I have the luxury of holding a long-term disability policy with my employer. I'm very happily recovering well from my stem cell transplant, but looking at my very short-term and long-term options for continuing my current employment or pulling back to spend my healthy time doing other things. In other words, multiple myeloma has created a need and frankly opportunity to retire early and offer income from my insurance policies.
What to do at this point is an important question today because at the moment I am lucky to be physically able to continue working. That may change in the future. So the question is whether I should be looking at activating these benefits now – I would likely qualify because I'm undergoing infusion maintenance therapies for at least a year – or wait until I may become more significantly disabled.
Going through my long-term disability policy is confusing. Understanding how social security or other part-time work might impact my claim is confusing.
Thus, my question is: Who can I turn to to help navigate this?
I certainly can speak to a claims rep for the long-term policy, but will they have my best interest in mind and can I openly discuss my hypothetical options? Does the financial advisor at my cancer clinic answer these questions or just medical coverage? Is there someone out there I can turn to?
I thought maybe some of you could point me to a place to get advice. (I know I haven't shared enough detail to get advice here; I would prefer not to disclose all of my financial details in the forums so we will forgo asking for definitive advice here.)
Forums
7 posts
• Page 1 of 1
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Mark Pouley - Name: Mark
- Who do you know with myeloma?: Self
- When were you/they diagnosed?: April 2015
- Age at diagnosis: 53
Re: Who to consult about disability options?
Hi Mark,
My 64-year-old husband had both short and long-term disability coverage with his employer when he was diagnosed. Speaking to a social worker at your cancer clinic might be beneficial, since they can help patients understand the disability processes (for both Social Security disability and private disability policies).
Regarding my husband's experience, he worked for 4 years while undergoing IV and oral treatment, but did not go to transplant. He eventually could not work any longer and at that point, he was approved for short-term disability, which then moved to long-term and then Social Security disability was approved in June 2015. Throughout the process, his hematologist had to document for insurance why he could not work and his current medical status. Long-term disability required documentation again recently to confirm he still cannot work.
Best wishes to you,
Chris M.
My 64-year-old husband had both short and long-term disability coverage with his employer when he was diagnosed. Speaking to a social worker at your cancer clinic might be beneficial, since they can help patients understand the disability processes (for both Social Security disability and private disability policies).
Regarding my husband's experience, he worked for 4 years while undergoing IV and oral treatment, but did not go to transplant. He eventually could not work any longer and at that point, he was approved for short-term disability, which then moved to long-term and then Social Security disability was approved in June 2015. Throughout the process, his hematologist had to document for insurance why he could not work and his current medical status. Long-term disability required documentation again recently to confirm he still cannot work.
Best wishes to you,
Chris M.
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Chris M
Re: Who to consult about disability options?
FYI Mark:
"Working with multiple myeloma & disability" (Beacon forum discussion started July 10, 2012)
"Working with multiple myeloma & disability" (Beacon forum discussion started July 10, 2012)
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Bob_D - Name: Bob_D
- Who do you know with myeloma?: me
- When were you/they diagnosed?: March 2015
- Age at diagnosis: 59
Re: Who to consult about disability options?
Take a hard look at your employer-provided group short-term and more importantly the long-term policy. Also, disability carriers are not all equal. UNUM is awful. Cheap, but good luck getting a claim paid. METLIFE is also bad.
Also, after 24 months from start of long-term claim (long term starts 6 months after short term), the definition of disability changes from own occupation to any occupation. Again, I am referring to employer-provided group plans that are governed by ERISA. Not SSDI.
Also, don't speak directly with any folks at the insurance company. They will tape your conversation and use it against you. Also, the disability insurance company will make you apply for SSDI. You will get the SSDI hands down, and your disability payment will be offset by the SSDI. Good news there is you automatically get Medicare in 24 months.
Just remember some great advice I got from the attorney handling my claim. You should not have a problem with this claim. We are not talking about Lyme disease or fibromyalgia here. However, disability is not an annuity and can always be challenged.
Also, after 24 months from start of long-term claim (long term starts 6 months after short term), the definition of disability changes from own occupation to any occupation. Again, I am referring to employer-provided group plans that are governed by ERISA. Not SSDI.
Also, don't speak directly with any folks at the insurance company. They will tape your conversation and use it against you. Also, the disability insurance company will make you apply for SSDI. You will get the SSDI hands down, and your disability payment will be offset by the SSDI. Good news there is you automatically get Medicare in 24 months.
Just remember some great advice I got from the attorney handling my claim. You should not have a problem with this claim. We are not talking about Lyme disease or fibromyalgia here. However, disability is not an annuity and can always be challenged.
Re: Who to consult about disability options?
Key point to all of this is a documented history of side effects impacting your ability to work. You must have your doc in your court! In my case, the docs have been getting hounded by lawyers about insurance fraud, making the docs nervous about declaring someone disabled. At least that was my experience.
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JBarnes - Name: Jerry Barnes
- Who do you know with myeloma?: Self
- When were you/they diagnosed?: Aug 17, 2012
- Age at diagnosis: 54
Re: Who to consult about disability options?
Hello Mark,
One thing to be aware, each and every employer’s short-term disability (STD) / long-term disability (LTD) policies are very distinct. You can have two different people, at two different corporations, with the same insurance carrier for STD/LTD, yet the policies offered at each of their respective company’s are distinct. The benefits are distinct. It all boils down to what specific benefits the employer has negotiated with the insurance carrier.
I recommend you read, re-read, and re-re-read the information you have at hand. Have your spouse or significant other read, re-read, and re-re-read as well. Take notes and discuss what each of you understand. If you only have a summary description for each STD/LTD, then request the detailed information.
You also have to take the Family and Medical Leave Act (FMLA) into consideration. FMLA is distinct to corporation size and whether the corporation has to offer it and/or when it is implemented for sick time. If the corporation is a larger one, FMLA begins on day one of STD for a period of 12 weeks. Unless, of course, the employer requires you to take FMLA while being out “sick.” Again, what happens after the 12 weeks is corporation dependent. The job can be held open or eliminated at that point in time.
Also, determine if your other employer-related benefits continue during STD; though, most importantly during LTD. Medical insurance, dental insurance, life insurance, disability insurance, AD&D, etc. Do they continue at group rates? If so, for how long? Once your employment is terminated? Through the end of LTD? Through retirement age? Does the employer pay these additional benefits or do you pay for them? Do you COBRA health when employment is terminated? Do spouse/significant other/family benefits continue? Same thing, for how long?
Once a person has converted from STD to LTD, the insurance carrier will have you apply for SSDI. The insurance carrier may have a third party assist with this process. The insurance carrier is reducing their liability by having a person apply for SSDI. Knowing multiple myeloma is on the Social Security list of disabilities appears to expedite the process.
Generally speaking, during STD, the insurance carrier will require monthly notes from your physician. During LTD, the requirement for physician notes is less frequent, dependent on person’s diagnosis and prognosis. It is not unusual for the insurance carrier to request annual notes at this point in time.
Day one of STD is considered day one of the 24-month period before becoming eligible for Medicare. Hence, Medicare will become the primary health insurance and your private health insurance through your company becomes secondary. That is, if your employer continues to offer the health insurance at group rates.
Read carefully what is listed after being on LTD for 24 months … confirm and understand the definition of “occupation” listed; and, how is it then determined? Again, this is employer-specific LTD policy. If it is listed as “own” occupation and then converts to “any gainful” occupation, how is the benefit determined?
Some states require statutory disability benefits by law. Is your state one of them? These benefits are concurrent with your STD/LTD.
On a separate note, dependent on the size of corporation, many, many large corporations in the USA have outsourced many of the human resources functions. This makes it a bit more challenging in getting the right and proper information. Just like medical appointments, document, document, document any and all calls!!!
After review of all of the information available to you, you may want to seriously consider an appointment with an ERISA-knowledgeable attorney in your state. As anything in any document, the devil is in the details of your STD/LTD document. Hence, the financial advisor at your local clinic, social worker, etc., will not be able to offer proper guidance. Also, just remember, the insurance carrier has their own well being in mind. Hence, once converted to LTD, the directive to apply for SSDI, mitigating loss to the insurance carrier.
Hope this helps?
Good Luck!
Zelda
One thing to be aware, each and every employer’s short-term disability (STD) / long-term disability (LTD) policies are very distinct. You can have two different people, at two different corporations, with the same insurance carrier for STD/LTD, yet the policies offered at each of their respective company’s are distinct. The benefits are distinct. It all boils down to what specific benefits the employer has negotiated with the insurance carrier.
I recommend you read, re-read, and re-re-read the information you have at hand. Have your spouse or significant other read, re-read, and re-re-read as well. Take notes and discuss what each of you understand. If you only have a summary description for each STD/LTD, then request the detailed information.
You also have to take the Family and Medical Leave Act (FMLA) into consideration. FMLA is distinct to corporation size and whether the corporation has to offer it and/or when it is implemented for sick time. If the corporation is a larger one, FMLA begins on day one of STD for a period of 12 weeks. Unless, of course, the employer requires you to take FMLA while being out “sick.” Again, what happens after the 12 weeks is corporation dependent. The job can be held open or eliminated at that point in time.
Also, determine if your other employer-related benefits continue during STD; though, most importantly during LTD. Medical insurance, dental insurance, life insurance, disability insurance, AD&D, etc. Do they continue at group rates? If so, for how long? Once your employment is terminated? Through the end of LTD? Through retirement age? Does the employer pay these additional benefits or do you pay for them? Do you COBRA health when employment is terminated? Do spouse/significant other/family benefits continue? Same thing, for how long?
Once a person has converted from STD to LTD, the insurance carrier will have you apply for SSDI. The insurance carrier may have a third party assist with this process. The insurance carrier is reducing their liability by having a person apply for SSDI. Knowing multiple myeloma is on the Social Security list of disabilities appears to expedite the process.
Generally speaking, during STD, the insurance carrier will require monthly notes from your physician. During LTD, the requirement for physician notes is less frequent, dependent on person’s diagnosis and prognosis. It is not unusual for the insurance carrier to request annual notes at this point in time.
Day one of STD is considered day one of the 24-month period before becoming eligible for Medicare. Hence, Medicare will become the primary health insurance and your private health insurance through your company becomes secondary. That is, if your employer continues to offer the health insurance at group rates.
Read carefully what is listed after being on LTD for 24 months … confirm and understand the definition of “occupation” listed; and, how is it then determined? Again, this is employer-specific LTD policy. If it is listed as “own” occupation and then converts to “any gainful” occupation, how is the benefit determined?
Some states require statutory disability benefits by law. Is your state one of them? These benefits are concurrent with your STD/LTD.
On a separate note, dependent on the size of corporation, many, many large corporations in the USA have outsourced many of the human resources functions. This makes it a bit more challenging in getting the right and proper information. Just like medical appointments, document, document, document any and all calls!!!
After review of all of the information available to you, you may want to seriously consider an appointment with an ERISA-knowledgeable attorney in your state. As anything in any document, the devil is in the details of your STD/LTD document. Hence, the financial advisor at your local clinic, social worker, etc., will not be able to offer proper guidance. Also, just remember, the insurance carrier has their own well being in mind. Hence, once converted to LTD, the directive to apply for SSDI, mitigating loss to the insurance carrier.
Hope this helps?
Good Luck!
Zelda
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ZippyZelda - Name: ZippyZelda
- Who do you know with myeloma?: Spouse
Re: Who to consult about disability options?
Zelda. Wow. Thanks for all the input. I knew there was a lot to consider. It is so complicated.
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Mark Pouley - Name: Mark
- Who do you know with myeloma?: Self
- When were you/they diagnosed?: April 2015
- Age at diagnosis: 53
7 posts
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