WHEN APPLYING FOR DISABILITY
So you've decided to stop working and apply for disability coverage.
(5) Prepare to do a lot of reading. See pinned articles in this sub-forum. See also the excellent articles at
http://howtogeton.wordpress.com. There is a lot of advice. Best to have those tips in mind now, and learn from other's mistakes!
So, by now, you should have:
a) reviewed your insurance policies (STD, LTD, SSDI)
Most of the disability advocates' online presentations strongly encourage that you review the eligibility rules and exclusions in the policies. Know the policy definitions for "disabled". Be able to distinguish if the policy is based on "own occupation" vs "any occupation". Be mindful of any time limits for conditions like "mental" or "nervous system" disorders.
If you don't understand the verbiage, make sure you ask a lawyer.
b) enlisted the assistance of your doctor(s)
Again, very important. A letter of support from your doctor: summarizing your medical history, progression of illness, reporting objective medical evidence, and assessment of your functional impairment, goes a long way. The lack of support, is also very telling.
I got 3 letters of support: 1 from my previous PCP of 2 years (very weak letter), 1 from my pulmonologist NP (excellent letter, co-signed by pulmonologist, not enough objective medical evidence), and 1 from my ME/CFS specialist (perfect letter with objective medical evidence). Letters 1 and 2 were not enough and my LTD claim was denied. After submitting letter 3, my LTD appeal was approved.
c) studied your own medical records
Ensure you request the FULL records; use the terms "clinician's notes" or "treatment notes". Visit summaries are no good.
d) enlisted the help of a friend or family member or disability advocate
It is a lot of exertion. Exertion is harmful to us. Save yourself by allowing someone to share the burden early on. I didn't mention this previously but you can request for assistance from a social worker or disability advocate.
I actually tried to request help from a free disability advocate but that person didn't actually provide any benefit to me. I was counting on an assessment of the strength of my evidence but she didn't meet my expectations. My husband and I still did all the paperwork ourselves. Anyway, your results may vary.
e) had free consultations with a lawyer
I got better advice from ERISA and Social Security lawyers or their paralegals. I had also consulted with a for-hire disability advocate, who also gave great free advice.
(6) Some tips on form-filling and phone calls
a) Answer questions in forms that you or your doctor(s) are to
fill in as if it's your worst day. We all know our ME/CFS symptom severity goes up and down. We tend to unconsciously put on a brave face when we answer questions about our daily living activities. This will give the insurer's examiner a false impression that you are fine. If you were fine, you wouldn't be stopping work and applying for disability! So, make sure to describe your bad days.
b) Detailed answers or short answers?
In both STD/LTD and SSDI, I was warned that I must pass along as much evidence as I can, in the form of medical records, test results, affidavits. This is because no new evidence may be submitted by the time you can sue in court (if it gets to that). I took this to mean that my own supplied answers should be long. After all, I do want my voice heard. However, I was told this can be a double-edged sword: my own words could be used against me, especially if this contradicts something in my medical record.
I got too late this warning to make my answers concise but straightforward; I had used the backs of the forms to continue my answers from previous pages. Fortunately, in spite of the long answers, my claims were successful. I believe it was because of my 2 day CPET, brain QEEG, doctor's and husband's letters of support.
However, if I were to have my husband help me fill out those forms again (especially for SSDI), I would only use the space allotted for answers and save the detail in affidavits (see below).
There are forms that your doctor needs to fill out. Ensure that you review the questions together with your doctor and that what he enters in the forms is consistent with what you think is your functional capacity. If you cannot lift 20 lbs, make sure he knows that. If you take multiple naps in a day, just to get by, make sure he is aware.
c) Phone calls from insurer (private or Social Security)
If you are like me and even talking on the phone is exerting, you may want to limit your phone conversations with the insurer (if SSDI, I am referring to Social Security as the insurer). You can either designate someone to receive/make your phone calls, or request all communications in writing, or both. Whatever the method, you should send in writing indicating your representative and/or how you want the insurer to communicate with you. You can frame your request as a "disability accommodation".
I also find it is best if I have time to think over my answers, as my cognitive deficits affect my ability to concentrate and lower my speed of thinking. I find I often miss one or two items. So, for me it was necessary: I made the request to have my LTD and SSDI examiners contact me by letter; else, my husband answered the phone calls.
(8) Affidavits
I read that it would be a good idea to get affidavits from your caregiver and employer, besides those from my doctor(s). I asked my husband to write one, describing in detail my struggles on a typical bad day. He described how my activity level changed from pre-illness and the different things he has had to take on, now that I am ill. He also indicated how often I had bad days versus good days; and what types of tasks I could do and not do on bad days and even on good days.
I agree that having someone else describe your day-to-day is more impactful than saying it yourself. I would have asked my recently former manager to write something similar, if my LTD appeal was also rejected. I imagine my manager would mention that I would more and more announce that I had to lie down and go offline but that I was a diligent worker and tried not to let my work suffer.
I actually included in my evidence a couple of my previous years' performance reviews, which established my reputation as an exemplary employee. I was doing very well in my career and had no reason to leave such a satisfying job, except for this debilitating illness.
While it was heartfelt, I decided not to include my mother's affidavit because it did not provide enough of a description of my functional limitations.
(9) SSDI application
a) I followed advice at HowToGetOn by
starting my SSDI application online but my husband and I took a long time to fill in the rest of the forms, about 4 weeks. By starting the application online, you establish your application date early. This matters because the application date (along with your disability onset date) will determine how far back you might receive back pay. Additionally, once you stop working, you should not wait too long before applying. Otherwise, you may not be eligible.
b) I also sent a
letter asking for extensions to any forms deadlines as a disability accommodation. From start to my approved initial decision, it took 5 months. About 2-3 of those months were spent taking the time to complete the forms.
(10) 2 Day CPET, Neuro-Psychological, QEEG
a) Paying and reimbursement for the tests
One advantage of paying out of pocket is if the test results are not convincing or contradict the claims in your case, you might consider leaving it out of the evidence you submit. This might be something you can do for STD/LTD but for SSDI, I am told you are compelled to submit ANY evidence relating to your claim. So, if you have any doubts at all that these tests will confirm your health conditions, you should probably be consulting with or engaging a lawyer. They would be able to help you determine how to bolster your case.
It is possible to have these tests covered by your health insurance. It will likely be treated as out of network. You will need a detailed receipt showing the CPT codes.
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Next, I will talk about what happens while waiting...
Need to have some of that cake
@andyguitar offered me again.
