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Company STD and LTD Benifits

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What is the name of your state? Michigan

I have a friend and she was on short term disability at her company, and they have a short term program which gave her some money. She also has a long term program at her company, and she has been forced to stay off work longer then she expected, and the company is giving her a hard time about paying the long term disability benefit to her so far. The keep giving her excuses and stalling, saying they haven't made a decesion yet. Should she contact her company on this issue, or seek legal help for this situation?


I'm a Northern Girl
On what basis are they holding back? What reason have they given her for not yet making a decision?

Is the plan self-funded (i.e. benefits are paid by the employer directly, not from an insurance carrier or plan administrator)?

What has her doctor said about her ability to return to work? When does the doctor anticipate her being able to work? Will she need any restrictions or accomodations?

Need this information before commenting further.
Extra Information

Insurance Company says they have contacted her mulitude of doctors she has seeing looking for was her medical problem and they need information from all of them before they can make any type of decision. She has also contacted all the doctors to send information to the insurance company. A couple of them haven't responded to the insurance company. They have told her it's her responsiblity to get them the needed information to make a decision. She has called these doctors several times and they promised to send the information, but the insurance company says it hasn't been done, and it's her responsiblity.

Insurance carrier is used by the company to pay the LTD.

She told me that the doctors have found a medical problem that may keep her from being able to work maybe for the rest of her life. They are trying many different medical procedures and medications to help her with this problem, not sure at this time what the overall outcome will be for the future.


I'm a Northern Girl
From what you are saying, the problem is not with the employer or the insurance carrier. It's with the doctors.

The carrier DOES have a right to her medical information before making a decision, and after the initial request, it is NOT the responsibility of the carrier to go after it. They are correct that, given a choice between the carrier and your friend, the responsibility belongs to your friend. Nor is it the responsibility of her employer; in fact, under the new HIPAA restrictions her employer may not be ABLE to do anything about this.

She needs to get on the doctors about supplying this information to the carrier.
Records at doctor's office

My friend says she has gotten all her medical information from all but one doctor's office for the insurance carrier. She has called them many times and they keep promising to give her the information, but it just isn't happening. Does she have the legal right to go directly to that doctor's office and request her medical records from that doctor, so she can forward the needed information to the insurance carrier. She also told me the insurance carrier is giving her a hard time about her needed to have every single doctor's medical reports, missing one they told her won't meet their requirements.


I'm a Northern Girl
Yes, she is allowed to go to the doctor's office and demand a copy of her records.

You seem to be implying that the insurance company is being unreasonable in looking for the records of every single doctor. If YOU were the one who was going to have to pay out many thousands of dollars, would YOU not want to make sure that you had ALL the information before making a decision, or cutting that first check? Would YOU go ahead and cut the check, and then trust that the recipient would return the money if it turned out that the missing information disqualified them for the money?
Thanks for the quick response!

Hi cbg,
I will tell her she has the right to demand those records, thanks for letting me know for her. Also, I can see your point, your right, if I had to pay out thousands of dollars I would want every detail possible!

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