My Lessons Learned regarding Disability Claims

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My policy even states this…
your Elimination Period and during the next 60 month period, you are unable to earn more than 80% of your Predisability Earnings at your Own Occupation for any employer in your Local Economy; or

3. after the 60 month period, you are unable to earn more than 60% of your Predisability Earnings from any employer in your Local Economy at any gainful occupation for which you are reasonable qualified taking into account your training, education, experience and Predisability Earnings
It is interesting @DebOw that your policy has 60 months before the "any occupation" kicks in. In mine it is 24 months! So, I am expecting some aggravation at the 24 month mark.

My policy doesn't specify a percentage of pre-disabilty earnings. I cannot muster up enough brain cells to assess if this is better or worse than yours.
 
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It is interesting @DebOw that your policy has 60 months before the "any occupation" kicks in. In mine it is 24 months! So, I am expecting some aggravation at the 24 month mark.

My policy doesn't specify a percentage of pre-disabilty earnings. I cannot muster up enough brain cells to assess if this is better or worse than yours.
My LTD policy pays out 60% of the salary I received prior to my disability. This income is not taxed so my LTD monthly benefit is similar to what I was earning when I was healthy. In other words…if you can work at any job that pays equivalent to what we are paying, you are no longer eligible. This is fair to me. However, this is so often used as an opportunity to cut off benefits. One thing I learned is that many times companies provide their employees a summarized copy of the LTD policy. I had to request the full policy, this is where I learned all the things that could dramatically effect me. My trouble came at the 24 month point. They canceled me stating I was no longer disabled. If you have any issues at that point please reach out!! I’m happy to assist any way I can. How often does your insurance company contact you for paperwork?
 
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I have been asked for updated paperwork for the six month period after I finalized my appeal submissions. Bot sure if this means every 6 months will be the norm...
Metlife is my carrier for LTD. It started in 2013 and canceled in 2015 by them. 6 month appeal and was reinstated with 6 months of lost monthly benefits. At this time they request documents from me once a year. I was curious how often paperwork was requested from others on LTD.
 
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I also found this handbook to be helpful. It covers not just ERISA (LTD) and SSDI but other patients rights like accommodation and health insurance. I understand the author Jennifer Jaffe passed away a while back. Even though the last edition was in 2012, I found the content to still be applicable. The sample disability letters gave me clues on what content I wanted to include in my LTD appeal.

Know Your Rights: A Handbook for Patients with Chronic Illness

https://books.google.com/books?id=czEhTdxHAK8C&lpg=PA23&pg=PP1#v=onepage&q&f=false

https://smile.amazon.com/Know-Your-Rights-Handbook-Patients/dp/0977749207
 
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So, I reread parts of the handbook that discusses health insurance. I currently have coverage through my husband. It sounds like no matter how expensive COBRA is, I should pay it, so I have continuous coverage and hopefully, preexisting conditions won't apply with my next insurer?

I have 2 years before Medicare kicks in. Sounds like I need to ask my husband to keep working for at least that long. He has 7 years before retirement age. My worry is what might happen if he gets laid off before 2 years.

Can anyone share any tips when shopping for new health insurance, given our disabilty and ME/CFS?
 
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(2) Decide if you are staying at work. I urge you to discuss with your doctor(s) the likelihood of remaining at work and returning to work given your current condition.
Believe it or not, I stumbled on the idea I might have actually have ME/CFS when looking up if other people with adult onset EBV infection tend to stop work temporarily but somehow return to work:
"Work Rehabilitation and Medical Retirement for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Patients. A Review and Appraisal of Diagnostic Strategies" by
Mark Vink and Friso Vink-Niese
https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC6963831/

This line convinced me to stop work and seek other doctor opinions (tthat I may have me/cfs): "Patients who are given a period of enforced rest from the onset, have the best prognosis."
 
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Another tip I wanted to share: do not be dissuaded or discouraged if you are younger than age 50 or if you were previously working sedentary or work-from-home job. As long as you have supportive objective tests (2 day cpet and/or neuro-psych eval), clear medical records, and a supportive doctor who is directly managing your me/cfs, you have a strong case!

I was age 45 when I applied for SSDI and had left a work-from-home IT job. I believe the 2 day cpet was the most compelling evidence.