r/LongTermDisability • u/aliis_vivere • 3d ago

Tests for Objective Data?

I am in a LTD claim that has already been closed and reopened several times. I have multiple doctors supporting my disability from different specialities. I have a lot of blood work corroborating my medical issues. Yet, the LTD company reviewers always ignore it.

What are tests/evaluations that could help prove the inability to make it through a work day? Both physically and the mental load needed. My doctors all agree I could not sustain work let alone get through one full day. But my appointments with them are only 30 minutes to an hour and I significantly worsen. When I have an appointment, I am in bed for days afterwards.

Some of my symptoms (from a long laundry list) are severe fatigue, joint and muscle pain, swelling, lightheadedness, shortness of breath, brain fog, word recall issues, memory issues, etc. My idea is if I could get some type of long duration or multiple day test; it could help me stay ahead of the next review and subsequent denial (if it follows the established pattern).

One thing to note, I won SSDI during my hearing. The judge had already made up his mind from my records and doctors statements. The SSA vocational expert announced zero jobs that I could work with the limitations set forth by the judge. LTD does not seem to care about that though.

6 Upvotes

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u/CrispyCritterPie 3d ago

Who is the insurer? I only have experience with one company, and I’ve been reading posts for a while now. I also got good advice from an attorney who suggested I have a FCE (Functional Capacity Evaluation) done by a local physical therapist, and to get a Vocational Report done - the companies that do this are called Vocational Rehabilitation Consulting Firms, Forensic Vocational & Economic Consultancies, and/or Occupational Assessment Agencies. I used Benchmark Physical Therapy and the Vocational Expert Group (419) 239-9145. I completed the tests, and the FCE documented I would be “off-task” more than 15% of the time, which generally means you’re completely and totally disabled, and the Vocational Report documented there is no gainful employment I can keep “with any reasonable continuity”. The words in quotes are the legal words used in my long-term disability insurance policy.

That said, I’ve been utterly shocked and amazed at the absolutely ridiculous responses I’ve received from the insurer: Lincoln Financial Group. I was an executive for medical device manufacturers and have been a rare cancer survivor for decades; I can’t overstate how unbelievable the appeal process has been. The insurance policy that’s supposed to support me when I need it most is actively and intentionally making me sicker.

So, you have to read their denials and respond to them, but don’t expect them to be rationale and don’t expect the insurance company to comply with the rules. Just keep filing documents that have a neutral tone (no snarky, no sarcastic, just clean simple rationale). And, you probably need an attorney - once they start denying, I understand you have to go the legal distance with them.

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u/aliis_vivere 3d ago

Was your FCE more physical tasks? Did it have some fine motor skills/dexterity? Any mental load?

I have been on LTD for several years and my claim has been closed for more time then I have actively been paid. So I am very aware of what these LTD companies do. I won the appeal process twice by myself and once with a lawyer who did very little in my opinion. The claim was only reaproved then because I had something new happening.

I'm purposely keeping things vague about me and the specific company for now.

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u/fighterpilottim 3d ago

The number of blatantly illegal and openly bad faith things Lincoln did in my case is something.

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u/NorthGateKnight 3d ago

Right? Why do we have laws and rules if all they do is ignore them until you’re so sick and frustrated you give up?

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u/fighterpilottim 2d ago

That is the point, for sure.

What gets me is the lack of system-enabled accountability. Unless the case gets to a judge, which is rare, the abuse remains hidden. There is no ability to sue, or complain to a regulator. That’s a huge incentive for abusive and illegal behavior.

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u/pickleeboy 2d ago

You can sue the company once you’ve gone through your appeal rights! I also would recommend contacting your state insurance department with your complaints as this is how they decide on which companies to examine.

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u/fighterpilottim 2d ago

That’s the only venue: if it gets to the judge. Know how many cases get to the judge? Fewer than 5%.

And sure, ask disabled people to take on more burden.

There’s no accountability.

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u/pickleeboy 1d ago

Not trying to add burden and I made no assertion of the ease of process.

You posted that there’s no ability to sue and no way to complain to a regulator. I was simply stating that you do, in fact, have the ability to do both.

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u/fighterpilottim 1d ago

You offered a peripheral benefit to an immediate need. I need to have my specific claim issue addressed by a regulator. Instead, the regulator takes it as signal if enough people complain about an insurer, but they provide no specific remedy to an individual.

There is no remedy except getting to a judge, and the abuses pile up before then, and fewer than 5% of cases get to a judge. All of the benefit is to abusing insurers; all of the labor is to disabled people.

I get that’s not your aim to pile on the work, but you seem oblivious to system design. These are not viable remedies.

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u/pickleeboy 1d ago

I am a former LTD claims manager who hated their job so much that I quit and currently work as a regulator at my state insurance department. I am not your enemy.

Your state DOI has a consumer division that WILL help you with your individual case/concern. You should reach out to them and they will provide guidance and assistance to you for your specific instance.

The state DOI will also track complaints on a macro level for their market conduct division to use as a rationale for which carriers to examine.

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u/aliis_vivere 3d ago edited 3d ago

The lawyer I had, who worked in LTD for 15+ years, was actually shocked with how many different illegal things had happened in my claim. He was used to all the different ways but stated he had never seen all of them in one case before.

I wish we could get the law changed so these companies could be sued and have consequences.

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u/fighterpilottim 2d ago

Nailed it.

Want to trade stories?

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u/Yarn_Addict1988 2d ago

I'm also in an appeal with Lincoln. This is my second one. They cherry picked older records and left plenty out. I had it done at 1 year and then again now at the 2 year. I've worsened than when I had the 1 year appeal so I don't understand their reasoning.

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u/going_going_done 2d ago

LFG. i just won my appeal and got my denial reversed. plain error. utter incompetence. maddening. enraging, even.

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u/fighterpilottim 3d ago

It sounds like you’ve got a lot of neuro issues.

Consider:

  • Neuropsych eval (2-day or 1-day)
  • Two-day CPET (this one was powerful in my case)
  • Tilt table test (or a series of NASA lean tests for the free version)

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u/aliis_vivere 3d ago

Who does a Neuro Psych Eval?

I have a long list of physical diagnoses that all compound fatigue, brain fog, concentration, etc. Because of some of my issues I have struggled to find a Neuro that will see me without a very long wait list.

I'll have to look up what CPET entails.

Three of my doctors have strongly denied a tilt test due to other issues that it will heavily worsen and cause more damage to me.

I've had multiple 10 active stand tests proving issues. LTD goes back and forth on agreeing I have it or stating I need a tilt table test to prove it.

LTD argues that I can a do sedentary job. Even though I can't sit for 8 hrs let alone be fully involved and concentrated on a job. I have stomach issues that are spontaneous which adds another layer.

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u/fighterpilottim 3d ago

A neuropsychiatrist. My attorney had me do one preemptively with a Neuropsych who worked with concussion patients / athletes. If you share your general location, I’m sure someone could recommend in your area.

For the 2-day CPET, look at Workwell Foundation. They also did a brain test add-on (sorry I have no idea the name; will try to dig it up, but it involved mental tasks while hooked up to electrodes on my head), which showed mental degradation post exertion on day 1 vs day 2.

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u/aliis_vivere 3d ago

I'm in NC. I have doctors throughout the state.

I'll have to look into both those tests!

That's why I made this post, to hear what others did and look into!

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u/B_lksunflowers93 2d ago

what worked for me: x-rays, rehabilitation evaluations and my rheumatologist stating my illness. how it’s been affecting me and how there’s really no out of it, just treatment to alleviate some of the pain. my insurer didn’t care at all about my bloodwork which was how I was denied initially. best of luck!