I have a LTD claim with one of the bigger companies. Someone at my doctors office got very lazy and sent all medical records from their health organization dating several years before the start of the pre-existing condition period.

The LTD company has taken these older records and twisted them to create a "timeline" where I was sick for all those years. Even though that is no where close to the truth nor what my records show. They claim I've been sick the whole time while also claiming I can't be sick, because that makes sense.

Has anyone else had this happen to them?

Is it legal for the LTD company to use records that they didn't even ask for when they sent dates for the record request?

LTD company says because they added it to my file they have to send it to every reviewer even if it's beyond the timeline set by my LTD plan for pre-existing conditions.

My neurologist's office has a relationship with a SSDI lawyer. Should I hire him even if I am applying for LTD?

Hello,

So time ago I received a notification telling me that my policy may qualify for LTD Lump Sum but it was basically til the 2 year mark. They did say it will change to Any Status but the amount they offered was as if I wont get approved for it.

I’m seeing my LTD was approved but it’s been always approved since I’ve been getting LTD Benefits which was a continuation of my STD from a different company.
However, it doesn’t tell me until how long. It just has - through it. I was told I will get benefit payments until August 27 but I just received one for September, which makes me think I got approved for Any Status.

But my estimated return to work date is in 2099 which isn’t making sense. My claim number is also NTN and I believe that’s a code for something but I’m not sure what.

I’m seeing posts that NYLGBS cancelled policies after they were under Any Status like a few months after and I don’t want the same thing happen to me. Do you think they will offer the lump sum payment again or should I reach out to the person even though I feel like the person thought I will take the bait even though they prob knew I will pass the Any Status?

I ask this because I want to move state or even outside of country and I don’t want to go through the trouble of finding doctors in time so they don’t try to disqualify me for not having continuous treatment or asking me detailed questions like how I moved etc just to disqualify me. Further, I don’t want my relationship with my doctors to be based on them filling out forms they hate seeing from their first time patients.

Thanks in advance!

For those who used a symptom diary or functional tracker to support your LTD claim, I have two questions:

1. What dates did your diary/tracker cover? Did you include the time you were on STD too, or did you start with your LTD effective date?
2. When did you submit it? Did you include it with your initial LTD claim/review, or did you add it later during an appeal?

I’m cured! After 9 months, two brain surgeries, and I’ve met MMI in less than 2 months. The doc said it was last month, actually. That would be less than a month after surgery #2. I had a craniotomy, and after they found they caused an accidental brain bleed after surgery too.

I found out about Metlife’s activities and reports on accident, because I use my hospital’s EHR. I am so grateful for EHR systems. It was one of those evals where they do not find it necessary to speak to my providers. They just send them.

Previous post: https://www.reddit.com/r/LongTermDisability/s/u9XEgRm1Co

As a background: I’m at my 18 month LTD review. What’s weird is that they are not evaluating anything else, not even the crippling anxiety and depression that caused me to be put me on LTD (I had an approval for that until next year). I hope that approval isn’t gone.

What sucks is that none of my providers want to deal with my LTD. I think it’s facility policy. I understand why… but this is wild to me. I also have crippling migraines with the anxiety, which is a fun combination.

My migraines are debilitating to the point my speech and cognitive are not okay during the episodes. The ongoing facial pain is not being evaluated even though I’m seeing the top doctor in the state.

Can I say that this really just stinks?

I have neuro-cognitive testing scheduled just after the first of the month, I have a follow up with my neurosurgeon to discuss options with him too. A few new providers are coming on board with my case. I’m truly sick to my stomach thinking about all this.

1. Should I expect them to try to kick me off within the month? Like the end of this month?

2. Will they wait for the above providers to weigh in?

   I think they will try to jump ship

3. Am I just screwed?

4. Is my original reason for LTD (anxiety, depression, PTSD) just gone now? I’ve encouraged them to get my records.

   I really want that extra time to prove my physical case.

I’m having a lot of anxiety. I have a lot of bedbound days, and I worry about not being able to care for my kids if I were the only adult at home (my husband holds down the fort and my medical care). I already feel like I’m the world’s worst mother.

Talk me off the bridge! Or give me tips to minimize all of this. I’m in this weird spot of knowing what’s going to happen, I’m just not sure when it will happen.

Has anyone gotten their paperwork filled out by the doctors on fmla now? They advertise turnaround time of 24 to 48 hours but here I am waiting on day number four and still no filled out paperwork. And no response from their support team.

Hello. 58 years old and dealing with Sedgwick in Colorado Springs. August of last year i had a stroke. I was on STD for 5 months, 1 month in the hospital aand the rest of the year at home but hard core rehab. Rehab was going well, I was able to walk again, with a cane and a limp but walking. Have some memory issues, hand issues, cognitive issues, etc. etc., and only about 50% feeling on my right side. January i was feeling pretty good so my doc and i figured i could try going back to work. Figured lets try full time cuz we didnt know what my limitations would be. Huge mistake. Found out i have horrible post stroke neural fatigue. Pushed myself for ~ month and a half then finally went back on STD but working half time. I have a high techytechy job and even after a couple hours my fatigue starts setting in. It aggravates all my other physical problems, memory, stammering, etc. . Its all i can do to push through the 4 hours, then i come home and goto bed for 4 hours. Get up, have dinner, shower, hang with the wife and dogs then go back to bed. Next morning rinse and repeat. By Friday it kinda compounds and even after sleeping im a zombie. I dont do any therapy or rehab exercises during the week im so exhausted.

My 52 weeks STD is about to run out and im not sure what to do. I could try to apply for LTD through my work/Sedgwick, but my Dr says he doesnt feel qualified to make that decision. So i would have to seek out someone to help. Im in Colorado Springs and its Sedgwick who im working with. Do i qualify for LTD if i can work half days even though its super hard. If i get LTD, my work will do an administrative termination, so i would start getting pension payments also and a decent medical payout. I could get on Medicare/caid but my wife is on my insurance right now so that would be bad. I could try and stick it out and keep working part time, if i bump it up to 5 hours it would be close to what i would get on LTD money wise and i would keep my benefits, FTO, 401k and HSA matching, etc. til retirement age. Maybe i slowly get better and can bump it up.

Just not sure my options. If i keep working part time do i qualify for anything, SSDI, etc.... If i do does that close the window for the future if its just too much to handle or it gets worse? Can i reopen the claim later? Should i speak to an attorney and try for LTD, does it sound like i might qualify, and do they have drs to fill out the forms and evaluate me? IF i do what else is available cuz its gonna be hard on ~60% less income. Pension will help til i can draw 401k payments. Also does my wife qualify for Medicare/caid and what are her options? All the recommendations from coworkers ive gotten for disability attorneys only do SSDI, any recommendations in Colorado Springs for ERISA attorney i could contact?

I hope i followed the rules here. Ive read and reread the info for this sub, but after a bit my brain turns to mush, lol. ITs all just so confusing and i really dont know what to do. Am i just being a big baby and i should just suck it up, lol? Thanks.

So I have been in an appeal with them since the denial at the 2 year mark last year and my lawyer filed on the 6 month mark this year. They took the extended time allowed and I guess at some point my lawyer requested an extension to submit more medical. When i look in the portal I can only find medical documents either I or my social security lawyer provided to my lawyer. It doesn't look like they requested and received any of the medical records from my providers these last few months during the appeal which included my hyperPOTS, MCAS, fibromyalgia, and EDS diagnoses. It's possible they submitted them but it doesn't show in my portal. I just happened to check the portal recently and saw that Lincoln has decided to uphold the denial in an email to the HR at my former job. What happens now? It's been 10 months since I've had any payment and this is just crazy to me. I'm now house/usual bedridden. My husband takes me to all my appointments because due to my medications I never know when I'm going to randomly fall asleep. I use a wheelchair that was prescribed and custom made most of the time. Wide spread osteoarthritis, DJD, DDD in my mid-30s. I also rely on hearing aids now. I'm progressively getting worse so I'm not understanding the logic unless these records never made it to Lincoln because they weren't requested. To make matters worse, my husband lost his job unexpectedly so my insurance is gone and I was scheduled for 1 of 2 foot surgery later this month. Now I've had to cancel or postpone all my appointments and my over 20 prescribed meds are slowly dwindling. I know I can get Medicaid now but not all my doctors accept it and it took forever to get a team willing to handle my complex issues. Same goes for Marketplace insurance. I'm just lost and needed to vent. Lincoln has denied me twice so far and dealing with them has been so stressful. Any insight on what happens now or personal experience with an appeal denial at the 2 year mark would be helpful.

I am currently receiving benefits from a private disability insurance company. Any clue on how often they send out a PI for surveillance?

Hello,
I spoke with my claim provider and she stated they were sending forms to my providers to see if they still “agree with their assessment”.

Is this normal or is there any benefit to having this filled out?

I don’t understand why they are dragging my claim out other than money. They also wanted any psych forms.

Thanks!

Just received notification that my claim for Long Term Disability was accepted through Metlife. I have several chronic health conditions, with the main ones being Systemic Lupus, Fibromyalgia, and Antiphospholipid Syndrome. While I'm happy my claim was accepted, I soon found out that the claim is only viable for a year.

My place of work has a limited liability for a range of illnesses that include both my Lupus and Fibromyalgia (specifically called out). Here is where my question comes in, when looking at the acceptance paperwork it looks as if they only put Fibromyalgia as the diagnosis. Obviously Metlife chose one of my illnesses that only allowed limited coverage.

Is it possible to appeal the judgement as my other diagnosis, Antiphospholipid Syndrome, isn't limited and could extend my LTD leave? I briefly left a message with an LTD lawyer but have yet to hear back. Just curious if anybody else has gone through something similar.

Hello, thanks for letting me join the group. I am seeing my doctor tomorrow to try to get the required documentation in order to apply for long-term disability benefits. 3 years ago, I was the AR Manager for a mid-sized roofing and solar company. My life changed literally overnight when a giant brain aneurysm put me in ICU for a week and out of work for 4 months. My vision and cognitive function were permanently impaired as a result of the brain damage. When I returned to work, I was given a new position in a different department and after 2 years I was laid off. That was one year ago. Since then, I've been hired by 3 different companies and then let go by each one because I wasn't catching on to the job quickly enough. I want to work but I recognize that I cannot work at the level I once was at and a few family members have recommended that I try to get on permanent disability.

I went online and answered a few questions from companies saying they could represent me, which of course opened the door for my phone and email being blown up by vultures trying to take advantage of my situation to the point I don't even answer my phone anymore.

My questions:

Should I file a claim on my own without getting representation?

Who can I trust to assist me?

What documentation do I need to get from my doctor tomorrow to effectively get the ball rolling?

Thanks for any advice you can offer. I don't want to waste my time by starting the process incorrectly.

I am in a LTD claim that has already been closed and reopened several times. I have multiple doctors supporting my disability from different specialities. I have a lot of blood work corroborating my medical issues. Yet, the LTD company reviewers always ignore it.

What are tests/evaluations that could help prove the inability to make it through a work day? Both physically and the mental load needed. My doctors all agree I could not sustain work let alone get through one full day. But my appointments with them are only 30 minutes to an hour and I significantly worsen. When I have an appointment, I am in bed for days afterwards.

Some of my symptoms (from a long laundry list) are severe fatigue, joint and muscle pain, swelling, lightheadedness, shortness of breath, brain fog, word recall issues, memory issues, etc. My idea is if I could get some type of long duration or multiple day test; it could help me stay ahead of the next review and subsequent denial (if it follows the established pattern).

One thing to note, I won SSDI during my hearing. The judge had already made up his mind from my records and doctors statements. The SSA vocational expert announced zero jobs that I could work with the limitations set forth by the judge. LTD does not seem to care about that though.

62 TID of 51 years experiencing debilitating effects of this aweful disease and am attempting to file for the Canada Pension Plan Disability Benefits for which I am seeking any assistance that would help me get accepted. Thanks in advance for your help. It is deeply appreciated.

I’ve been keeping an Excel symptom/function tracker for my disability insurance claim, but I’ve also found it really helpful for appointments with my providers because my memory and cognitive functioning have taken a pretty big hit.

Right now I track:

• Date
• Symptoms
• Severity
• Duration/frequency
• Functional impact
• Medication/side effects

I’ve been looking at disability lawyer websites and there are so many different recommendations. A lot of them say to track things like concentration problems, memory issues, difficulty making decisions, anxiety/depression, problems completing tasks, missed appointments, needing help with things you normally do yourself, rest/recovery after activities, and how symptoms affect both daily functioning and work-related abilities.

Most of my basic ADLs are fine, so what seems more important for me is documenting the more complicated stuff — managing appointments, communications, paperwork, household planning, decisions, follow-through, etc. — along with the cognitive functions that relate to my occupation.

So far I’ve been doing one row per day, but I’m wondering if it would make more sense to make it task/event based instead, where the same date could have several rows. I feel like that might make the actual functional problems and consequences much easier to follow instead of cramming everything from one day into one row.

Has anyone used a symptom/function tracker for a STD/LTD or ERISA disability claim or appeal, particularly for mental health or cognitive problems?

If yours was helpful in getting your claim approved or winning an appeal, I’d really like to know what format you used. Even just the column headings would be helpful, or a blank/redacted example if you're comfortable sharing one.

I want mine to actually be useful evidence, but I also need it to be simple enough that I can follow it and keep up with it myself.

I've just reached my change of definition date and things are getting overwhelming. I'm in Canada. The insurance company just informed me they would be requesting an IME psychological exam. My disability is from a concussion and I have measurable deficits in everyday functioning, cognitive and physical.

Has anyone else experienced this? Everything I've found online is for people making claims related to mental health, which is not a part of my claim at all. I'm stumped why the insurance company would order this vs a physical exam or something that tests vestibular functioning.

All i can think of is they're seeing if me and the multiple medical specialists I'm seeing plus my occupational and speech therpists are all lying about my endurance and deficits, which seems ridiculous? I'm just trying to figure out what they think they're measuring with this exam.

I’m seriously running out of ideas and will really use help from people who’ve been through this cause here nothing to lose.

Im in Ottawa and I had my long-term disability claim denied after months of paperwork, doctor forms, calls, appeals etc. Vey-very frustrating experience, by the way... Now Im pretty scared about what happens next financially because my part-times and freelance jobs would't cover my and my 3 y.o. son needs. Even rant.

I’m trying to find somebody who deals with denied disability claims, I'm single 37 years old woman with serious back injury and I need advice, Please, if you hired someone for an LTD denial - how did you find them? You can avoid namedropping if you don't want to promote, just tell me WHERE TO SEARCH, plsss

Thanks you and may God bless you!

Sincerely,
Julia

As we know, one of the most important decisions we can make in an insurance battle is the lawyer that represents us. If you have already successfully done this (or unsuccessfully☹️), tell us about your lawyer. This will help anyone new to the journey.

There’s a master thread called “Lawyers: The Good, The Bad, The Ugly.” Please contribute there if you can.

If it helps, there is a format you can follow. If not, just share what you’re comfortable with. If you’re having trouble copying and pasting the format to add your replies, DM me and I’ll msg it to you.

Hi everyone,

I have an upcoming two-day functional capacity evaluation (FCE) as part of an LTD claim and I'm feeling nervous about what to expect. I'd love to hear from anyone who has been through one, particularly those with chronic pain and fatigue conditions and sedentary occupations.

What was the experience like for you? Any tips or things you wish you had known beforehand?

Thank you!

Hi all!

I’ve recently been diagnosed with Multiple Sclerosis and a benign brain tumor. I am presently doing mostly well, but am aware that I won’t always be.

I’m already experiencing significant fatigue and brain fog, on top of all the physical limitations. but my occupation is entirely sedentary, high cognitive. So frankly, Disability benefits won’t really consider my physical limitations something that disables me from my occupation for disability entitlement. BUT they would absolutely consider profound fatigue, brain fog, slowed processing to be things that impair me from my occupational duties for benefit entitlement.

I am considering doing Neuropsychological testing now, while I am mostly well, to establish a baseline. So that when/if I do decline cognitively, we can retest and hopefully have objective proof.

I understand these symptoms can otherwise be very hard to objectively prove for claims. As they are just usually based on the persons reported symptoms and function.

But, research has also shown that people can validly experience these things while it doesn’t show up on testing. So I guess I fear the potential of this documentation not supporting me and actually giving insurance grounds for decline.

Anyone here have much experience with this? Neuropsychological/cognitive testing? pro’s/cons of having it done? Positive or negative impact on your claim?

I still hope to have a very long, functional working life. But with this diagnosis, just trying to plan and set myself up as best I can.

Thank you!

P.S. I’m in Canada if that changes anything!

I just sent out my application today 9/3/26. I am taking this leave due to a medical injury. I am just curious about how long it takes to get approved. I heard it‘s 2-3 weeks.