approved SSDI, denied STD/LTD ...

[pooh1965]

(Arizona)... Hi. I recently was approved for SSDI. However, I have been fighting for my STD/LTD thru my employer for the past nine months. They keep denying me stating I do not meet the definition of disability. They have never requested an IME. SSDI did however, request a consultative exam, of which I completely complied with. Regardless of what my physicians, therapists and other treating MD's state, my STD/LTD uphold their decisions. Now that I have been approved for SSDI and meet the definition of disability, what are the chances this approval could/would overturn my claim for STD/LTD thru my employer ? (they have been acting in bad faith, however this is an ERISA case, and I have yet to find representation willing to assist me).... any suggestions ? thank you for your replies....

 

[Beth3]

Each disability plan has it's own definition of disability. It's entirely possible to be considered disabled under one plan but not another.

From my experience (I'm a senior HR generalist), social security has a more stringent definition than most employer-sponsored disability plans, so it is odd that you'd be accepted for SSDI but not STD and LTD. However it all depends upon the language in your company's plan documents. Being accepted for SSDI is not necessarily relevant to being considered disabled for your employer's plans but it does make their decision to deny benefits increasingly questionable.

If you haven't done so yet, you need to file a formal appeal with the STD & LTD carriers in writing. Information on how to do that must be provided in your plan document/insurance booklets for each disablity plan. If the carriers still deny your claim, then your next step is to file an appeal with your State's Insurance Commission.

 

[pooh1965]

how to use the language of the policy to overturn a denial ??? .....

hi. thank you for your advice...I tried to file with my state insurance commissioner, but they wont assist me due to this is an ERISA matter. I then filed complaint with the DOL welfare benefit and pension dept..they too, stated all they could do is help me gain access to my admin. file which I already have.... I also filed complaint/request for review with my employer, as they are the claim administrator of the std/ltd policy...I did this about two months ago, and havent heard from them. when I called my STD/LTD, they advised me my claim is still in appeals. I first appealed around dec 2001. but it appears they are holding steadfast in their decision of denial. one atty I spoke with advised me to use the language of the policy to overturn their decision. and also requireing the claimant to accept such job modification was inconsistent with the plain terms of the plan, as it only required that she be disabled from her "reg occ" and not her "reg occ with modificiations".. my STD/LTD are claiming that if i felt i was disabled and unable to perform my reg occ at my employment, that i should have found employment elsewhere..but according to the above note by this atty, that would be considered a modification (finding employment elsewhere) and my SPD doesnt state " reg occ w modifications", just disabled from my reg occ .... does this make sense ??? they appear to be making unreasonable policy interpretations ... this is an ERISA case, and I have been unable to find an Atty willing to assist me in my area.... how do I use the language of the policy to overturn their decision ??? any suggestions greatly appreciated...thank you....