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RSD and Disability Insurance

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Unread 01-18-2013, 03:19 PM   #1
Nanc
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Default RSD and Disability Insurance

Hello All! I need some help. I have applied for disability through my work's short-term/long-term disability insurance carrier. They have denied my claim even though records document RSD/CRPS in my face and all four extremities. Does anyone with RSD who has gone through this process have any tips or recommendations for me?The medical review staff with the insurance company said that I could do sedentary work and my records did not indicate otherwise.

I had a functional capacity evaluation (FCE), but it only tested my strengths and weaknesses. It did not test anything related to using my hands all day at work, etc.

I am obviously going to appeal, but would appreciate any helpful information.
Thanks!!
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Unread 01-18-2013, 06:17 PM   #2
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Nanc,

I'm sorry you are going through this frustrating process. I am not familiar with short term and long term disability, but can support your decision about appealing the decision.
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Unread 01-18-2013, 08:06 PM   #3
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Hi Nanc,

I have not gone through that specific process, but my impression is that it must be somewhat similar to the WC battles and SSDI approval process that I have been through.

What exactly did your FCE say/conclude ?

I'll give the example of one filled out for me (and I forget the exact details, so I am making up these numbers.....) My PCP wrote that I could stand up to 15 min/hour, then multiplied that times an 8 hour shift, for a 2 hour total of standing per 8 hours. He also wrote that I could sit for up to 30 min/hour, then multiplied that times an 8 hour shift, for a 4 hour total of standing per 8 hours. That makes it look like I could do something that involved sitting and standing for 6 hours. Those numbers are my max. That also doesn't account for the 15 minutes each hour (or more) that I usually have to be laying down. Not many jobs can accommodate that. A FCE that just looks like I could sit/stand for 6 hours could and did sink me in my initial SSDI application.

Look closely at what your FCE says/concludes. You may or may not feel comfortable posting that info here....and that's fine either way, as long as you look at it closely. Don't read it as someone KNOWING you and your history. Read it as someone trying to figure out if there is ANY way this person can do ANY work for a few hours a day.

You may need your physician to write up a more specific FCE if he agrees that you are unable to work.

Best of luck. This is such a difficult process and the stress certainly doesn't help our pain issues.
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Unread 01-18-2013, 08:24 PM   #4
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To add.....your FCE should also reflect if you can technically perform an action, but that results in additional pain which must be treated with rest and/or medications that affect your ability to concentrate.
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Unread 01-18-2013, 08:45 PM   #5
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Usually it's required that once you're approved for long term disability insurance, that you then apply for SSDI. They will often provide an attorney at no charge.

There are definitely some similarities between both of these processes as well, and the stickies in the SSDI/SSI NT section should help. The publisher NOLO offers a very thorough guide on applying for SSDI as well.
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Unread 01-19-2013, 05:17 PM   #6
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I am on LTD through my previous employers policy. It was effective after being off work for 6 months before it came into effect. As Lit Love said they require for me to be on SSDI after 36 months. I have started the process and they provide the legal assistance.

I was not diagnosed with RSD yet when my claim with my LTD insurance was filed and approved. At that time it was considered post surgical nerve damage. I have limited use of my hand that started after surgery.

I can try and answer or help you with any questions. The LTD process took a little bit, but my adjuster who worked on the case was pretty helpful in the process.
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Unread 01-19-2013, 08:46 PM   #7
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Thanks for the replies!

My doctor completed the paperwork for me to go on short-term disability first (6 months) and then it would transition over to long-term disability. I understand that once it transitions over to LTD, they will work with me on applying for SSD. If SSD is less than the 60% I would received from the LTD carrier, then they would subsidize the difference.

We supplied the disability insurance carrier with the required forms, dr records and FCE and they denied the claim. They said that the FCE states that I can do sedentary work and the medical records do not indicated anything otherwise. My medical records all indicate RSD/CRPS in all four extremities and face. I have it in my face, both hands, shoulders and left arm, left leg and both feet. I do financial and HR work, it involves using my hands all day everyday! I can't just sit at my desk all day doing nothing...ugh!!

Finz - I am going to go through the FCE again and I will send you a PM if that's ok.

Thanks again!
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Unread 01-21-2013, 08:53 AM   #8
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Nanc, my wife received short term disability (6months) because of RSD. She worked in Benefits outside of DC. When her long term was due (2 year) her doctors were switched at the last moment (head of the pain center) in which the doctor explained for 15 minutes that my wife had RSD (in which we knew this for 3-4 years) And walked out on us never to be seen again. He denied her long term and told the employer she was just fine and dandy. This got the insurance company off the hook and sense my wife could not work, she could not return to work in which she was terminated, letting the employer off the hook. Since my wife worked in benefits she knew 3 years before hand how she would be terminated.

Nanc, be diligent and get all your ducks in order before the 6th month is up. Move that doctor squarely into your corner because you will need that doctors signature for the long term disability. If you don't get it you will be denied. If a spouse or family member can go with you to all your appointments that would be an advantage. Good luck!!
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Unread 01-22-2013, 07:02 PM   #9
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Quote:
Originally Posted by Nanc View Post
Hello All! I need some help. I have applied for disability through my work's short-term/long-term disability insurance carrier. They have denied my claim even though records document RSD/CRPS in my face and all four extremities. Does anyone with RSD who has gone through this process have any tips or recommendations for me?The medical review staff with the insurance company said that I could do sedentary work and my records did not indicate otherwise.

I had a functional capacity evaluation (FCE), but it only tested my strengths and weaknesses. It did not test anything related to using my hands all day at work, etc.

I am obviously going to appeal, but would appreciate any helpful information.
Thanks!!
Nanc
Hus was on short term then went to long term after company said there was no job he could any longer. He was approved for long term but we had to agree to apply for ssdi, which we did. Got denied. They provide us an atty to go to next step, the ALJ hearing. The rule with most LTD's is first year "you can do your current job". The 2nd year, it's you can't do any job. Read your long term papers and what they say for first, second year, etc.

The insurance companies do rely on what is in your med record per your doctors, etc. You need a doctor in your corner for your diagnosis.

No exp with your disability diagnosis, but do wish you the best....
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Nanc (01-22-2013)
Unread 01-22-2013, 10:07 PM   #10
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Thanks Jimking and Ironbutterfly!

My husband went with me yesterday to see my pain doctor. We discussed him writing a letter to describe how the pain of RSD is impacting me and the use of my hands. I went over a list of things with him that he needs to include in the letter, he agreed with it all and his nurse was also taking notes. They are going to email me the letter since I am still waiting for the denial packet (with appeal instructions). I think my doctor is in my corner now. I told him that he was the only one who could help me at this point and he said he would.
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