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mikster

Junior Member
Virginia.
I fist began symptoms in May of 2004. I had severe sciatic and low back pain. I was out of work for 6 months and although I had to fight with my employer each step of the way, my short term disability was approved time and time again. Partial salary was paid during that time. When it turned into long term disability after the 6 months of STD, my employment was terminated and I had to re-submit all of my paperwork along with medical records for 18 months. Apparently they made a mistake and thought I did not elect a LTD benefit for the previous year although I did and they are now aware of it. After 4 months of this hassle, the LTD folks sent me a letter denying my benefits. I understand back pain is a tricky thing and I'm sure they do not want to pay for it. However, I am still unable to work after 1 year of conservative treatment. They have found evidence of degenerative disk disease and yet the doctors say this can affect some people with pain and others it does not at all. All I know is that I cannot sit for more than 20-30 minutes at a time without pain. My job consisted of sitting at a computer 8 hours a day. I have physician statements describing limitations of no heavy lifting no sitting or standing for long periods of time. My letter from my employer states you are considered disabled if you cannot return to work and perform with reasonable continuity the material and substantial duties of your customary occupation. After a Physician advisor reviewed, they state the medical documentation does not support that my condition is of a severity that it would have significantly impaired my ability to work and therefore the claim is denied. It looks like my appealing will just result with the same decision. Can a lawyer help with this type of situation?
 


aquaticmami

Junior Member
Shame on your employer

mikster said:
Virginia.
I fist began symptoms in May of 2004. I had severe sciatic and low back pain. I was out of work for 6 months and although I had to fight with my employer each step of the way, my short term disability was approved time and time again. Partial salary was paid during that time. When it turned into long term disability after the 6 months of STD, my employment was terminated and I had to re-submit all of my paperwork along with medical records for 18 months. Apparently they made a mistake and thought I did not elect a LTD benefit for the previous year although I did and they are now aware of it. After 4 months of this hassle, the LTD folks sent me a letter denying my benefits. I understand back pain is a tricky thing and I'm sure they do not want to pay for it. However, I am still unable to work after 1 year of conservative treatment. They have found evidence of degenerative disk disease and yet the doctors say this can affect some people with pain and others it does not at all. All I know is that I cannot sit for more than 20-30 minutes at a time without pain. My job consisted of sitting at a computer 8 hours a day. I have physician statements describing limitations of no heavy lifting no sitting or standing for long periods of time. My letter from my employer states you are considered disabled if you cannot return to work and perform with reasonable continuity the material and substantial duties of your customary occupation. After a Physician advisor reviewed, they state the medical documentation does not support that my condition is of a severity that it would have significantly impaired my ability to work and therefore the claim is denied. It looks like my appealing will just result with the same decision. Can a lawyer help with this type of situation?
First, shame on any employer who makes a disabled employee feel guilty for suffering a disability and taking advantage of benefits they've paid into during their term as an employee. We don't pay into these plans without reason and it's rather sickening that employers take this stance to get out of their responsibilities.

Second, yes an attorney will definitely help. They will take a percentage of the benefit you are awarded (usually back pay from when you filed the claim.) The attorneys will know the right way to file an appeal to obtain a positive outcome. Also, there is less chance of denial with an attorney, because the appeals committee knows addtional appeals may continue until the case goes through. I've heard of up to three appeals and then a win. Usually, they will not take the case if they don't think there is a possibility of winning, because that's how they are paid. I'd look into one.

Last, don't ever allow anyone to make you feel badly for suffering the effects of a disability. Insurance is for the purpose of covering a risk, disability, health, or otherwise. The idea that we pay into these plans and should never expect the benefits is lunatic. It's like saying we purchase auto insurance and never expect coverage.
 

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