Long-term disability benefits

[Joan M]

This topic has been discussed here before, and lately I've been checking into it more just in case I'm in need of long-term disability benefits.

For those of you getting, or having applied for, LTD benefits via your employer, was your advanced cancer diagnosis questioned as being a pre-exisiting condition?

So far I've gotten some free legal advice through an agency via the telephone, and I'm gathering up my employer's policy, etc., and will probably need non-gratis advice to verify everything. I haven't yet posed this question to the person giving the pro bono advice, and the answer may depend on my policy.

I had early stage bc in 2003. It advanced 3 1/2 years later, which was six months after starting with my current employer.

Right now I'm on short-term disability through my employer due to a thoracomtomy I had in early July (but I'm not getting paid salary because I used up all the benefits available within a 12-month time span when I had a craniotomy in October). Also, the lung surgery was to remove a fungus due to cancer treatment in the lung, and there was no cancer in the path report.

Joan

[Sheila]

Joan
I had both short and long term disability, but after 6 months, my company made me apply for Social Security Disability...which was a given as a stage IV cancer patient. I was awarded the SSD, then my company decided they no longer would pay. Unfortunately, I should have fought them, but it all happened at a time when I was struggling to get my cancer under control. I would apply for Social Security, you have to be off 6 months before they pay. Stage IV is an automatic, and pay is based on what you earned and paid in. Then you would also have medicare as an option.
Hope this helps....like we dont have enough to do fighting the cancer!

[Jackie07]

Joan,

I am still waiting for the 'hearing' of my disability application. Mine is based more on the two brain surgeris I had in 1990 and 2001. My most recently neuropsychological testing showed a drop of scores in a couple of areas. And my doctor has advised me not to drive based on a picture tests on changing traffic scenes. (We had mentioned to her about a couple of minor car accidents I'd had in 2007-2008 - looking back, I felt very blessed to have just 'minor' accidents - I was blaming the weather, not realizing my 'reaction time' had already been way off.)

I contacted a couple of attorneys at the very beginning (last summer when my teaching contract was not renewed), but they wanted me to apply by myself first and then go to them after I got turned down. So we went to one of them last November, yet I am still waiting for the hearing (it was turned down again, but the counsel said it was 'normal' procedure. They are taking a percentage of the back payment when the case is approved. And the fee shall not exceed $5,000.)

My point is 'be prepared for a long drag' and be prepared to 'fight' for either the long-term disability or the SSA disability.

[Pam P]

Joan - My recent experience with my application for disability with my employer was smoother than I imagined. I was promptly approved - as stage IV there was no question. I don't remember if there would have been a pre-existing condition issue in the policy as I have been with this employer since before the diagnosis in 2001. What does your employers policy say on this? I would think the advanced cancer occurrance after you were employed with them should be the status that automatically covers you. As Sheila said, ifyou don't qualify under your employer's plan because of the pre-existing, SSA will definitely approve you.... but it is the 6 month wait of not working. I'm really hoping your employer's policy will not be an issue and that you can move ahead with this without having to fight for it... but fight hard for it if you need to!

[Joan M]

Thanks for helping to clarify the issue with more information.

It seems that my case may be a little involved, because the surgeon would probably have to declare me medically disabled, since I'm on short-term disability under his care. But that could be problematic, especially since I stopped taking Percoset two days ago (and now I'm having insomnia until my body gets used to it, I guess). The current disability is related to the surgery, and I'm not sure whether the insurance company would take the advanced-cancer part into account under that circumstance.

Even though I stopped taking the pain meds, I'm still in a lot of discomfort. My main problem is my roughly three-hour daily commute and long working hours. I'm out of the house at least 12 hours per day, so I really have to be ready to return to work. Otherwise I'll be miserable and could also further injure my muscles. My back-to-work date has been changed from September 1 to 14 (and I'm not getting paid because I used up my short-term disability when I had the craniotomy in October and 12 months hadn't passed before the thoracotomy).

There may be a possibility of working from home. Right now I work remotely one day per week due to my early morning Herceptin treatment every three weeks. But working remotely more days would probably also involve the surgeon "approving me" to do that, which means that he can then eventually approve me to be back in the office four days a week.

I'm not sure how my boss would react to my just asking to work from home more due to problems from the surgery. This is complicated by the fact that I work in a newsroom, which implies having to be in the office. Also, I don't have a long track record there -- just under three years, since I had to change jobs when my former employer of over eight years relocated one of it's offices to North Carolina (that was an easy commute with good hours). It's also complicated by the economy. My boss has been threatening to get rid of reporters who don't shape up (I'm not a reporter), where before he would have just told them to get their asses in gear.

And speaking of the economy -- I could go back to work and eventually get laid off, in which case I would have nothing but unemployment and COBRA. If I have long-term disability, I would have 70% of my now so-called "10% temporarily reduced" salary. So it's a big issue. It's not just a surgical problem that may eventually work itself out, and then I can just get another job if I'm laid off. It's a terminal illness, even if I'm not currently terminally ill or won't be very ill for a while. LTD would commence in 90 days, which in my case is October 2.

These choices are very difficult, and I'm still gathering information.

Joan

[Darlene Denise]

Aren't you on treatments for your MBC? As Stage IV you will qualify for SSDI and that alone should qualify you for LTD. I am receiving both. I din't read all of the posts on this thread and maybe I am missing something. You also qualify for accelerated benefits on any individual or group life policies.

I was an insurance agent for 31 years, so, if I can help just let me know.

Darlene

[Pam P]

Joan - Your employment situation is more complicated than mine is and all of what you describe is over my head. I hope you can connect with some experts who can lay out the options and different scenarios for you. In my insurance policy I qualify for disability just by the fact that I fit the criteria of stage IV bc - regardless of whether I'm currently receiving treatment. If that applies to you then even if the surgery recovering was resolved you'd still qualify. Good luck and keep us posted. Pam

[Joan M]

Darlene and Pam,

I think I understand what you mean, just being stage IV is enough to qualify

[Joan M]

Darlene and Pam,

I think I understand what you mean -- just being stage IV is enough to qualify me for SSD. However, I wouldn't be able to live on only that alone, which is where the LTD comes in.

I'm under the impression that if I go from short-term to long-term disability at work (LTD commences after three months of short-term), the insurance company will probably require me apply for SSD. After being on SSD for two years I would be eligible for Medicare. If the company lays me while I'm on LTD I would be able to get COBRA for 29 months if I'm on SSD.

I'm waiting to receive my LTD policy from the insurance company and will let you know what happens. This would also entail finding out how long LTD would last. The pro bono attorney said many LTD policies pay until age 65, but she'd have to look at the policy to find out exactly.

Joan

[Lori R]

Joan,
I've chimed in on other disability threads as a compassionate observer but not one with much experience. So, I remain very interested. Pam is certainly a great resource as she is currently making her way through this maze.

I completely empathize with your dilemma. I would receive 50% of my salary on LTD which is double what I would receive from Social Security. Thus, a reliable LTD check would make a huge difference in the quality of my life.

Research on my company's policy is that once you are approved, the LTD coverage remains in place even if you are "laid off". If you think about it, after a period of time, any FMLA protection expires and our company will need to fill the position. In my case, the LTD coverage would run until I am of the age to be eligible for full social security benefits. (65?? 67??? something like that)

It is extremely important to receive those documents from HR and review them in detail. You will be amazed at what is in them. I realize you are focused on disability right now but also obtain any documents supporting company sponsored life insurance and health insurance.
I'll PM you with the name of a WONDERFUL woman who has worked in the benefits area for years. She helped me review the documents and she knew to look for language that allowed me to pay for company life insurance even after I am no longer with the company. This provided an extra financial cushion for my husband and daughter in the event I'm not here. A HUGE relief. (also she does this for free!! She spent hours with me and was enormously knowledgeable)
Unfortunately....I share your concern about the unknown and fear that an insurance company would deny me mid-stream when I was in one of my NED stages. By this time, I would no longer have a job and would be forced to live on the very small social security.
For now, I am NED, feeling good, somewhat confident about my work status. If I recurr again, I will probably opt for the LTD path.

[Joan M]

Lori,

Your feedback is really helpful.

I think that Darlene also mentioned the life insurance part.

I do need to see the LTD and insurance contracts. I haven't contacted HR directly because I don't want to raise an alarm, as I'm not sure what I'm going to do yet, but owe it to myself to find out the facts given I have advanced bc. I went directly to the insurance company for the LTD contract, which they are sending me. I think up until this surgery, I've been irresponsible about finding out about all this. I would just keep putting it off.

In my case, I've been paying in to optional LTD on each paycheck (it's a couple of dollars), and that's why it's 70%. Otherwise, it would be 50%. Deciding to pay the extra money per pay period was a lesson I learned in 2000 with my former employer -- before I even had early stage bc in 2003 -- because my sister died at 51 due to causes related to MS and she was terribly disabled leading up to her death. It was a wake-up call to me, the extra protection. So I continued that practice with my new employer, and then my cancer spread after that.

Joan

[Sheila]

I just felt the need to chime in here, as I was just reorganizing all my paperwork from back in 2003 when I did this. I also paid a high premium with my company for the supplemental short and long term disability insurance. I worked for a worldwide construction company called Bechtel. The insurance was through Cigna. After being on short term disability for almost 6 months, and getting ready to roll into long term disability, Cigna demanded that I apply for Social Security Disability. I did and was awarded SSD without any problems. The long term disability would then pay the difference between what SSD paid and the amount that would equal 66.666% of my income. This all osunded too good....well after receiving 2 SSD checks, and the difference from Cigna, they decided I was no longer disabled. They stopped all payments, and my combined income went from almost 3000.00 permonth, to 1258.00. ..During this time I was recovering from surgery, in chemo, its like they waited until they knew you didnt have the strength to fight. It would have meant getting a lawyer, then they get a share of any money awarded....alot of headaches. Just a warning, if you have CIGNA insurance for disability, beware! They did a special on them on Good Morning America a while back, and it was my story to a T. They hope you will die fighting them, so they never have to pay!
That was 6 years ago, and I am just fine with the 1587.00 a month I now get from SSD ...I became eligible for edicare, but I only take the part that is free, so I am not paying 120.00 per month for the other that I dont need. I finally figured that if a company like CIGNA needs the money that bad..they can have it....maybe they would like the cancer to go along with it!

[Joan M]

Sheila,

Thanks for the heads-up.

This is incredible. I don't have Cigna, but they seem to have a reputation and caught the attention Good Morning America. What they did was really contemptible.

Did Cigna say why they decided that you were no longer disabled? That is, why they reversed their decision. You had advanced cancer by then, and their change of heart was certainly a contradiction.

I've also heard that most insurance companies will require an employee to apply for SSD when they apply for LTD benefits.

Joan

[Pam P]

This has been a common status line push on facebook the last couple of days. So appropriate - thought I'd share it here.

"No one should die because they cannot afford healthcare. No one should go broke because they become sick. No one should be held to a job because of pre-existing condition. If you agree please post this as your status line (on Facebook) for the rest of the day."

[Sheila]

Joan
They (CIGNA) did make me apply for SSD, but then, they disagreed that Stsge IV cancer is considered a disability. It didnt matter that I was going for constant treatment, that the Dr. didnt want me around sick people due to immune system (and remember I am a nurse)...they have done this to many others...as have other insurance companies. They dont want to pay for us...we are too costly! Hope your insurance company doesnt treat you the same...I am thankful we had my husbands income to fall back on, if not, I would be considered eligible for assistance according to Illinois guidelines....kind of sad! Just be prepared fr anything.

On the bright side, I did find out that if one is on permanent disability, you can apply yearly for a exemtion on your homeowners property tax that can save you a few dollars...not alot, but anything is better than nothing.

Pam, I like your saying...if opnly more thought like that!

[Joan M]

Pam,

I'll drink to that.

Joan