has anyone had to go onto LTD from work and if so has it been beneficial or not? Reason I ask is that I went on Short Term in May which is approved for 6 months. At that time (November) for me I either have to be well enough to go back to work or go on LTD. I have been paying for LTD Insurance for about 30 years or more. Only now, I find out that the insurance company (Sedgwick) forces a person to apply for Social Security Disability as a requirement. Then they deduct the amount I will get from SS from what they would pay. Incidentally, if I choose to collect my pensions, they deduct that too. Thus they basically wouldn’t have to pay a thing as my pension along with SSD would be greater than the 60% they payout. Thus, I am unable to collect from my pension at all until my LTD runs its course. So the only way around this is to try to return to work in November even though I have stage 4 Metastatic Prostate Cancer and thus I really wasn’t intending to do that.
Fortunately, I am doing quite well as of now as I am on the PSMAddition trial but it has been quite the journey so far as I live in NM and have to drive back and forth to Mayo in Phoenix approximately 500 miles away so my wife and I have made this 1000 mile round trip over 20 times YTD but again, I am doing fairly well with this treatment.
Now I feel I have no choice but to try to go back to work which I really did not want to have to deal with. I feel like Sedgwick’s practices are unethical and misleading. Does anyone have any experience with this and have any suggestions for me?
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PC-22
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I can tell you SSDI is permanent Disability. You most likely will get denied, and need to file an appeal. (Wife been there done that) Appeals can take months to years.
Very little is simple when it comes to disability benefits. "Why Is Your Onset Date Important?If you applied for Social Security Disability Insurance (SSDI), your onset date determines how much in past-due benefits, or "backpay," you might get. The SSDI program offers up to 12 months in back due benefits, so having an earlier disability onset date means that you'll get a larger lump-sum payment. Your onset date also determines when you become eligible to enroll in Medicare. And because Social Security doesn't pay short-term or "temporary" benefits, your AOD helps the agency decide whether your health conditions will be disabling for at least one year." disabilitysecrets.com
I apologize if you get a reply from me twice. I thought I responded earlier but I don’t see it so perhaps didn’t actually send it. Anyway, from what I understand, Stage 4 Metastatic cancer falls under SS Compassionate Allowance disease thus should be streamlined.
Even if not, apparently once they finally approve they will back pay to original date applied for benefits. Thus Sedgwick even has a clause in this case that if /when SSDI does back pay, I would also be responsible to reimburse Sedgwick back to that date. I feel this is fraudulent on their part as my understanding is that I have paid into SS for over 40 years so since and since Sedgwick reduces this amount is basically them paying me with my own money. In my case, I do not see LTD as a company benefit but rather another hurdle to navigate through.
I spoke to one of my representatives supervisors this morning and all she could say is that that’s just how it is. I could tell she was nervous when I told her I think I am going to have to get a 3rd party (Legal) to explain how they can do this to people. In the meantime, I only have to go back to work for 90 days to reset my Short term benefits thus kicking this can (LTD) down the road another 6 months from that time.
What a nuisance but as of now I do not have much choice but to play their game.
My husband had paid into Long Term Disability. After diagnosed stage 4 we were initially refused. We immediately contacted a lawyer who took our case.
All I know is the are slimy when it comes to paying LTD. He was 55 at the time. I was handling most of this snd yet it all dropped from my brain except you will need a lawyer. The lawyer took a % the first year. At 65 the disability stopped I believe. He lived 14 years with stage 4. Good luck. There was some clause about how many times they can deny you. I remember being grateful that we acted quickly. All I can say is we were shocked and then disgusted, but we won our case.
I am in Canada so the rules may be different. I did short term from my disability insurance and have been on long term disability for almost 5 years now. Mine also required me to apply for the government disability pension (Canada Pension Plan disability) which is deducted from my LTD. Like you, my LTD also pays about 60% of my former income.
During this time my regular pension is continuing to grow. The rules say I must switch from LTD to my regular pension this spring when I turn 61. My LTD looks less but is not taxable so my net income will be about the same when I fully retire at 61.
My advice is to not to go back to work. I have found that I need much less income than I did before. I have savings if needed but I haven't touched them yet. I have had a great 5 years of retirement, spending lots of time with family and friends. I have had fun checking things off my bucket list. I don't know how much longer I have to live so I'm making the most of it now.
My current PSA is undetectable. My bone mets are not visible on scans. Other than the medication side effects, I'm feeling great. I attribute a lot of my good heath to the lack of work stress and the time I have to focus on a healthy living lifestyle.
I love this kind of attitude .. . . A career can be a fullfiling pleasure but presents a stress when we are managing a disease, ours or someone else's. I just passed 19 years since dx, have had many recurrences and treatments but always try to "live" like I don't have a disease. I do have my mentally "down" times and find a way to pick myself up. Good continued luck!
I don't claim expert status, but I do have some past background as a licensed agent. The terms you are describing sound fairly typical for an LTD policy> it sounds like you participated in an employer LTD group plan administered by Sedgewick? To my knowledge, Sedgewick is an administrator, and not an insurer.
I think you are exactly right. After reading your reply I am pretty sure Sedgwick is the administrator, and yes it is part of employer LTD group plan. I guess I just never realized that this plan that I have contributed to the last 30 or so years of my 40 years with the company is basically worthless to me.
After reading the plan in detail I also find it interesting that it does not apply in a few states like California and couple of others. Seems like perhaps this issue came up in those states and their state labor boards got involved or something. Anyway, I think I will be okay but was very surprised they could do this and I am still very frustrated with the situation.
Unfortunately New Mexico has nothing like that. And although we are a poor state, I think SS distributions are taxed here. I guess it doesn’t matter that much since the insurance company will garnish the whole amount anyway
If you received the benefits that you apparently thought /hoped the plan provided, the premiums would have been much higher I'm quite sure. Had you been younger and not near SS/pension age, would your view of the coverage be different?
I am on Prudential LTD, and they also force you to apply for government disability, but they also provide a company to represent you in that claim that streamlines the process and makes your chances of approval higher. There’s nothing about them, forcing me to take or have any part of my pension, though
I probably didn’t write clearly in regard to my pension as I was so upset.
Anyway what I meant to say is that I am “Unable” to collect on my pension because if I do, they will Garnish that too. At least the amount between SSDI and the remaining amount owed so that there is literally nothing left for the insurance company to pay out.
thanks. After reading maley2711’s reply I am sure that Sedgwick is the administrator rather than the insurer. And yes I also think they would help streamline the process as it benefits them for me to get approval. I just feel that receiving SS benefits should be separate from LTD as I have paid into them separately, thus I thought they would pay out separately.
I to was surprised to find that ltd deducts pension and social security benefits from their coverage MetLife is my insurance…You can yank your elected officials that allow this unethical if not criminal practices by insurance company… They essentially pay nothing… of Human Resources did not advice me of this loop hole… but I also carried critical illness insurance which they promptly paid a one time sum of 20,000 … infuriating…
It is not unethical or illegal......it is clearly in the contract/policy that each insured receives when approved for a plan. If it didn't work that way, the premiums would be higher.......and you can buy such policies if you don't mind higher premiums.
My point is that unless you read the contract word for word you will miss this stipulation…it may not be illegal but it’s certainly unethical… This should be right at the top of the contract in bold letters so you don’t overlook or miss it…
I went though some of this with Anthem Ins. I was able to appeal their initial denial and get my SSDI in place with the help of a Disability Specialist. These folks charge charge less than an Attorney ($220/hr in my area) and are willing to either act as a coach or manage the whole thing. I was able to draft the appeal and review it with them. used some of the same content to get a compassionate allowance through SSA at the same time. It is stressful and at least a half-time job.
Thanks, I don’t think I would have any issues being approved for SSDI. My frustration is that the insurance company will garnish my entire account. Makes no sense to me
Its not a scam. Look at your policy. If it were as you expected the premiums would be sky high. All LTD policies are that way. Anyway, it looks like your SSA claim will be fast tracked.
Yes, I am sure it will be fast tracked. And although there is mention of it like on page 341 of a four hundred page plus company plan, this has never, not even once been (highlighted) during open enrollment.
The message they alway say is that LTD protects you with up to 60% of pay due to qualifying injury or illness. They never say anything about garnishing SS benefits or pension benefits. So yeah, I still feel I have been scammed.
My simple initiation into insurance complications: my last FT job did not inform Medicare that I had retired and changed to part-time status . I strongly believe that the company was self-insuring, so my premiums were sticking to their fingers and not going to any third party. My medical expenses for six months were billed through the company health insurance instead of Medicare. Five or six phone calls did not get the change done, I should have sent a letter.
Wound up paying about $500 to one doctor when the dust settled. I wonder if the company had to pay the remainder of my insured expenses, or did some clerk in the main office figure out a way to bill Medicare for the medical costs I ran up during that six months?
As for LTD and LTC, it strikes me that "you can eat your fill of all the food you brought yourself." Not much different from a savings plan funded by regular monthly deposits.
BTW, I am about a year into stage 4, metastases visible on scans, just started Xtangi/enzalutamide, PSA dropping, working with the VCU Health System.
Thank you. I too am about 1 year into stage 4 Metastatic disease. (Gleason 9) My local MO did not offer much of a positive outlook. I did research and was able to get on the PSMAdditions trial and my PSA is now undetectable but I still have considerable pain in both iliac bones, groin area, knees (especially right knee) and feet. I wish you well with your treatment.
I have been receiving LTD benefits through my employer for the past 9 years, I applied for and received them not long after dx. I tried working while receiving treatments and it was too stressful and difficult. My job required travel and had a lot of stress, not something I wanted in my life. I also applied for SSD and was approved so now I receive both and after a waiting period I have Medicare insurance.
I couldn’t imagine still trying to work while dealing with the SE’s of treatments. I enjoy every day now not knowing how many I have left and certainly wouldn’t want to spend them working. I’ve never heard a eulogy where someone says what a great worker someone was. They always talk about time spent together, that’s what’s important.
I will speak about what happened to us 9 years ago when my husband was 62. We had 3 LTD private policies. 2 paid right away until he was 65. The other one paid a total of 5 years. We applied for SSDI and that was not easy. Finally hired an attorney. He told us that if you get turned down, the appeal is 100% turned down. They actually just rubber stamp a no on all appeals. Insurance will be backdated to the first day you applied (even though you got turned down). Attorney (4K at the time) gets you a in person appointment with a judge. You meet with a judge in a room. While waiting for the judge we understood how picky they are because most the people look like they are addicts pacing rapidly. Anyway, minutes later judge approves SSDI. Super annoying that it took that much to get SSDI. The money you owe the attorney comes straight out of that (even though you will pay taxes on that portion). At that time, you qualify for the max amount you would get if you retired at max age. PS your LTD sounds no bueno.
Unless the criteria changed, a diagnosis of Metastatic Castrate Resistant Prostate Cancer is eligibility for medicare disability. No "agent" necessary, it's been a few years since I applied, it was remarkably easy, fill out the form/s, attach the evidence of diagnoses, 30 days or so for an acceptance was for me. You'll be paid retroactive SSDI to the date of diagnosis, a lump sump, then receive monthly SSDI checks. you'll also be on medicare disability. When you turn 65, you're automatically switched over to regular medicare, it was transparent, happened like magic. You'll also receive incentives to work and earn money up to a certain level. It was really easy for me. One downside is that your medicare annuity is somewhat frozen to the month you went on disability. If you have employer health insurance they will be come "secondary". I was 62. As I said, this was a few years ago, at that time I was somewhat disabled from chemo and other treatments, but I've recovered with durable remissions between recurrences. I know someone will followup with questions, I prefer not to answer them, just go on what I wrote above. Good luck!
PC-22, I am collecting LTC disability from my LTC insurer, Genworth, and they have abided by the terms of my LTC policy perfectly thus far. My payments are not connected to my SS benefits. I don’t know anything about the company with whom you have your LTC policy, but insurance contracts are normally overseen by each state with different rules and regs varying from state to state. You can check with the NM department that regulates insurance, and the state will check and explain if the insurer is properly administering your policy. Sadly, insurance policies are skillfully written to protect the insurers from paying claims that they have the legal ability to avoid paying, and ethics seldom has anything to do with the insurance business. It is a biz of gambling and making money. They gamble that you will die before they have to pay you anything.
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