Disability Insurance

[Harpoon]

Ok, so here's the story in a nutshell:

In February of last year (2003) I told my boss at work that I could no longer continue to work because of how sick I was getting wiht the valve trouble and the heart failure and such. I felt like crap, I couldn't function, it was time to go home and conserve my strength for surgery.

Fine, We all knew it was coming and had already gotten the ball moving somewhat before I said I had to stop.

About a day or so later I got the Family and Medical Leave Act forms for claiming disability due to a medical condition.

Deal is, you have your doctor fill out some stuff and you fill out some stuff, sign it all then turn it in and you get disability insurance for your time off work because you're sick or whatever.

Well I was a "little" slow getting some of this stuff together and unfortunately didn't sign the paperwork before I ended up going on the vent at the Cleveland Clinic. Needless to say, I wasn't signing ANYTHING for a while after that.

I got home in May and asked about the forms and such, could I submit them "retroactively" since I wasn't able to get them in before surgery?

My wife and my dad said no, don't worry about it, that it was too late now.


Well I mentioned it to my cardiologist today during my appointment with him and he seemed to think otherwise, that there certainly could be a case made for my "incapacitation" and I should be due some benefit for the time I spent flat on my back sucking air through a plastic tube, and thereafter...

I was out of work from mid-February to the end of August, about six and a half months.

I was wondering if anyone else here has had experience with this sort of thing, filing for temporary disability due to a valve surgery and what they may have encountered.

I kinda doubt anyone was in my situation, not having been able to complete the forms before going into the hospital, however I guess if something came up suddenly that could happen.


Anyone??? =)

 

[Ross]

I'm not sure how the FMLA plays into this, but if you were eligible for short term disability at the time of incapacitation, yes you should be able to collect some money for that time.

When my aneurysm blew, it didn't exactly give me time to inform my employer that I was going on a medical vacation. My wife had to deal with all of it along with the help of my supervisor. They put me on short term disability which converted over to long term, but I held a salaried management position at the time. There are so many variables that come into play with this type of question. Perhaps our insurance man Dale, can provide some of his insight?

 

[fisher6476]

I am curious about how the FMLA comes into play here also. I have a salaried job and through the company I have disability insurance that I pay for. As far as I know that is the only disabilty benifit I am entitled to.

 

[Georgia]

Demand the disability.pay. You pay for it, you chould have received it. Make lots of noise if they won't let you make a claim. Go to the insurance department. Did you have Unum Provident? If so, they're under indictment and there's a national class action suit against them.

Insurers are notorious for trying to keep you from making a claim. I never had to sign anything because I was put in the hospital immediately upon diagnosis. The company took care of it and the disability insurer (happened to be Unum Provident) called me and got the information they needed. I had a wonderful experience with UnumProvident (it happens that I'm perhaps the only person in America who did).

I really think you shouldn't take no for an answer. If they start in about length of time to make a claim, go directly to your state insurance department.

I'm not sure why you'd go with the FMLA; if that impacted my leave I don't know anything about it. Perhaps your employer requires FMLA stuff to justify paying your benefits while you're off without pay.

(I work for an insurer; not accident/health, but there are certain things insurers of all lines have in common; namely, that they don't want to pay claims).

 

[Harpoon]

FMLA=Family and MEDICAL Leave Act


I was on medical leave for about 6 months.


I'm doing some poking around....

 

[Lisa in Katy]

FMLA isn't exactly benefits, is it? Doesn't it just protect your job, or say that the company has to give you a job when you are able to return, within a reasonable time, of course. I can't remember how many days, but I was thinking 90-120. I think it applies when you are ill or when a family member is ill. Most health insurance has a 1-year limit on filing of claims, but I'm not sure about disability.

 

[Guest]

Lisa gets a gold star .

FMLA simply states that the company must hold your job, or offer you one of similar abilities, etc., upon your return. FLMA does _not_ guarantee that you will receive pay during your time away.

Short Term Disability, however, does give you that pay.

Luckily, my company offers Short Term Disability, so I received full pay and benefits, etc., while I was gone 2+ months a year ago.

[Which reminds me, I was reading through some of the Emails my sister sent out a year ago...and it was kinda weird...I may have to post them sometime here for you all to read....kinda interesting, even if I do say so myself...LOL.]

Unfortunately, aforementioned company is "investigating" my sick time in 2003....irony rocks .

HTH...peace...always,
Cort S, pig valve & pacemaker-enhanced 30/swm
AIM=fc72mc...YIM=knightfan2691 / "The Uniter"..."Mr Road Trip"
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[Lisa]

I echo the comments of the others..if you had short/long-term disability insurance, you should be eligible for benefits...Regardless of whether or not you had prior approval. That's what it's for! You are usually required to submit the forms as soon as possible after the "emergency situation."

A note on the FMLA: It's good for a maximum of 12 weeks in a calendar year. And your company may require that any accrued paid vacation, sick leave, or paid leave days be exhausted during and in conjunction with FMLA leave. It's also up to your employer as to whether or not you will be paid for any FMLA leave after exhausting your accrued paid leave.

 

[heartyone]

Harpoon,

You sure are entitled to receive short or long-term disability payments from policies you may hold privately or that you are covered under at work. That you are filing retroactively is irrelevant.

Some of these companies make it purposefully difficult to collect, though, so be prepared. Experience has taught me that the insurance companies play this game--if they make it as difficult as possible to file a claim, then right off the bat they'll drop 20% of the people they should be paying out to, because those people won't stick with the process. I've seen this in filing for long term care for my in-laws and for disability for my wife.

So, be prepared and patient and you will get your money.

Good luck and I hope you are feeling well today.

 

[Davidcv67]

My question is how long can one be on LTD? If I go out on surgery and the Heart Lung machine blows a fuse and makes me a half-wit...can I be on LTD forever? or will it have an end date?

 

[heartyone]

Hi David,

Well, let's all pray that you don't come out of surgery as a half-wit, that is unless you go in as a half-wit then we want you to come out exactly as you went in.

The heart-lung machine is not going to blow a fuse and you are going to come out just fine.

Long-Term Disability is just that--Long-Term. If you have a LTD plan with your current employer, it would kick in usually after around 6 months of short-term disability. The Long-term policy would pay for as long as you are unable to work. Where it gets tricky is the question of what percentage of your salary it will cover. Some LTD's will pay only 50%, other employers have them written up as paying a percentage to "be determined by the employee's direct supervisors at the time of disability." Makes you want to stay on their good side, don't it?

We have a bit in common--my wife suffered a marfan's related dissecting aortic aneurysm last year and's got herself a shiney new mechanical valve, dacron aortic arch and branches. She's not into message boards, but I am, so I'm the talker here. She was on short-term disability for 6 months and then returned to work part time, and slowly returned to full time.

When is your surgery scheduled?

 

[LoriZee]

Harpoon

Harpoon

Hi,
I'm pretty new to these boards, but I posted my story on Heart Talk.
I think your physician is correct. You should be able to collect, after all you weren't in the position to do much.

They may ask you why you didn't have a family member or friend fill it out for you....

Anyway, I see you had trouble with your Tricuspid.. I mentioned on Heart Talk I had three open heart surgeries. Possibly a fourth...I'm hoping not...The newest procedure is to go into the side...being my chest was open already three times.

In 1993, I had my Mitral, Aortic valves replaced and ring around the Tricuspid.
Now they tell me my Mitral is leaking...Just what I wanted to hear.
I am being observed closely, hoping it won't happen for a long time into the future. Sure...not my luck.

You mentioned that you run...oh I can't do that...that is my one desire, is to be able to run...I wish I could.
Well God Bless you and take care...

Lorraine

 

[Harpoon]

I "can" run but I'm not a marathon runner or anything like that.

I'm fairly active and physically fit. I've always been that way and it's probably part of why I'm in as good a shape now as I am, inspite of all the crap I went through last year. it's probably one of the things that helped me survive.


I was born with a heart defect called transposition of the great vessels. That was fixed shortly after birth and I lived a "normal" life after than until I was about 28 years old, that's when I developed a persistant cough...

That cough turned out to be one of the first signs of heart failure which was a result of a leak in part of the repair to my heart and then a failing tricuspid valve. I had to have the repair fixed and an artificial valve to replace my tricuspid in March, 2003.

It took a while to get back to being as active as I was before surgery, but things really started improving when I was able to get home in mid-May and then cardiac rehab through the summer.

I still have "off days" but for the most part I'm pretty good to go.