and told me options about surgery if it doesn’t work. What should I do about my doctor telling my insurance co its really ok to go back to work when clearly the pain level is where it was when I first went out on short term.

    Ed Feb 13, 2020  #63

  • Jay: Most employers do require employees to return to work after their FMLA has been exhausted, unless they grant you an extension. In fact, once FMLA is exhausted your employer may/could have terminated you even if you were approved and collecting the STD benefit. You should continue to pursue your STD claim and make sure your doctors submit all relevant and requested medical records. If the claim is denied, I suggest you contact our office and speak with one of the attorneys to address the specific questions you have regarding your situation.

    Jay Symonds Dec 7, 2019  #62

  • I have been battling with the STD company for a little over a month now. They have approved fmla based on medical info from Dr. But for STD they said that I dont meet the criteria and now they are waiting on my therapist to send more notes. I suffer from General Anxiety disorder refractory to treatment. I was just inform today that my FMLA has ran out and I have no other choice but to report back to work. My Dr has placed me out of work until Jan 13. Reason why I’m out of fmla so quickly is because I had intermittent leave for bonding with child so I never got a full fmla for Disability. What can I do as now my anxiety is through the roof now?

    Jay F. Dec 7, 2019  #61

  • I am currently on long term disability with one employer. If I voluntarily leave this company and join another, can the new employer’s health insurance deny me coverage? I’d been told that as long as my insurance does not lapse, I cannot be denied but need to be sure before I leave the coverage I currently have. Thanks

    Chris Dec 5, 2019  #60

  • I truly hope someone on here can help me. I work for Sedgwick and they also manage my STD benefits. In June I was approved for my STD benefits for my mental health condition, however they contacted me a month later and said my leave is no longer supported based off my provider using the word euthymic to describe my mood that day. My provider immediately sent the claims specialist a 3 page letter and explained that I do not suffer from depression so that is why she used that term. This has not helped, I have been appealing every month going forward with more and more documents from my providers but their outside hired provider does not support my disability. I got a call from my claim worker last week and said one day would be supported because I had a panic attack while in my Doctor’s office, so my question is how can a claim be based on one day in the office, I struggle with this daily and cant go to the hospital each and every time I have a panic attack. Please help guide me on what to do I’ve drained all my savings and I’m a single mother facing eviction I dont know where else to turn.

    Kristy Nov 15, 2019  #59

  • “Too much surgery”, I am sorry to hear of your issues and of your claim denial. There is an appellate process to challenge this denial by Aetna. We are always available for a free consultation. Please call us and we will request that you send us a copy of the denial letter. We look forward to speaking with you.

    Alex Palamara Nov 12, 2019  #58

  • I submitted my claim September 27th because my doctor requested pre-surgery cleanse. I did not want to be at work with nausea and diarrhea which is a symptom of the cleanse. My surgery for a hysterectomy and hernia repair and bladder repair was scheduled October 3rd. I was told by Aetna they could not approve September 27th through the 2nd of October because a cleanse was not medically necessary to them even though it was prescribed by the physician. I then had a breast reduction October 17th. I was told my claim would be approved October 3 until November 13th. I have been having trouble after both surgeries with my energy level, focus, headache, exhaustion, constipation, nausea and dizziness. I also have trouble driving because of the pressure on my stomach and pelvic area and my breasts are still extremely swollen. I have asked my physician to send my medical records and per Aetna (through my employer) I am required to go back to work even though it has only been 4 weeks.

    My claim was denied because I have a sedentary job. I have explained to my physician that I have a very high demanding position that requires me to almost perform job duties of four different people. I also have to drive an hour and a half to get there. What options do I have because I’m physically unable to drive an hour and a half to work and I currently can’t sit for over 2 hours at a time. I’m still getting rides just to my physician’s office which is less than 5 miles away. My recovery is taking longer than I imagined.

    Too much surgery Nov 9, 2019  #57

  • Richard, you would need to file an appeal if the insurance company denied your claim. If you have questions you can contact our firm at 888-729 3355.

    Rachel Alters Oct 14, 2019  #56

  • My doctor said I could go back to work in carpentry with restriction! don’t take 20 lbs in weight! The insured company stopped my payments even after I took a MRI scan and even the doctor said I was out of work. Does the company pay me back?

    Richard Oct 14, 2019  #55

  • Surgery, unfortunately Sedgwick does a lot of suspect things when managing claims. Sedgwick isn’t liable for paying your benefits, it’s your employer that’s on the hook if you have to litigate. If your appeal is denied you will need to find a lawyer in the state you live in to sure you employer.

    Rachel Alters Sep 21, 2019  #54

  • Hello,

    I had peroneal nerve decompression surgery on 5/6/19 and I was out of work for recovery from 5/6 to 5/26 at which point I was still having severe pain and spoke with my doctor who took me off work completely until 6/3/2019 and then released me to work only 1/2 days until 6/25.

    Sedgwick approved my disability from 5/6-5/26 and then denied my recovery time from 5/27-6/24. I then filed an appeal including a note from my doctor indicating that my surgery was not typical and I didn’t present with typical diagnosis; my surgery was experimental peroneal nerve decompression. I’m still having issues with my leg and the pain is still bad, since then I’ve had another procedure done on my leg that I didn’t take time off work for.

    How can Sedgwick approve your surgery and then deny your recovery time? Sounds like my appeal is also going to be denied.

    Surgery sure but not recovery time? Sep 21, 2019  #53

  • John, even if your employer decides to terminate your employment and rehire you later, possibly ending your LTD and other employee benefit coverage, you may still apply for long-term disability since your claim begins from your last day worked and at that time you were a covered employee.

    Cesar Gavidia Sep 13, 2019  #52

  • I have short term and long term group insurance from my employer. Was approved for short term disability, now it has ended, filed for my long waity on the insurance company decision and waiting for a surgery next month. My employer call me wants to fire and rehire me till I’m ready to return to work. Can I be denied my long term?

    John Sep 13, 2019  #51

  • Colleen, to clarify did the insurance company refuse to provide you coverage because of your medical history (actually give you a policy) or did they deny a disability insurance claim you made under your policy?

    Stephen Jessup Sep 5, 2019  #50

  • I have combat PTSD and have been out of work since 8/8. I was in the hospital on the Behavoir Unit for ten days and now I am doing an intense Partial hospitalization. The dr said I can’t go back to work until 10/1 and that would be parttime. I got short term disability from a private company through work cause I was afraid this would happen but they denied me due to mental illness. Do I have any course of action?

    Colleen Sep 5, 2019  #49

  • Eric, unfortunately the insurance company is permitted to hire a physician to perform a paper review of your records and determine that you are able to work. If you are going back to work before your LTD kicks in then you should appeal on your own. If you are going to roll into LTD then I would consider hiring an attorney to assist you with your claim.

    Rachel Alters Aug 29, 2019  #48

  • My short term disability was denied by a independent Medical Examiner that I never meet or even talked too. All they did was talk to my primary doctor about me. Is this the way it should go a doctor that never sees someone can make a decision about someone?

    Eric Aug 29, 2019  #47

  • John, approval and/or denial of FMLA leave is an employment issue for which you may want to consult and employment attorney. The U.S. Department of Labor’s Wage and Hour Division (WHD) is responsible for administering and enforcing the Family and Medical Leave Act for most employees. If you have questions, or you think that your rights under the FMLA may have been violated, you can contact WHD at 1-866-487-9243. If you have questions regarding your LTD claim with Aetna, I suggest you contact our office and speak with one of the attorneys to address the specific questions you have regarding your situation.

    Jay Symonds Jul 12, 2019  #46

  • Back in June 2018 I was diagnosed as having a retroperitoneal soft tissue sarcoma/RSTS (LEIOMYOSARCOMA/LMS) of the inferior vena cava (IVC). I was started on 30 radiation sessions in preparation for surgical excision, medically deemed the ONLY curative for RSTS LMS. On 11/05/2018 I went on 12 days FMLA leave which eventually rolled to STD(AETNA) on 11/19/2018, eventually turning to LTD(AETNA) on 5/23/2018.

    Post radiation the surgery was scheduled for November but was aborted when the anesthesiologist attempted to start the anesthesia in my right jugular vein (RJV). Surgery canceled as the RJV was discovered to have a large blood clot, which turned out to have been caused by a biopsy of my thyroid 7 days earlier. I was then scheduled for 6 six cycle of chemotherapy in order to attempt to keep the RSTS LMS from growing in order to eventually perform the surgical removal done post the chemo. The last (sixth) chemo cycle was completed mid February 2019. Assessment for surgery began. After extensive tests and physician consult with experts on treating RSTS LMS form other countries, it was determined that due to the radiation and chemo that my liver had been damaged to the point that surgery was more of a threat than not so surgery was once again nixed.

    As my leave agencies, FMLA/AETNA/employer HR, continued to request and obtain pertinent information from all of my physicians, the FMAL /Hr determination interpreted from my physicians responses is that my recovery is “indeterminate”. Because of this my corporate HR will not approve an LTD extension past the current 0730/2019 end. Further I was told that I either had to return to work 08/01/209 or resign.

    While I feel strong enough to return to work at this writing, based on all the existing medical knowledge concerning my condition, it is the experience for all known cases that RSTS LMS will progress rapidly and in fairly short time I may well be negatively affected to the point that I may no longer work. My question is, given that I am medically disabled still per my physicians, on what basis could the HR deny my extension based on the statement “Now that your recovery has been deemed indeterminate”? THANK YOU

    John G. Jul 11, 2019  #45

  • Bobbi, I am sorry to hear all that you are going through. Often, there is no explanation for an insurance companies delay in approving your claim. However, they may be awaiting records from your treating providers or from the surgical center. One thing you must do is submit all supportive records ASAP. Please feel free to contact us at your convenience so we can learn more about your claim and assist you any way we can.

    Alex Palamara Jul 2, 2019  #44

  • I hurt my knee at work back in dec 2018 ,turned it into workman comp but all they did was x-ray and ibuprofen although I could barely walk on it. They said I had a bad sprain. I was released from work comp but pain and swelling continued. I dealt with it until May 2019 when I finally saw my PCP and he put me on short term leave and ordered MRI which showed torn meniscus. He sent me to Ortho specialist on April 9 who prescribed me another anti-inflammatory. Didn’t get better so surgery was done may 21. My follow-up was June 10 and I still have alot of swelling and trouble walking for extended periods. My PCP put me off again ,until my next Ortho appointment July 22. I had no issues with my claim being approved or with payments until my last follow up ,I’ve not received payment since June 7. I’m confused on y it could still be under review when I just had surgery. Recovery from surgery is 4-6 weeks ,my Ortho Dr said sometimes up to three months. I should add I had a horn repair,partial meniscus removal,and plica band removal .

    Bobbi Jul 2, 2019  #43

  • Renee, if your claim has been denied by Hartford they should have provided you with a denial letter explaining the reasons that it believes you do not qualify. The letter should provide you with the timeframe you have in which to appeal that decision. You would challenge and address Hartford’s denial through the appeal process that it provided under your LTD Plan. Please contact us to discuss how we can assist you with your appeal with one of our disability attorneys.

    Cesar Gavidia Jun 14, 2019  #42

  • I had a partial hysterectomy – during surgery the doctor discovered I had stage 4 severe endometriosis. The doctor cleaned off my remaining ovary and surrounding organs as best as possible in the hopes that I can live with the single ovary until natural menopause. The Hartford approved me to be off 4 weeks. The doctor stated that I had to be off 8 weeks. During my 8th week appt, the doctor noted my complications from the endometriosis. I was out 2 weeks additional after this. The complications were extreme pain. This included passing gas, bowel movements, sitting for long periods (over an hour), etc. I was on narcotics throughout the day.

    I had this additional information sent in to the Hartford. Their conclusion was that pain was subjective and I should have come back to work after 4 weeks. How can I fight their conclusion? I have a history of anxiety and depression and this has been causing me so much mental distress. My work is coming after me now for the money paid while on leave that was now denied. Please advise or help!

    Renee Jun 14, 2019  #41

  • Bobby, it depends on your disability insurance coverage. In order to qualify for benefits you are required to meet very specific term and conditions which you will only find in your disability insurance policy.

    Cesar Gavidia May 18, 2019  #40

  • Hello,

    I am in the extended period of eligibility for SSDI. I returned to work and after 9 months have to apply for std which I have from my employer. I have a mental health related illness. My psychiatrist fully supports my std claim. Is it very likely the STD will get approved and as long as my doctor continues to support the claim I will receive STD for 6 months which is the policy term? I am thinking since I was approved for SSDI in the past it would be very difficult for them to deny the STD claim. The insurer is prudential.

    Thank you

    Bobby May 18, 2019  #39

  • Confused, it is not uncommon for the carrier’s consulting physician to contact a claimant’s physician and manipulate the conversation such that it benefits the carrier. Unfortunately, once your physician makes a statement like this it is difficult, though not impossible, to overcome that on appeal. I suggest you contact our office and speak with one of the attorneys to address the specific questions you have regarding your situation.

    Jay Symonds May 7, 2019  #38

  • I was in a car accident and suffered a herniated disc. The same disc is severely degenerating. I have been out of work for almost 8 months. I used all of my STD and it is now rolling over into LTD with Unum. My doctotor did not release me to work. Unimpressed delayed my LTD claim. They requested tons of paperwork (which they received), and all of it showed I sustained an injury in the car accident. Unum then requested a call with my doctor and I feel they bullied him in releasing me back to work. So my doctor has released me to work, however my organization approved my ADA claim through the rest of this month. How is it that Unum can tell my doctor to release me for work when I know I am no where near capable of performing my job? How are they able to make the decision that I should return back to work without my input?

    Confused Claimant May 7, 2019  #37

  • Avi, it sounds as though additional information or documentation was discovered that altered the company’s initial determination. I suggest you contact our office and speak with one of the attorneys to address the specific questions you have regarding your situation.

    Jay Symonds May 6, 2019  #36

  • Hello.

    My short term disability was approved and now it’s been two months and they are sending me a letter that it was denied, also asking to pay back what was paid out. Is this even possible?

    Avi May 6, 2019  #35

  • Nicole, unfortunately the carrier can take over 3 months to review an initial claim. In an ERISA governed claim they have 45 days with the option of taking two 30-day extensions. If they approve it they will pay the claim retroactively to the day benefits should have started even if you return to work.

    Victor Peña Mar 21, 2019  #34

  • I found out I was pregnant in May 2018, at 18 weeks my high risk doctor told me that I could not work because of my high blood pressure and high proteins, I started to get short term disability in sep 2018 until Dec 2018 and my employer advised me to make a claim for long term disability because I still had several months to give birth and 6 weeks after delivery.

    My problem is that the disability company is still asking for medical records and in 2 weeks I am supposed to return to my job and when I call they keep saying my claim is under investigation, it’s been like this for almost 3 months. If it gets approved, would they have to pay for the months the claim was submitted?

    Nicole Mar 21, 2019  #33

  • Eve, I suggest you contact our office and speak with one of the attorneys to address your specific situation. They will need to see a copy of the denial letter and your Policy. Under the federal statute that governs your claim the insurer must provide you up to 180 days to file an appeal.

    Jay Symonds Mar 5, 2019  #32

  • Hi there!

    I was on STD last year and they just paid me on November 2018. I asked my case manager on STD if i need to send in new medical forms to support for my LTD and she said no need and she will process my LTD right away since it was too late already (her fault) and I thought she is still my case manager for LTD coz she said she will process it right away coz its been too late already so that i will be paid. November and december passed but i never heard from them about my LTD so I called after new year.

    On January 2019 I received a denial letter dated january 25. My case manager advised me to book an appointment to my doctor right away and get medical records that I have not been submitted and she said appeal as soon as I have all the records. I am so confused that they approved my STD for the injury I got from work but denied my LTD? It’s almost a year that I’m not working but I’m not receiving anything.

    Eve Mar 5, 2019  #31

  • Angel, I am sorry to hear all of the troubles you are having with the insurance company. Unfortunately, most group insurance policies allow the insurance company to “offset” other income benefits claimants receive. In your scenario, it sounds like Social Security approved disability benefits after STD and LTD were approved and as such an overpayment is owed. I have heard the reason why must group policies are so affordable (the monthly premiums are so low) is because the “offset” provisions (as well as the laws that govern these policies).

    Whether he signed the paper or not, the overpayment will likely be odd under the terms of the policy. If the insurance company denies his claim or if you have any troubles, please do not hesitate to contact us for a free consultation.

    Alex Palamara Feb 4, 2019  #30

  • My husband started drawing STD in May 2016. He was unable to file paperwork. Initial diagnosis was bi-polar, severe depression, mood swings, anger outbursts, poor decision making, problems interacting with others, etc. His doctor felt he needed to see a specialist. I went above and beyond to provide them all paperwork and it is a constant struggle to get them to pay. the policy limits most mental illness to a two year policy with the exception of organic brain diseases and Alzheimer’s. According to his physician and online bi-polar is an organic brain disease. He also has other conditions in which his doctor is specifically stating that due to high blood pressure, GERD, high cholesterol, gout etc. he is unable to work. One issue I have is that no handbook was provided to me regarding the policy, I just did as instructed. After STD ran out and he moved to LTD, they required that he file for disability at the Social Security ,office., in which he won. The kicker is they are issuing me check stubs minus the SS amount and say I owe $18,000 from STD and LTD they paid while he was out.

    After researching, I understand that if the company pays for the policy, you are required to pay the funds back if approved for disability, however he worked for the company for 12 years, contributed to the STD and LTD plans as well as paid for the buy up amount. Not being provided a handbook on the policy after asking numerous times, dealing with the company that handles disability has been a pain the the rear end. They say he signed a piece of paper stating he would pay it backout from back pay of SS.This is untrue because I have kept diligent records and they cannot or will not provide me a copy of this paper. I am in the process of appealing, but do not understand why you pay out of your check a portion of the policy plus the upgrade. What is the purpose of having STD and LTD.

    When I received SS, my company did not ask me to pay back I look at it from this scenario. When he dies, will I have to pay back his life insurance if I get survivor benefits and am I entitled to the money they failed to send me, but not the check stubs and is there away to recoup on my tax return in any way? Thank you for your prompt attention and I appreciate your guidance. A final note: I have had to appeal many times because they have their clinicians evaluate if he is able to return to work or not. His doctor’s say a definite no, however the clinicians that have never even spoken to him say he is able to work Also at the top if a company pays, you have to reimburse, but if you pay, you do not. I need assistance. I am over y head. This is an International company based from France, offices all over the US with their American home office in Palatine, IL. Our residence is TN. Please advise. He bought his home out of college, which we are about to loose, scramble for food because we are not eligible by less than $100.00, down to one car. When it rains, it pours.


    Angel Feb 3, 2019  #29

  • Concerned, your friend should contact a disability insurance attorney immediately to discuss her options. Since she has been denied she will be required to appeal Sedgwick’s decision; however, she should not attempt to appeal herself since she may be limited to only one appeal and if it is denied any potential mishandling of the appeal could affect her long-term disability claim and the outcome of any future litigation.

    Cesar Gavidia Dec 15, 2018  #28

  • A friend of mine is in stage 4 renal failure. Shes been on STD but they have denied her claim stating they needed the update from her Dr and her claim will be approved. She contacted her Dr and they said they faxed it over. She called Sedgwick and the told her they got it and that it should take about 7 business days for her pay. She called back on the 8th business day and her claims person told her it’s still being denied and that she has to appeal the claim. On 12/10/18 she got surgery for av fistula for her to start dialysis and can’t lift over 10lbs per Drs instructions for 4 months do to the healing process. Is there any course if action besides going through her HR to get her STD approved? Concerned friend in Mass

    Concerned friend in Massachusetts Dec 14, 2018  #27

  • Frustrated, I am so sorry to hear of the ridiculousness that the insurance company has put you through. Please contact me immediately so that we can discuss your claim. Your claim is likely governed by the ERISA laws so the insurance company does have a deadline to provide an answer on your LTD claim. Please call me so that we can discuss your claim, the ERISA laws and how we can assist you. I look forward to speaking with you.

    Alex Palamara Dec 11, 2018  #26

  • I was taken off work as a nurse after my foot began swelling and causing nerve changes such as numbness. I had testing done that showed nerve damage, and my doctor restricted me from a lot of activity, including walking or standing for long periods as well as no driving. I am a visiting nurse. My STD went over fine, but my LTD is not accepting any of my proof. They have requested the same visit notes over and over from all 3 drs (primary, foot, and nerve). I have sent them all the requested papers as well. It’s going on 3 months with no payment, and with no money coming in, I either need to go to work or have my house start being foreclosed on/utilities shut off. Who do I call for help getting them to approve my claim? They have extended their time frame 2 times already for a decision.

    Frustrated Dec 10, 2018  #25

  • I was taken off from work by my employer due to they wouldn’t or couldn’t accommodate to my restrictions made by my doctor, should I get approve for my LTD, due to the fact my doctor is not the one to release me. I have surgery next month, been off from work since November 2017 due to an injury that occurred on the job.

    Concern individual Nov 20, 2018  #24

  • Worried Wife, the only requirements to LTD are those set forth in the Policy. You should request the Policy in qwriting from the HR group as the employer is required by statute to provide the Policy. Typically there is an elimination period which is the amount of time you must be disabled before LTD benefits will be paid (e.g., 90 days or 180 days). The elimination period usually runs concurrent with an STD claim and maximum benefit period. I suspect your husband’s HR contact is wrong and he/she certainly cannot prevent you from filing an LTD claim. You should request the LTD claim forms and submit the LTD claim. I suggest you contact our office and speak with one of the attorneys to address in more detail your specific questions regarding your situation.

    Jay Symonds Nov 3, 2018  #23

  • My husband has stage 4 renal failure. He has been declared end of life. He is filing his SSDI and we have no doubt from what we have been told it will go through.
    Then he called his HR person to start the claim for his LTD only to be told he can’t file because he doesn’t have STD. She said they require you to have the STD to use the LTD and most people are fired before they get the LTD approved.

    No one ever told him he had to pay for the STD in order to use the LTD. Can they do that? He has been paying this for almost 20 years. He dropped the STD 3 years ago due to budget issues. I can’t get any answers from google to the simple question. Can they force you to buy STD in order to get the LTD?
    He has paid for the LTD the entire time.

    Worried Wife Nov 2, 2018  #22

  • Confused, whether you are capable of returning to work is a decision to be made between you and your doctor. If you have already been approved to August 31st then you should be ok unless your doctor has extended the return to work date beyond that date in which case you should have your doctor provide support for his opinion.

    Victor Pena Sep 19, 2018  #21

  • Confused. I was taking out of work by my doctor for depression and anxiety. I was approved for STD by the insurance company. My doctor extended my date to return to work and after reviewing my psychiatrist report I was approved for the extension. Now my psychiatrist has extended my date again for the same reasons but I got a new case worker and she said my. extension has been denied and claim will be closed. Mine you my visit was August 10. I was approved until August 31 and I called in this morning to check my claim status and was given this information. I am confused am I to go back to work even though my Dr has not released me.

    Confused Sep 18, 2018  #20

  • Margaret, you would need to file an appeal of the denial of your STD benefits within 180 days from the date you received it. If you did not file the appeal you should contact the insurance carrier and ask if they would accept a late appeal.

    Rachel Alters Sep 12, 2018  #19

  • I had been taking off of work for my hand therapy for my arthritis and lupus for 3 years, I’d never had any problems of getting paid out for my 3 months off. I do hand therapy for 2 and a half months, and my doctor wants me to do my new hand therapies I’ve learned for the other 2 weeks at home before returning to work to rest my hands from therapy for awhile.

    The insurance company refuse to pay me for my other 2 weeks because they felt that I had no restrictions to go back to work and finished my therapy. I had informed them that my doctor I had retired and i had a new doctor in between my therapy, but when they had their doctor contact my new doctor that informed them that he had just learned my records and that the other doctor had requested this time off, but he told me that when their doctor called him he asked him questions like they were giving him choices to pick from and not his opion on me. He also wrote a letter saying that to them, but they still refuse to pay me those 2 weeks. Do you think I have any case to try and collect my money? This happened in December Last year. TY

    Margaret Sep 11, 2018  #18

  • Suzanne, if there is no number to reach them out, you need to start sending letters to them via certified mail and fax. Your excuse for why the surgeon took you out for 4 months certainly sounds reasonable. Hopefully they will listen to logic and act reasonably themselves. You may wish to put what you are stating here in writing and fax/mail it to them immediately. If they don’t pay you the final month of benefits, you may have to appeal their decision which will not be a quick process unfortunately.

    Alex Palamara Sep 2, 2018  #17

  • Hello. I had back surgery May 31 2018 and have a return to work date of Sept. 20 2018. My problem is that The Hartford at work approved my STD until August 18 2018, when I applied for an extension their response is that it is suspect for my Surgeon to have given me the 4 months off BEFORE my surgery even though my workplace insisted on an exact return to work date and due to my physically demanding job they decided on the extent of my leave so I can return without any restrictions as required by my workplace. I have on multiple times tried to contact The Hartford at Work group but they haven’t given me an extension or a final decision, it has now been 2 weeks past the end of my approved medical leave. Is there anything I can do? No money coming in.
    Suzanne W.

    Suzanne W. Sep 1, 2018  #16

  • Michael, assuming this was a Short Term Disability claim the administrative requirements are significant and ongoing given the week to week payment of the claim. A non-responsive treatment provider can significantly hamper a claim and the timeliness of payment. Although your FIL is now back to work you don’t want a repeat of this situation should he go out again in the future. A conversation with the PA is probably wise but also understand that the family may need to be more involved (i.e., pick up and submit the records) to ensure all that needs to be done is getting done in a timely manner. Should the need arise in the future feel free to contact our office and speak with one of the attorneys to address specific questions regarding your FIL’s situation.

    Jay Symonds Aug 29, 2018  #15

  • My Father-In-Law had a stroke in December and was placed on disability. He has comorbidities that were left unchecked prior to his stroke because he never went to the doctor. The Dr he was seeing is actually a PA. She would not release him to return to work because of his diabetes until June. The disability company is denying the claim stating he could return to work and no sufficient data was provided to show he shouldn’t. The PA has been very difficult to get paperwork from and kept submitting stuff last minute after multiple calls hounding her to get the paperwork in by deadline. It seems to me this is more of a issue with the PA who wasn’t either tracking my FILs condition appropriately or wasn’t doing her job on getting the information in. We believe he returned to work about the time he should have however he could have started a few weeks earlier. They have recently denied the Appeal. I don’t know if this should be addressed with the PAs office or the disability company. Honestly I don’t feel like the PA was doing her job to get information to the disability company.

    Michae Aug 28, 2018  #14

  • Tuesday, yours is one of the more egregious denials I have heard. Please contact our office to discuss the denial and how we may be able to assist you in getting your benefits restored.

    Stephen Jessup Jul 19, 2018  #13

  • I have a terminal cancer. I found out in March. The insurance company paid disability benefits until June. They are now saying people with cancer work and there is no reason to extend the claim. My Onocologist stated on their form I could go back to work when I felt ready. I don’t feel ready yet. I am still receiving chemotheraphy. They denied the claim stating people with Cancer work. They are asking the doctor what is the anticipated return to work date. The doctors response is she has a terminal cancer. It feels like they are going to deny the claim because the doctor did not provide a return to work date. When I asked him about it. He said he cannot determine that because he does not know.

    Tuesday T. Jul 18, 2018  #12

  • Sandra, if your policy does not cover pregnancy (which is rare) then the carrier may be right. We would need to see the policy to determine what your rights are under same. Additionally, California does provide state based disability that you should look into. Please feel free to contact our office to discuss your STD situation in greater detail.

    Stephen Jessup Jun 30, 2018  #11

  • I’m going out on maternity leave in a week in California. My STD policy refuses to cover me until after I have the baby. My doctor has written me out of work, I have gestational diabetes and I am a veterinarian and unable to perform my job such as lifting 50 pound pets, performing surgery or being on my feet for 10 plus hours a day often with no breaks or food. I told my STD provider all of this and they refuse to cover and said that it doesn’t matter that I cannot safely continue my job that I must continue to work if I want to get paid as they do not consider being pregnant a diasability despite me falling under the legal definition of disability in California.

    Sandra B. Jun 29, 2018  #10

  • Marlene, to continue receiving STD you must establish that you meet the Policy definition of disability. It’s unclear from your question whether this is a self-funded salary continuation plan or a fully funded insurance policy. There can be a meaningful difference between the two. In some cases the claims administrator will rely on what the average recovery should be and try to enforce that absent clear medical evidence from your providers that your specific situation requires a longer recovery period. It will also depend on the type of occupation you have. I suggest you contact our office and speak with one of the attorneys to address your specific questions regarding your claim situation.

    Jay Symonds Jun 5, 2018  #9

  • My name is Marlene and I had complete knee replacement surgery 6 weeks ago, my short term disability paid me for 4 weeks and then stopped paying me saying I had to return to work after 4 weeks. I still have swelling of the knee and my doctor wouldn’t release me to go back to work. Is this legal and is there any recourse to take against the insurance company? I have been an employee at my company for over 20 years and have paid my Short Term Disability weekly with no previous claims.

    Marlene Jun 4, 2018  #8

  • Emily, you do have an interesting fact pattern in that the doctor is not certifying any type of disability. Under a disability policy there will be a requirement that your condition prevents you from working, and that it be supported by the doctor. Have you discussed with HR the issues you’re having with the disability carrier?

    Stephen Jessup Jan 23, 2018  #7

  • My employer has short term disability insurance. I am pregnant the work told me they could not accommodate my normal pregnancy work restrictions on the position i am on so they put me on disability at 16 weeks. Disability compony said i had to renew my clam after 2 months later. Now insurance company keeps moving my claim to different departments and say that their is no medical reason for my disability and that the work says i cant work but my doctor never said i couldnt. Yes my doctors never put me on it in the first place. I asked if i should go back to work they said no. What am i supposed to do i can not afford to live with out pay or pay insurance if i am not getting paid. I am at 33 weeks so i still have a nother month till baby comes and 6 weeks after that?

    Emily Jan 22, 2018  #6

  • Frustrated, there is no such thing as a “permanent disability” as it relates to a private or employer provided policy and the carrier has the right to request updated proof of ongoing disability- to include medical records and claim forms. It may be possible to get the carrier to decrease report requirements but there will almost certainly still be an ongoing reporting requirement. Please feel free to contact our office to discuss your husband’s claim further.

    Stephen Jessup Dec 30, 2016  #5

  • My husband has been approved for SSDI retro back to November 2015 when he went on STD and subsequently LTD. He got his award letter in March of 2016, and officially quit his job in May 2016 but was out of work at that time.

    His LTD company has all of the information about his back injuries and also he had to have a cervical laminectomy due to severe degeneration in 3 discs. The Dr. he saw did x rays on his back to look at his old back surgeries and also had an MRI done. He has degenerated and has constant pain in both back and neck. He will be 55 in January and SSDI knows he was an electrician for about 30 years, cannot be rehabilitated to learn a new vocation and falls under their guidelines for Disabiility. His LTD has record of this too.

    He no longer is seeing a Dr. for his condition. There is nothing they can do to help him and he is permanently disabled according to SSA.

    Question is….why are they sending monthy APS forms when his Dr. already explained his condition and that he is permanently disabled? It is a long form and it costs money every time they have to fill this out.

    He did have an attorney to help him get his SSDI. Should he contact him and also can this attorney write a letter to his LTD ins. company?

    Thanks in advance for your help.

    Frustrated Dec 27, 2016  #4

  • My dr has not released me to go back to work,but the short term Dr’s say there is no reason why I can’t so do i go back to work even though I have not been released from my dr

    Kim Nov 5, 2016  #3

  • Kelly, I don’t think they would intentionally lie as it would be hard to conceal it as your whole claim consists of a paper trail for the past 8 years. That being said, being stupid and uninformed as to the information in your claim- that is more than likely from what you are saying. Have you spoken to the doctor that allegedly returned you to work? Quite often when a new claims manager gets onboard they seem to be intent on finding ways to deny claims, but with the information you provided I believe they would be hard pressed to find a basis that would “stick” at least in the long run. Please feel free to contact our office to discuss your claim in detail.

    Stephen Jessup May 24, 2016  #2

  • I have a new claims manager, within the last nine months. He asked for a APS from my Cardiac Surgeon, which we supplied, in November, 2015. I have been on Long Term Disability for 8 years, for 3 Heart Surgeries and some other health issues. He called me two days ago, to say, this same Dr., send another APS in for me, releasing me back to work? I said I don’t know anything about this, as far as I know my Dr., has me off work, I have to check with him. I just got out of the hospital 7 weeks ago, for another very serious problem, which I reported to you. He said he had no record of it? I called my Doctors office later that day and they said that this was true. They had received another Attending Physians Statement, but hadn’t sent it in yet. Will the insurance company out and out lie to you and is that even legal? He was also really rude to me. He called on my Birthday and I think he did it just to upset me. I asked if he knew it was my Birthday and he simply said, “Should I call back tomorrow?” Nothing else. I said, no, go on and he did. It was really weird. I had to ask him 3 times, if he had my file in front of him, because the last 3 things I had called into the Company, he didn’t know. Like the fact that I had just gotten out of the hospital, 7 weeks ago and had to have a blood transfusion, 6 bags of blood. I almost died, I was very sick and still am. They are running tests. I am always really good about updating my medical records, but he acted like he didn’t have any of that information. I have never been treated like this, by them before. As I said, he is new to my claim and I am curious to hear your response. I have Aetna Long Term Disability. I purchased it when I was working, for an employer. Thank you, Kelly

    Kelly May 19, 2016  #1

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Do you work in my state?

Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.

What are your fees?

Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.

The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.

In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.

Do I have to come to your office to work with your law firm?

No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via telephone, e-mail, fax, GoToMeeting.com sessions, or Skype. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.

How can I contact you?

When you call us during normal business hours you will immediately speak with a disability attorney. We can be reached at 800-682-8331 or by email. Lawyer and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.

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After practicing over 27 yrs., suddenly I was now unable to practice any more. Having Atty. Steven Dell and his awesome team represent me was the best decision I made having to deal with my disability claim. Their knowledge, expertise and professionalism gave me the peace of mind and confidence to get me through one of the most difficult times of my life. When you really need someone to have your back, knowing that you have the best that there is, makes all the difference in the world.

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