Short Term and Long Term Disability through my Company

Hello,

I am currently on short term disability leave (have been since 1/1/09) due to syncope issues.  I have been to my family doctor, had heart tests completed, went to an endicronologist and am currently working with a neurologist.  I have fainting and dizzy spells several times a day, and have totally blacked out about five times over the past year, the most recent episode a few weeks ago where I fell and hit my head and was admitted from the ER to the hospital for three days.

I am working through my company's disability company, [insurance company name removed], who is giving me a difficult time claiming my benefits because there is no firm diagnosis for these syncope episodes.  However, as these episodes are so frequent and come on unexpectedly, I cannot drive due to fear of fainting at the wheel, and am unable to concentrate to work effectively.

My question is - how do I deal with my insurance company who is making it difficult to collect benefits, especially given the fact that I don't have a firm diagnosis, yet have dangerous symptons making me unable to work.  Also, my ST disability runs through for 26 weeks, then onto LT disability after that, both of which are at reduced pay.  How does being on disability impact my employment?  I have passed the FMLA 12 weeks job security, and if I am able to retain a lawyer and get my disability approved longer under ST and into LT, if my company terminates me, do I still collect these benefits through my company's insurance company, or am I left with nothing?

Any help is GREATLY appreciated.  I am the sole income provider for my family, and am greatly worried about the position that I am in.

Thank you!

I am working through my company's disability company, [insurance co. name removed], who is giving me a difficult time claiming my benefits because there is no firm diagnosis for these syncope episodes.  I assume you're referring to claiming LTD benefits (carriers examine those claims with much greater scruitiny than they do STD claims.)  Please explain what you mean by the "difficult time" they're giving you.  Are they requesting you see a doctor of your or their choosing for a second opinion?  Have they denied your LTD claim?  Something else?

 How does being on disability impact my employment?    It doesn't.  But the length of time you're on medical leave does.  After 12 weeks of FMLA, your employer is free to terminate your employment if you are unable to return to work.

 if my company terminates me, do I still collect these benefits through my company's insurance company, or am I left with nothing?  As long as the disability began while you were employed, the carriers are obligated to pay STD and then LTD benefits to you under the terms of those plans.  If your employer terminates your employment, that has no bearing.  You should take a look at the insurance certificates for both plans and review that language.  You should also take a close look at the language in the LTD plan as to how it defines disability, which very likely will be considerably more stringent and specific than how it's defined in the STD Plan.  You'll also want to see how/if the LTD Plan integrates with SSDI benefits if you become eligible for those - and what your obligation is (if any) to apply for SSDI benefits is under the LTD Plan.

Laymans take:

My spouses LTD covers up to 52 weeks--and there is lots of incentives to the employer to seek to have it shut off. But with this particular employer they tend to bend the rules to include people--others want you to trip up so as to lower thier costs!

I would suggest you take great care to play inside the plan  or employer rules---and skilled counsel would be a big big plus if there are significant $$ involved.  Don't make the foolish mistake like one of my friends did when employer said she was ready to return to work and she did not appear--got fired on spot--lost big time. I told her to show up--she was bull headed.....

In your example I can see some merits to having another drive you to work and showing up BUT this is major technical area and I strongly suggest you get counsel first--before you reappear at door step.

But you need to check things out--in some cases if you reappeared and worked for a few weeks you would restart the time clocks.  One plan I know of (its on my desk) you can restart some clocks by showing up for a day or two,   You have your attorney review YOUR plans and rules .

In some cases it may be better to show up and have employer decide its unsafe to have you work V you decide its unsafe for you to show up-and employer says you are unwilling to work --but you leave the technical call to your attorney!

My spouses LTD covers up to 52 weeks--and there is lots of incentives to the employer to seek to have it shut off. But with this particular employer they tend to bend the rules to include people--others want you to trip up so as to lower thier costs!

1)  How many spouses do you have?   :)

2)  LTD plans, by their very nature, are virtually all fully insured and once the claim is made, are entirely in the hands of the LTD insurance carrier.  Other than supplying job/employment-related information, the employer has no hand whatsoever in making the decision to approve or disprove benefits.  And since LTD premiums are totally "group pooled," there is no premium impact at all on an individual employer if a claim is approved.

3)  I don't know what type of disability benefit your spouse has but at 52 weeks, it's not an LTD benefit as understood within the insurance/group health industry.  A bonafied LTD benefit will run to age 65 and sometimes longer if the claimant becomes disabled at 62 or more years or age.

I am currently still on STD disability.  The insurance company is giving me a difficult time meaning they keep telling me to go see my doctor ASAP even though I tell them that I need to wait until they get my test results.  As of now, they have approved my STD until my appointment with my neurologist tomorrow.  My issue with the company is that without a firm diagnosis (which I will know tomorrow after my appointment), the insurance company says I should be okay to return to work.

Do you happen to know a good attorney that I can work with in the state of Michigan?  I have had a hard time finding one that could specifically help me with my disability insurance carrier for now and for the potential future LTD insurance benefits.

I appreciate your responses!

My issue with the company is that without a firm diagnosis (which I will know tomorrow after my appointment), the insurance company says I should be okay to return to work.  That just doesn't make any sense.  Many people have to go on medical leave with debilitating symptoms that can take quite a while to diagnose.  Given your symptoms, I can completely understand why that's proving challenging.  Some ailments are only diagnosed through a process of elimination (through all sorts of tests) and that takes time.

Do you happen to know a good attorney that I can work with in the state of Michigan?   Sorry, I don't but even if I did, I couldn't give you a referral as it's against the rules of this board.  (Besides, you don't want to trust your legal affairs to an attorney some stranger on a bulletin board suggested.)  Contact your local or State Bar Association and ask for referrals to attorneys in your area who handle this type of issue.  (Personal injury attorneys likely do as well.)

Good luck.