K
kickboy
Guest
Does anyone have a recommendation for an ERISA/LTD lawyer in the Chicago suburbs? Thank you for your help!
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S
SpineAZ
Guest
Have you been denied LTD benefits? If so what was the reason for the denial? Often you can appeal quite well on your own the first time. You just want to check to see if there are further levels of appeal in which you may want to bring on an attorney.
As for recommendations I doubt you'll get too much of a response. Many people here don't have LTD and are dealing with WC or SSDI. That being said a good attorney who deals only in disability law is your best bet. ERISA comes into play in that it says "you have the right to appeal". In most cases the appeal is based on the LTD company saying "you aren't disabled" in which case ERISA isn't involved beyond the fact that denial of benefits under plans governed by ERISA have appeal rights, just the definitions in the policy of "totally disabled"
As for recommendations I doubt you'll get too much of a response. Many people here don't have LTD and are dealing with WC or SSDI. That being said a good attorney who deals only in disability law is your best bet. ERISA comes into play in that it says "you have the right to appeal". In most cases the appeal is based on the LTD company saying "you aren't disabled" in which case ERISA isn't involved beyond the fact that denial of benefits under plans governed by ERISA have appeal rights, just the definitions in the policy of "totally disabled"
K
kickboy
Guest
That is very helpful -- thanks for your reply and advice.
I have disc problems for years (bulge + facet inflammation, no sciatica). It has gotten worse lately and now I can't sit or stand for more than a few minutes without lots of pain. I have been with a pain doc for about a year now. It's my second pain doc. The first gave me steroid shots and pain meRAB. They did not work. The second one gave me the epidural, steriod shots and it did not work. He then switched to heavy pain meRAB (making me loopy, so sorry if I'm incoherent). Been through PT and it seemed to make it worse.
My job is very much that of a bureaucrat at a private company. It involves lots of meetings and lots of document generation. The type of work is stressful by definitions and has long hours by (in any company). My productivity has dropped to near zero and I can't fake it for much longer (already getting concerned looks)
The company provides the disability insurance. I can't sit at my desk to do anything productive, can't sit in meetings and can't even stand in one place for long. I really have to be on my back at home for much of the day (like now, and typing upside down hurts!)
or walking around.
Surgery has been suggested, but I told I am not a great candidate since it is not really clear if it would work. It would be hit or miss and may make things worse.
I have never done the disability thing so I am really erabarassed about not being able to do my normal job. I have not filed yet, but I need to soon before I just get canned for being unproductive. I have not raised the prospect of disability with my doc yet (don't know how to do it).
Thank you for any advice you can give.
I have disc problems for years (bulge + facet inflammation, no sciatica). It has gotten worse lately and now I can't sit or stand for more than a few minutes without lots of pain. I have been with a pain doc for about a year now. It's my second pain doc. The first gave me steroid shots and pain meRAB. They did not work. The second one gave me the epidural, steriod shots and it did not work. He then switched to heavy pain meRAB (making me loopy, so sorry if I'm incoherent). Been through PT and it seemed to make it worse.
My job is very much that of a bureaucrat at a private company. It involves lots of meetings and lots of document generation. The type of work is stressful by definitions and has long hours by (in any company). My productivity has dropped to near zero and I can't fake it for much longer (already getting concerned looks)
The company provides the disability insurance. I can't sit at my desk to do anything productive, can't sit in meetings and can't even stand in one place for long. I really have to be on my back at home for much of the day (like now, and typing upside down hurts!)
or walking around.
Surgery has been suggested, but I told I am not a great candidate since it is not really clear if it would work. It would be hit or miss and may make things worse.
I have never done the disability thing so I am really erabarassed about not being able to do my normal job. I have not filed yet, but I need to soon before I just get canned for being unproductive. I have not raised the prospect of disability with my doc yet (don't know how to do it).
Thank you for any advice you can give.
K
kickboy
Guest
Thanks for your response SpineAZ. Based on your bio, you probably have as much experience as any lawyer in this subject. Basically I just want to make sure the paperwork and support is done "right" the first time. I don't want to make any durab mistakes that someone with an experienced eye would easily catch. I did not intend to have anyone represent me at this stage, but just to advise me on any weaknesses in my claim and how to nip them in the bud. Like how many doctors should support it? Is one good letter better than 6 so-so letters? Should I bring a lawyer or an observer to the independent medical evaluation?
K
kickboy
Guest
How do I know what the APS looks like before I file? I want to be prepared before I file. I have a feeling there will be bad consequences from the company as soon as I file, so it is best that I do everything in advance.
S
SpineAZ
Guest
Many employers and insurance companies post them on line so using the terms Long Term Disability Attending Physician Statement will likely bring up a few different examples. If you have LTD through your employer and there is any site regarding your benefits your specific one may be posted there. If not there are a wealth of examples available.
Here are some of the items (varies depending on your coverage):
Date symptoms first appeared or accident happened
Date you first treated the patient for this condition
Date you advised the patient to cease working
Date of last visit
Date of next visit
Frequency of visits (weekly, monthly, other)
Has the patient ever had same/similar condition
Diagnosis including complications and ICD9 codes
Subjective Findings
Objective findings (including physical findings and test results)
Height/weight/dominant hand
Treatment including meRAB
Surgical Candidate?
Treatment plan will get person back to work?
Referred to any other providers for this or other conditions?
Bed confined? Hospital confined? Arabulatory? House confined?
Dates of any hospitalizations
Limitations standing/sitting/walking/bending/stooping/lifting/carrying/use of hanRAB
Physical impairment level of functional capacity, physical activities: (none, slight, moderate, significant, severe)
Psychological impairment (if so details)
Rehabilitation (if applicable)
Prognosis
Here are some of the items (varies depending on your coverage):
Date symptoms first appeared or accident happened
Date you first treated the patient for this condition
Date you advised the patient to cease working
Date of last visit
Date of next visit
Frequency of visits (weekly, monthly, other)
Has the patient ever had same/similar condition
Diagnosis including complications and ICD9 codes
Subjective Findings
Objective findings (including physical findings and test results)
Height/weight/dominant hand
Treatment including meRAB
Surgical Candidate?
Treatment plan will get person back to work?
Referred to any other providers for this or other conditions?
Bed confined? Hospital confined? Arabulatory? House confined?
Dates of any hospitalizations
Limitations standing/sitting/walking/bending/stooping/lifting/carrying/use of hanRAB
Physical impairment level of functional capacity, physical activities: (none, slight, moderate, significant, severe)
Psychological impairment (if so details)
Rehabilitation (if applicable)
Prognosis
K
kickboy
Guest
I found the form! Thank y
What do I list for former treatment providers (i.e., previous pain doc). He may not even remeraber me and was still able to do my job at that time (although with difficulty).
Also, the form seems to ask about other physiciens. I am being treated for other things but has nothing to do with the disabling condition. Do I need to disclose all of that too?
What do I list for former treatment providers (i.e., previous pain doc). He may not even remeraber me and was still able to do my job at that time (although with difficulty).
Also, the form seems to ask about other physiciens. I am being treated for other things but has nothing to do with the disabling condition. Do I need to disclose all of that too?
S
SpineAZ
Guest
Much depenRAB on what disabling conditions you have, if you've already been approved for STD and are now transitioning to LTD, your occupation, what type of doctors you are seeing, and your condition history.
I went out of work in May 09. I already had a history of 2 recent (06 and 08) neck surgeries and prior back surgery in 1993. I went out for back and neck pain I had a 2 year history of active treatment with a Pain Management doctor. My job at the time was part sedentary and part more active (customer visits in the surrounding states (TX, NM, NV).
Add this all up and my STD was approved right away 6 month later when LTD came around I was approved as I had undergone PT and testing and was moving toward surgery. I had surgery in 02/2010 and now LTD is asking that I apply for SSDI. That's a signal that LTD expects the claim to last longer.
Having an IME early is rare. The first claim review is a comparison of all medical information in comparison to the requirements of your occupation. Most LTD companies give you Attending Physician Statement (APS) Forms for you to give to doctors. Give them to any and all treating providers. But first craft your own "Personal Statement of Disability" that you give as a tool to each doctor. Follow the APS form and craft your statement "My job requires the following which make me unable to do these tasks due to my symptoms/conditions of X, Y, Z and then follow the APS answering from your perspective.
Is the LTD through your employer? If you are open to it share with me your job and current conditions and I may be able to give you some tips. Besides being a spine and knee disaster I spent 15 years in STD and LTD industry from Claims to Account Management. In my case my LTD began at 6 month out of work but plans vary.
I went out of work in May 09. I already had a history of 2 recent (06 and 08) neck surgeries and prior back surgery in 1993. I went out for back and neck pain I had a 2 year history of active treatment with a Pain Management doctor. My job at the time was part sedentary and part more active (customer visits in the surrounding states (TX, NM, NV).
Add this all up and my STD was approved right away 6 month later when LTD came around I was approved as I had undergone PT and testing and was moving toward surgery. I had surgery in 02/2010 and now LTD is asking that I apply for SSDI. That's a signal that LTD expects the claim to last longer.
Having an IME early is rare. The first claim review is a comparison of all medical information in comparison to the requirements of your occupation. Most LTD companies give you Attending Physician Statement (APS) Forms for you to give to doctors. Give them to any and all treating providers. But first craft your own "Personal Statement of Disability" that you give as a tool to each doctor. Follow the APS form and craft your statement "My job requires the following which make me unable to do these tasks due to my symptoms/conditions of X, Y, Z and then follow the APS answering from your perspective.
Is the LTD through your employer? If you are open to it share with me your job and current conditions and I may be able to give you some tips. Besides being a spine and knee disaster I spent 15 years in STD and LTD industry from Claims to Account Management. In my case my LTD began at 6 month out of work but plans vary.
S
SpineAZ
Guest
I should have mentioned, you certainly can seek out a lawyer. Some states also offer disability advocates. IF you use a lawyer you should also apply for SSDI at the same time and choose a lawyer that can help on both.
S
SpineAZ
Guest
I created a list that has current and former treating doctors. When you apply they send you forms to fill out and a few APS. You give the APS to any doctor currently treating you for the disabling conditions. When I applied for STD my pain doc insisted the Orthopaedic spine surgeon I was seeing be the one to "disable" me BUT they's fill out the basics on an APS and send all my recorRAB.
So you want to provide contact information and treatment dates for the prior pain doctor but no need to contact him UNLESS he treated you in the period since you went out of work.
If your primary care is not the one treating you for the disabling condition then you still provide his/her contact information but they wouldn't be appropriate for an APS. For some, 1 APS from 1 doctor is sufficient. For those actively seeing 3 doctors for their disabling conditions, then each neeRAB to complete an APS (so if the insurance company senRAB 2 APS, and you need 4, make copies AND an additional copy extra to keep just in case.
When did you last work? Did you have STD? If not when, under your LTD, can benefits begin?
K
So you want to provide contact information and treatment dates for the prior pain doctor but no need to contact him UNLESS he treated you in the period since you went out of work.
If your primary care is not the one treating you for the disabling condition then you still provide his/her contact information but they wouldn't be appropriate for an APS. For some, 1 APS from 1 doctor is sufficient. For those actively seeing 3 doctors for their disabling conditions, then each neeRAB to complete an APS (so if the insurance company senRAB 2 APS, and you need 4, make copies AND an additional copy extra to keep just in case.
When did you last work? Did you have STD? If not when, under your LTD, can benefits begin?
K
K
kickboy
Guest
Thank you. I never went on STD, I'm still exhausting my vacation. So I am really early in the process. My company STD is 6 months. LTD kicks in after that.
I saw a couple of differnet orthos a long time ago. They were of no help. They just said they don't know what is wrong and sent me away after confirming I did not have cancer. So I decided that only a pain doc could help and did not even pursue another ortho.
I saw a couple of differnet orthos a long time ago. They were of no help. They just said they don't know what is wrong and sent me away after confirming I did not have cancer. So I decided that only a pain doc could help and did not even pursue another ortho.
S
SpineAZ
Guest
Part of LTD is the evaluation to see if the claimant has been disabled during the entire elimination period. If you will first apply for STD, and will have that for 6 months, then applying for LTD is way in the future.
For example, if you became ill today and had a 6 month LTD elimination / waiting period that means LTD would begin sometime around late Deceraber. So applying now does no good as you can't prove disability into the future (except in terminal illness or catastrophic accidents).
LTD for a diagnosis of pain is tough if there is no diagnosed condition (such as MS, spine deformity, rheumatoid arthritis,etc). So continue to see whatever providers are appropriate. Eventually my orthopedic spine surgeon may say he can no longer treat me surgically and my primary disability care may transition to my pain management physician. Until then LTD and SS want to see me treating with an OSS.
Does your STD plan require you use vacation? If not it may be a good idea to go into STD and preserve vacation in case you return to work. At the end of my STD my position was eliminated and then they did a single payment to me of remaining vacation time.
For example, if you became ill today and had a 6 month LTD elimination / waiting period that means LTD would begin sometime around late Deceraber. So applying now does no good as you can't prove disability into the future (except in terminal illness or catastrophic accidents).
LTD for a diagnosis of pain is tough if there is no diagnosed condition (such as MS, spine deformity, rheumatoid arthritis,etc). So continue to see whatever providers are appropriate. Eventually my orthopedic spine surgeon may say he can no longer treat me surgically and my primary disability care may transition to my pain management physician. Until then LTD and SS want to see me treating with an OSS.
Does your STD plan require you use vacation? If not it may be a good idea to go into STD and preserve vacation in case you return to work. At the end of my STD my position was eliminated and then they did a single payment to me of remaining vacation time.
K
kickboy
Guest
You've been very helpful. I think I get the process now. Yes I will do STD and preserve my vacation (whats left of it). I am not required to used it. Thanks!!