long term disability denied - then what ?

[Sr. Mints]

curious of peoples insight/ideas/thoughts on this if you have any

in february I slipped on the ice and hit my head on a pole was diagnosed on a moderate concussion and told to took 10 days off work (and rolled that in to some already booked holiday time. then in March a few days after I returned to work, I fell down a flight of stairs, cracked my skull, spent 5 or 6? weeks I the hospital and have been doing speech language, occupational and physio therapy 4-5 days a week since.

I had no short term disability though work and s was basically on medical ei, but when medical ei ended and my LTD was to kick in--this week--I was denied coverage because I had a previous concussion in april 2017 – they said that was a preexisting condition

I am not sure what route to take next. Appeal the decision? my doctor have sent over all my medical info that specifically states that the april concossuon has nothing to do with what is happening now (I didnt even miss a day of work last april: I only went to the sheldon chumir because I walked into a low tree branch, banged head fell over, and thought I did something to my shoulder, and they said I probably had a mild concussion, and nothing showed up re: my brain on the imaging that was done).

The rehab folks suggest appealing might lead to a final decision of no, but I dont even know what that means for sure. i think it was just a thinking out loud comment one of them made this morning, they were quite disappointed in the news too but really didnt have any answers.

incidentally when I applied for LTD the plan was for me to return to work this fall, but I had some subsequent test done--a neuropsychiatric analysys --and now the physiatrist brain doctor says she doesnt want me back for at least 6-9 months. Some results came back where I am in the 90-99 percentile, but others such as memory and focus/concentration are in the 2-5 percentile, and I would just fail at my job and either get dismissed or frustrated and quit, she said

so now the plan is for continued rehab into january. The insurance company isn--or wasnt?--aware of the new return to work timeline when the denied my coverage. I only found that out this monday, and my coverage was denied tuesday, yesterday.

so: do I hire a lawyer for the LTD? the internet seemed populated with tfirms that specializes in that. But even if the decision gets reversed, will it all get eaten up in fees? or will it be 2026 by the time anything comes of anything? Is there a point to going that route? Or again, appeal the decision through insurance company?

I figure if i end up not beingable to go back--I am told that I likely will be able to return if I continue to make progress like I have been (and improvement is seen as long away of two years after I am told.) but in the case that I cant for some reason…. I dont know what happens then. the notification that I was denied has come as quite a shock .

Now Im thinking to just bail on rehab and try to return to work asap anyway? like get a bull#### CYA note from a walk in clinic note that says all set to return - thats all my employer needs to be satisfied. yes , i am told that is being irrational-- but what options is one left with? I have already taken approx 5 months off, another 6-9 just isnt going to happen

*excuse all the typos, writing this took my like 45 minutes

[iggy_oi]

Did you fall down the flight of stairs at work?

[White Out 403]

Get a lawyer.

If you aren't unionized no one is in your corner. The government treats everyone like they're trying to scam LTD, and your employer will push for you to return to work asap. Get a lawyer.

[Locke]

Originally Posted by White Out 403

Get a lawyer.

If you aren't unionized no one is in your corner. The government treats everyone like they're trying to scam LTD, and your employer will push for you to return to work asap. Get a lawyer.

I generally hate the 'Get a Lawyer' crowd, but in this instance that really does seem prudent.

Pm'd.

[troutman]

Generally lawyers in this area work on contingency, and take a % of your award? Usually around 30%? If you aren't successful, you don't pay.

[Red Slinger]

I have nothing to add in terms of helpful advice but I'm really sorry to hear you went through that and I hope you're getting better.

[marsplasticeraser]

As others have said, get a lawyer for this. Especially if second accident happened while working.

[Amethyst]

I agree with the "get a lawyer" crowd. At least for an initial consultation and then you can always decide from there. Sorry, I don't have any particular suggestions of where to find an appropriate lawyer.

[blankall]

I work in BC, so can't help you with this. However, I will say benefit denials are very common, many times with little or no reason.

One issue with getting a lawyer on contingency is that settlements usually occurs sometime after benefits are denied, and you may not settle for many years. It's typically a cash settlement in lieu of benefits.

You may not be at that stage yet, as it sounds like you still have a chance of getting on benefits. But yes, talking to a lawyer won't hurt.

[Minnie]

Does VladTheImpaler handle this stuff or is he more the injury lawyer kind of lawyer?

Sorry this happened - it's a pain in the ass right when you least need more pains in the ass.

[Dion]

I would go and talk to a lawyer. They will first look at all your medical data and determine if you have a case. If you do, they then will then work on a contingency basis taking a certain percentage of what you win.

Disability insurers are notorious for denying claims and forcing patients to take them to court. Their hoping you'll just give up.

[Northendzone]

^ it should also be noted that disability insurers pay claims as well.

File an appeal, keep your employer in the loop, and get some legal advice.

[Ashartus]

Make sure your employer is in the loop and talking to whoever arranges your benefits. Several years ago when filling out the paperwork for an increase in my coverage I made the mistake of mentioning I'd had a knee problem many years before as a teenager; they not only rejected my increase but rolled it back (because a long-ago knee problem somehow made me a high risk for needing LTD for my desk job I guess...). I fought and appealed to no avail, but as soon as our benefits consultant got involved he was able to fix it.

[simmer2]

Originally Posted by White Out 403

Get a lawyer.

If you aren't unionized no one is in your corner. The government treats everyone like they're trying to scam LTD, and your employer will push for you to return to work asap. Get a lawyer.

Not a big fan of this response, it's full of generalizations.

If the corporation is an upstanding one, they'll want to help out and figure out how to make it work for you.

If you trust them and like them, I would have a conversation with them first to see what they can do to help.

A lawyer may be necessary though, yes.

[iggy_oi]

Originally Posted by simmer2

Not a big fan of this response, it's full of generalizations.

If the corporation is an upstanding one, they'll want to help out and figure out how to make it work for you.

If you trust them and like them, I would have a conversation with them first to see what they can do to help.

A lawyer may be necessary though, yes.

My advice would be to contact a lawyer before having any further discussions with your employer about this matter. Regardless of whether or not your employer will or won’t help you out the fact of the matter is if you were injured while working they may be liable to ensure you are made whole for any lost wages and medical expenses resulting from the accident. That they have from the sounds of it left you to handle the matter almost entirely on your own raises some red flags.

[EVERLAST]

Vlad the impaler

[Peanut]

Originally Posted by simmer2

Not a big fan of this response, it's full of generalizations.

If the corporation is an upstanding one, they'll want to help out and figure out how to make it work for you.

If you trust them and like them, I would have a conversation with them first to see what they can do to help.

A lawyer may be necessary though, yes.

It’s not the employer it’s the insurer/benefits provider doing the denying.

My experience with disability (admittedly it was short term disability not long term) is that it all happens completely at arms length from your actual employer.

[Amethyst]

Originally Posted by Peanut

It’s not the employer it’s the insurer/benefits provider doing the denying.

My experience with disability (admittedly it was short term disability not long term) is that it all happens completely at arms length from your actual employer.

The company should have someone who sets up the program though - kind of like a mortgage broker - between the company the person works for and the one with the insurance plan. That person might be a helpful go-between. If he/she is selling a lot of insurance for the company, they might listen better to that person than to the individual claimant. We have someone like that. I only know that because he came and gave a presentation when our benefits were switched from Blue Cross to Sunlife. He said that if we had any problems with Sunlife, we could contact him and he would help to straighten it out.

[Slava]

Originally Posted by Amethyst

The company should have someone who sets up the program though - kind of like a mortgage broker - between the company the person works for and the one with the insurance plan. That person might be a helpful go-between. If he/she is selling a lot of insurance for the company, they might listen better to that person than to the individual claimant. We have someone like that. I only know that because he came and gave a presentation when our benefits were switched from Blue Cross to Sunlife. He said that if we had any problems with Sunlife, we could contact him and he would help to straighten it out.

Well I do this, and it's worth a shot. But the truth is an advisor only has so much pull. In reality, in a claim scenario the advisor can try to get results, but they're not going to cover things just based on them asking.

[Amethyst]

Originally Posted by Slava

Well I do this, and it's worth a shot. But the truth is an advisor only has so much pull. In reality, in a claim scenario the advisor can try to get results, but they're not going to cover things just based on them asking.

Maybe something to try before a lawyer though?