Short-Term Disability Approval/Denial

[medicamanda 0]

Every insurance company has different requirements. I'd call your customer service number and ask them. Many times they won't pay if it's for elective surgery, but if you have really upscale coverage, it just might.

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lol, I work for county government, and though I absolutely love my job, they definately dont have upscale benefits! I do have enough sick and vacation time saved up to take the 6 weeks off, but that will wipe out all of it, which makes me nervous. I have had the disability insurance for a couple of years, but have never filed a claim, and as embarrassing as it is to admit, I am not even sure what company it is through. Lol I just know it comes out of my paycheck every month. I will definately look into it though. My medical insurance will cover the surgery, but I am not sure if that will make it a medical neccessity in the eyes of the disability insurance company. Guess I have some researching to do!

[Yvette1026 0]

Some notes from an ex-benefits administrator

1.) your surgery IS an acceptable use of your STD (so is having a cold for more than 7 days etc...) any medical reason to be off work, that you have a signed dr's excuse for.

2.) Most STD plans require a 7 day waiting period, so be prepared to have a week's worth of PTO to cover that week, unless you pay extra for the "no wait" that some insurances offer. In some cases they require 14 days of a waiting period but 7 is most common.

3.) She pays for her insurance, and it's there for her use. If she has a medical excuse for 6 weeks, Metlife will allow her their pre-determined allotted time to be off work. And anything further would require a treatment plan and office notes. Even if the dr says 6 weeks he/she will be required to fill out paperwork explaining why the PT requires a longer than normal recovery time.

And although many of you don't agree with her methods and she may not have properly presented this; she's entitled to use her STD and she actually does have a reason to be off work if it's approved by her doctor and if you read between the lines of what she wrote you'll see it, if you're trained in it.

She's burnt out.

Surgery (although elective) is a major life event and stressor, with what most would already consider a very full life load (ft job and school) the added stress of life changing surgery and the adjustment period required gives her enough of a reason to be off work for a few weeks. All of this was more than likely recognized by her DR, although not a mental health expert, and he provided her with the excused absence.

Everyone is entitled to their thoughts and opinions on the matter, but unless you can deal and speak to the facts and truth of the situation or there's an MD at the end of your name all of these opinions are for the most part invalid and just pixels on a screen.

Just my 2 cents anyways...

Happy New Year all and to the poster hope you get the assistance you need, if you need it :biggrin:

Edited January 1, 2010 by Yvette1026

[minimeme 1]

Everyone is entitled to their thoughts and opinions on the matter, but unless you can deal and speak to the facts and truth of the situation or there's an MD at the end of your name all of these opinions are for the most part invalid and just pixels on a screen.

Just my 2 cents anyways...

You do realize that by telling people their opinions are invalid because they dont have MD behind their names, it pretty much invalidates your own argument, right?

[Yvette1026 0]

You do realize that by telling people their opinions are invalid because they dont have MD behind their names, it pretty much invalidates your own argument, right?

Semantics my dear...

[ElfiePoo 109]

You don't need an MD after your name to know it's fraudulent use of insurance when someone says they don't want the disability time off because of their surgery but because they hate their job.

[ElfiePoo 109]

What I find even more interesting and telling about this thread is that the posts where the OP made the original claim that she didn't want the disability because of surgery but because she hated her job...and the one where she tried to justify the fraud...have both been deleted.

So 'someone' recognizes it as fraud.

.

[zobee 0]

My understanding is that Short Term Disability is **usually** a benefit paid by the employer, not the employee's premiums -- so putting aside for a moment whether or not this is considered fraud, chances are pretty good that it will not mean an increase in premiums to employees, it will mean an increase in the premiums paid by the employer. :huh2: So if the premiums for STD increase, then the OP is sticking it to her own employer, not her fellow, premium-paying Metlifers.

Additionally, most employers make you use all of your sick time before you file for STD, so that tells me that the OP is pretty desperate to have this time off, yes? If it were as simple as fraud, I don't think she would burn all of her sick time, just to spend a few weeks off that she didn't truly need, but then, that's just my perspective.

I think that ymjackson1 is right in that we do not know the situation. We don't know where the OP's head is right now. It could very well be that she needs the time off due to mental or emotional strain caused by some situation on her job. God knows I've had jobs and/or projects on an otherwise wonderful job that have caused me much emotional distress, and I would bet that there are some here who can say the same. It is very possible that "I hate my job" actually means, "I need a break before I jump on my desk with a staple gun and go postal on everyone." :eek:

The point is that if the OP feels she needs to take a few weeks off, then I'm not going to tell her that she doesn't, because I don't know what her situation is; and if she really feels she needs a mental health break, well -- that would qualify as a medical need, and that is what the insurance is there to help with. :cool2:

Having said that, if the OP truly does feel like she needs to take some mental health time, then to be totally above board, she ought to have her doctor approve the time on that basis -- mental health. But really -- is that likely to happen? Lets be honest here -- Employers tend to think that "mental health" equals "weakness" :sad: so it could mean the kiss of death to any potential career advancement.

So I agree again with ymjackson1 -- IF the OP truly needs the time off, then she should be allowed to take it without being judged.

If she does not need it, and she's truly sacraficing all of her sick time for an entire year, simply to pursue some nefarious plot to increase the STD premiums paid by her employer -- it will out, eventually. This scenario would be more indicative of the way in which she approaches her life and work on a daily basis, and that isn't something her boss is likely to overlook for long. :glare: If this is truly the type of person she is (and we can't possibly know that she is, but if so ...) then eventually, her boss will tire of her excuses and lies and fire her.

So in the absence of any actual facts, I'm giving the OP the benefit of the doubt, and assume that she needs the mental health holiday and hope that she gets what she needs.

[ElfiePoo 109]

My understanding is that Short Term Disability is **usually** a benefit paid by the employer, not the employee's premiums -- so putting aside for a moment whether or not this is considered fraud, chances are pretty good that it will not mean an increase in premiums to employees, it will mean an increase in the premiums paid by the employer. So if the premiums for STD increase, then the OP is sticking it to her own employer, not her fellow, premium-paying Metlifers. .

And sticking it to her co-workers because where do you think the employer is going to get that money from? Certainly not from their own pockets.

My husband has short term disability through his job for medical reasons. Hating his job isn't a medical reason.

If someone has to lie...whether it's the provider or the consumer...in order to get those benefits, then it's fraud, no matter how you justify it.

My last word since I learned long since that dishonest people will always justify why they aren't 'really' dishonest in order to get what they want and there's no reaching them.

Flame on, Johnny.

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[flychica 0]

Well if she needs a mental health break then, she should use up all her Sick Time/PTO or Vacation. Whatever is available with her company or start a new claim specific to her mental issues.

As someone who actually processes claims on the side of the insurance company......not an HR administrator. I know for a FACT what is required to meet those eligibility requirements to be approved for receiving benefits. So MD or NOT.....I do know what is needed to get a claim approved and a check paid out for that time period. Being an HR admin is totally different from actually having all of the policy language in your face...compared to a basic summary and believe, most people even Agents that sell these policies do not completely understand most medical, dental, life, std/ltd or even ltc policies.

Fact is......even she, the OP was questioning whether it would be approved and seemed to fear it would be denied. Because Metlife was calling to ask questions on why she needed 6 weeks off considering she works a desk job. That there put red flags up for the claims examiners.

No one is saying that she shouldn't use the benefit, but she admitted it had nothing to do with medical necessity. It had to do with "not wanting to be at work". And depending on the company, some employers pay for the STD/LTD in full for their employee's...or some pay majority and the employee's pay a portion. Just depends what they give their employee's. The point is......IT STILL DRIVES UP COSTS FOR ALL PARTIES involved.

So as someone with just an opinion..........if she truly "medically needs" the 6 weeks, she should make use of it. But at the end of it all.....Metlife will make that decision and if I wanted to be real funny, believe I could contact their fraud department....send them this thread and I'm sure they will find out who she really is and her real reasons for wanting STD. Heck, anyone could.

I would have gave her the same benefit of the doubt if she didn't start throwing out the remarks she did...specifically about defrauding.

[btrieger 21]

Hi all, I have been on the lbt site for a few months, but this is my first time posting. I am on my cell, so apologize for any missing punctuation or misspellings. I have my first consulation with the surgeon next month, so still very early in my journey. I am a paramedic, and due to the heavy lifting requirements I know I will have to be out of work for at least 6 weeks. I have short term disability insurance, but hadnt even considered trying to use it. I thought that since it will be an elective surgery that it wouldnt be an option. Does anyone have any info on if it would be covered, and if so, since my job does require extensive amounts of heavy lifting if it would cover more than a weeks pay? Any response would be truly appreciated!

Ask your surgeon what he thinks about you returning to work.

We had a truck driver in one of my mandatory nutrition and behavior classes that had a similar question.

The answer was that he shouldn't need more than a week or two off.

The heavy lifting restrictions are usually for bypass patients.

[zobee 0]

@flychica: Since I didn't read the comments you are referring to before they were apparently deleted, I cannot speak to any intention on the OPs part to purposefully defraud her insurance company. All I have to go on is what I have read, and what I have read does not provide enough information for me to judge what she is or is not trying to do or why.

I will take your word for it that she stated she was attempting to defraud her insurance company, and that being case, then yes, I would have to agree that her actions are wrong.

You can, of course, do what you feel you need to -- However, I think that sending her insurance company this thread is a bit of overkill. Again, if she is lying to her employer about this, then she has more than likely done so in the past, and chances are she will be terminated. I believe that goes around comes around and dishonest people will get what they deserve in the long run.

@ElfiePoo I choose to believe that you did not just infer that I am a dishonest person, simply because I do not choose to string someone up by their toes and set them afire, based solely on a handful of poorly thought out posts. Instead, I choose to wish you much peace.

@nobody in particular -- I find it interesting how much rancor this thread has stirred up and as a student of human nature, I cannot help but wonder why. Did I miss something? Did she flame someone or make some personally derogatory comments?

[btrieger 21]

The OP is only 28 years old. A lot of us having been working longer than she has been alive. We get time off for stress. It is called vacation.

I had a couple of heart attacks in September and underwent a coronary cath and stent placement. CIGNA, the STD considered this surgery but only allowed me 2 weeks. I probably could have used another week or 50 but they were right and I was ready to return to work.

So, if 2 weeks is enough for heart attacks and a cath; 6 weeks is way out of line for a lapband.

Edited January 2, 2010 by btrieger
forgot to finish :)

[flychica 0]

@flychica: Since I didn't read the comments you are referring to before they were apparently deleted, I cannot speak to any intention on the OPs part to purposefully defraud her insurance company. All I have to go on is what I have read, and what I have read does not provide enough information for me to judge what she is or is not trying to do or why.

I will take your word for it that she stated she was attempting to defraud her insurance company, and that being case, then yes, I would have to agree that her actions are wrong.

You can, of course, do what you feel you need to -- However, I think that sending her insurance company this thread is a bit of overkill. Again, if she is lying to her employer about this, then she has more than likely done so in the past, and chances are she will be terminated. I believe that goes around comes around and dishonest people will get what they deserve in the long run.

@ElfiePoo I choose to believe that you did not just infer that I am a dishonest person, simply because I do not choose to string someone up by their toes and set them afire, based solely on a handful of poorly thought out posts. Instead, I choose to wish you much peace.

@nobody in particular -- I find it interesting how much rancor this thread has stirred up and as a student of human nature, I cannot help but wonder why. Did I miss something? Did she flame someone or make some personally derogatory comments?

I said I could, didn't mean I was doing it or planned to. Like you, I feel what comes around goes around and the end result is most likely she will be denied STD for the length of 6 weeks. As someone else mentioned above, there's usually a 7-14 day waiting period....so in the end, she would still be using her PTO. LOL.

And yes, she was telling us its not like she's a welfare mom with 7 kids by 7 different fathers.....abusing the system, etc. etc. You missed the key posts from her. LOL. She probably went back and deleted them because she realized how she looked.

Edited January 2, 2010 by flychica

[zobee 0]

@flychica Sorry, my bad, I should have phrased that better. I did not mean to imply that you planned to call the insurance company, I was simply trying to express that I do not feel moved to do so.

So much ado, LOL.

Came back to add that this is why I dislike it when people delete posts -- you can erase a word from a page, but you cannot erase it from the memories of those who read it. Unfortunately, by choosing to delete a post, in effect, the poster is deleting any hard proof that she may have been misunderstood. Better to leave a regrettable post where it is, and then offer an apology, then to delete it, I think.

Peace, all!

Edited January 2, 2010 by zobee

[btrieger 21]

Please call it "short term" and not "STD". I have a filthy mind and every time I see "STD" I start laughing. :smile2: