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Mar 13, 2014

I am happy, sad and mad all at the same time. Long story short....My LTD company informed me two weeks ago that due to the results of the functional capacity exam they ordered my to complete I am no longer considered disable to perform "any work" so they are only paying me for 24 months per my policy. On the day of the exam I had to drive myself due to limited support system and estranged from my family. Insurance company stated in the letter that since I was able to drive myself to the exam and put gas in my car even though I paid at the pump I could do other forms of work other than then my own. Also they said they had video surveillance of me checking my mail at home and waving to my neighbor. WOW...I am still in pain everyday from Peripheral Neuropathy, chronic fatigue and a whole list of other Aids related symptoms. I feel so violated and upset that 27 years of working for the same company means nothing. Sorry for the ranting...My question is... Today I received a letter from my attorney who represented me at my SSDI hearing stating that I was approved and should get the Notice of Approval in the mail in about a week. Do I have to turn my eventual back pay over to LTD even though they said my payments cease in a couple of months? Now that I have been approved for SSDI and hopefully soon after Medicare what should I do first? Thanks...Mad, Scared and Happy.

Response from Mr. Chambers

I do not blame you for being angry. But the best thing to do now is appeal their termination of benefits. It sounds like the disability policy came through an employer. If so, then it comes under the federal law ERISA. That law requires them to let you appeal up to 180 days after getting the termination letter, plus it gives you a right to get a copy of their entire claim file on you, including the surveillance tapes.

Immediately, send them a letter telling them that you plan to appeal, but, in order to do so, you are requesting a copy of the complete claim file "as is your right under ERISA." Follow up to make sure they got the letter and ask when you will receive the file.

Meanwhile, I encourage to try to find an attorney to help with your appeal. If you are like most of us, you need an attorney who will take your case on a contingency basis so you don't have to pay out money up front. Start with any AIDS Service Organization or HIV/AIDS Legal Services Agency in your area and ask for referrals. Otherwise, see if your local bar association has a referral line (some in larger cities have a line dedicated for HIV issues). Also, non-profit agencies may not charge at all.

Otherwise, do a browser search for "contingency ERISA attorneys (name your city)".

You stand a good chance of winning your appeal since you just got approved for SSDI. Also, I wouldn't worry about the surveillance. Taping you carrying groceries or filling up your car with gas does not prove you can work an 8 hour day, day after day after day.

Regarding reimbursing LTD with the SSDI retrospective payments, you probably do owe them the money HOWEVER, I would focus on the appeal now and not offer to pay them anything until the appeal is resolved. Don't spend it either until this is resolved.

Good luck, Jacques

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