[piano97]

I applied for SSA for Bipolar 1 rapid cycling in August 2016. I got approved earlier this month, and back-dated to last September even though I worked about 4 months between that date and when I filed.

I have now applied for long-term from working, dating back to when I first was diagnosed and unable to work (November 2014). I used FMLA often, ran out, when on medical leaves, eventually resigned, tried another job, failed, etc. If my elimination period started in November 2014, I met it by September 2015, which is when SSA found me disabled.

I read my LTD policy and it has a 12 month limit on 'mental' disorders. I wrote a letter and said I challenge it. I just did that today.

Has anyone else ran into this?? I read some things online that sometimes you can challenge it and win. Some states don't allow the insurer to limit mental claims.

ALSO, they told me I didn't file in time to have a valid claim and June 2016 would have been the deadline. I was manic then and obviously couldn't file. After I recovered some, and everyone was telling me to file SSDI, I did so in August 2016. So I filed as soon as I could.

Let me know any insights, thanks

[Wild Coyote]

RE: challenging the mental health claim limitations

If your employer is completely self-insured (often utilizing an insurance co to administer benefits), federal laws/regulations govern the policy.

If your employer is not self-insured (hires in an insurer via insurance policies), state laws/regulations govern the policy.

Most State Banking and Insurance Commissioners have a list of insurance companies/employers and can tell you which category your employer falls into and whether state or federal regulations prevail. These offices can usually give you more info you may find helpful.

Some State Banking and Insurance offices also have an advocacy service which may offer to help you in your desire to challenge the terms of the policy.

A side note: if your stated illness (disability) caused you to miss a deadline, it seems that shores up the disability claim (shows impairment), rather than closing the claim. An attorney would try to argue this I'd think.

Hope you find some piece of info somehow helpful.
Fighting for LTD claims can be very challenging and can be won.


WC

[BipolarMama31]

My LTD is thru an insurance company my employer paid into, but I have been approved by them, and denied by ssdi. So, I'm not sure.
All I can say is, read everything they send you. Make copies of what you send them. Take notes from phone calls, and hire an attorney if need be.

Good luck!

[Wild Coyote]

Originally Posted by BipolarMama31

My LTD is thru an insurance company my employer paid into, but I have been approved by them, and denied by ssdi. So, I'm not sure.
All I can say is, read everything they send you. Make copies of what you send them. Take notes from phone calls, and hire an attorney if need be.

Good luck!

This is great advice!
I have a whole file drawer dedicated to my LTD insurance company, dating back 30 years. They try hard to lose/cut the claim during the first 10 years.
I have certified every written correspondence and have followed-up phone conversations with written summaries of conversations, esp if something they were saying was questionable. They were saying things they were not willing to put in writing, so I'd call them out and keep a paper trail going, which became useful in winning a judgement against them, overseen/awarded by the U.S. Dept of Labor. (My files-- notes, certified letters made the whole case... and won the case.)

Stay on top of things with the LTD insurer. Be prepared to legally fight them if necessary.


WC

[piano97]

Coyote, was their mental health exclusions in the policy you received benefits on?

[Wild Coyote]

Originally Posted by piano97

Coyote, was their mental health exclusions in the policy you received benefits on?

I don't recall if there was a mental health exclusion.
My LTD claim was based upon physical illness.


WC