I have been on LTD for 4 years and during that time they have denied and re-instated me several times. It’s been beyond stressful and I feel like they have caused my mental health deteriorating. I have gone through 4 caseworkers. My file is huge, I have a physical disability and I am dealing with major depression and severe anxiety. I know I am unable to work at the capacity they expect of me (minimum of 70% of my previous job). I get major pain after 3 to 4 hours and have to stop anything i am doing. I suffer from severe migraines each week that last anywhere from 24-48 hours. They can wipe me out for days afterwards. My doctors have stated there is nothing that can be done about my physical pain and this is a “life long disability” for me. My current caseworker had me attend an independent psych assessment which is 16 pages long of basically saying I have serious mental problems. Doctors have written there is “optimism” of me getting better mentally and that i should be encouraged to work but not beyond my tolerance. I have told the insurance company I could possibly manage 12 hours per week but my pain symptoms make me unreliable and I don’t know when my migraines will flair up so I’m really scared to enter into a work contract and fail (what employer will want to hire someone so unreliable?, I’m sick all the time). The insurance company came up with a 6 week intensive return to work plan, including 10 sessions of pysch counseling and 2-3 times per week rehab that states I will be improved by 50% in as little as 3 weeks and will return to part time for gradual return to work 6 weeks after completion of the rehab and then full time there after. All my doctors have written that rehab will not benefit me but they have sent my file to rehab anyway.
I don’t know where they come up with this. When my file shows evidence of ongoing issues for 4 years (and counting!), they decide I will be “cured” in as little as 3 weeks! This is also the exact plan they forced me into 2 years ago and I failed and had to return to LTD.
I feel as though they are not reading the evidence in my file that proves I should be on LTD. My new caseworker doesn’t seem to read anything. She is now withholding my funds until my doctor fills out some forms of why I can’t participate in the return to work plan. Right at Christmas! I have been doing everything they ask so I find this approach really unfair.
I feel like I am being harassed to return to work when i am unable. They have all the proof but somehow its not enough?? What can I do?? Will i be harassed to return to work until i give up? What can i say to my caseworker to make her understand ? How can i get them off my back?
She phones me every 2 weeks to follow up on how I am doing and I tell her nothing ever changes. I am stuck with this disability and this pain and I just can’t work at the capacity they expect of me. My benefits state they have to pay me unless I can work 70% of my previous pay. She only extends my benefits every 4 months and then tells me i will be cut off unless i can prove other wise. This is causing me huge anxiety. My condition will never change, its all there, and I don’t understand why i need to keep going to the specialist who continually tells me theres nothing more he can do. I am at a loss of why i have to keep telling them the same thing over and over.
What can i do to end the harassment and have them believe me once and for all? or is this a nightmare I have signed up for because i am disabled? Its not fair
Sorry to her you are going through such a stressful time. Unfortunately, there is no easy answer here. The best approach is to cooperate with them to the fullest extent possible. This pace of follow up by them won’t last forever. If they are suggesting a return to work, it is often best for you to give it a try, and give best efforts, and attend your doctor office during the process. You should only stop the return to work process if it is under clear directions from your doctor. By trying, even if you think it will be unsuccessful, you take away the argument that “you didn’t even try”…which is often unfair, but it is how they would use this against you.
David Brannen
Disability Lawyer with Resolute Legal
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Your doctors need to not be on board with rehab. They need to have a reason as to why. Contacting the ombudsman of the insurance company or the medical director might help. Do you research on the rehab company and the doctors involved. I went through the same stuff. These companies work for the insurance company not you. The doctor who owned and run my rehab was up on proffessional misconduct charges and they said they could have me 80% better is just unrealistic. If that were the case no one would be on LTD. Do your research well. Ratemds.com is a good place to start.
Thank you for your reply. I have tried returning to work on this exact plan they have presented again and I was unsuccessful (It was 2 years ago but nothing medically has changed for me). The first time I tried and told them I was struggling and couldn’t manage, they said “too bad, this is the job you chose” and they closed my file, refused to work with me, even after I provided a doctors note saying I was in too much pain. It took a further 4 months for me to get back on LTD with more documentation, even tho they tell you it will be only 2 weeks!. Each time they cancel my file, I go through serious and detrimental financial stress and fall into major depression because it takes 6 months to get back on. I have severe anxiety that they will just cut me off if I "try " and return to work and I’m again unsuccessful. I can’t go 6 months without any money. I don’t like the idea of just doing what they say to please them when I know my own body and what I can or cannot tolerate. Its all written in the file for them so I don’t understand why I am expected to “participate” when I can’t really participate in what they expect of me. I’ve always maintained I can do a few hours but they expect me to return to full time or 70% of my previous position and it’s just not doable for me.
I find this very frustrating because they see that i am able to do a little and I want to do what I can but what I can manage, is not gainful. Yet they continue to push me to do what they expect, not respecting the file of what I can actually do. Do they have no obligation to read the file or their own independent exams? They all back me up but they all say there is “hope” that my mental health will get better but not my physical issues. So the insurance company is running with the idea that my mental health will get better and is ignoring that my physical side of things will not get better (this is my biggest barrier to being successful at returning to work) which is very frustrating. I feel like we are going around a merry go round.
Is there a golden ticket of a document that I can get from my doctor that shows I am unable to do their rehab, that forcing me into these types of return to work set ups are a waste of time and money because I cannot do it?
I also find their conclusions completely out to lunch, there is no science based evidence behind their presentations of how I will have a clean bill of health is as little as 3 weeks(!). How is it that I must provide evidence upon evidence to support my claims and they can come up with bogus info to support theirs and then close my file? I find the process shady, i don’t trust them at all and i just don’t know how to approach this anymore. Should I write them a big long personal letter of what it’s like for me day in and day out? I don’t know what else to do…I don’t know how to get through to them that i cannot return to gainful employment. I could probably manage 12 hours per week but i can’t survive off that. It’s such a difficult place to be in, I wish i could work!
I don’t know of a golden ticket but your doctor can write them a letter documenting each return to work and why each failed and why subsequent ones are a waste of time.
Welcome to my world farmgirl! It sucks big time and I swear I now have PTSD because of the harrassment the Insurance Co has put me through. And after 32+ years of impeccable service to my Company I definitely didn’t deserve to go through this when I didn’t create the Disability!
My answer to the Insurer was that I could not go to Rehab as I was not well enough. My Doctor spent 2 hours on the phone with the Insurer - unpaid - taking up time from other patients - and no matter what she told them or asked them - the insurer either didn’t reply or ignored what my Doctor had to say. Both my Doctor AND my Specialist wrote the Insurer very very curt letters about why I could not work and that their harrassment was causing further deterioration to my health. They didn’t care - they proceeded to cut off my LTD benefits. My appeal failed. I am suing. In a few weeks we go into “Questioning”. Meanwhile my Employer terminated my employment without notice/severance so I’m suing them next. I had to go over a year without income. Was sooooo close to losing our home and filing bankruptcy. By the grace of God it hasn’t happened - yet. Insurers suck - they do not care what you have to say. In my appeal I included a long letter about why I was disabled backed up with all my medical files. They don’t dispute my “diagnoses” - but they continue to state there isn’t proof I can’t physically work. The expect you to go back to work because you can’t survive without an income. Personally I think there should be some type of Law that restricts their tactics! But until that happens - we have to choose our own fate. I despise ALL insurers. If it isn’t the Gov’t taxing us for everything they can get - the insurers also do. Think of all the mandatory insurance we have to pay - car, house, health, etc. - but when we need the services they offer with their insurance policy - HA - they find every loophole they can to wiggle out of it. Why do you think they’re Billion dollar companies? I chose to go without an income and fight them tooth and nail - all the way into a Courtroom if I have to. But you have to do what’s best for you.
