[0:01] If you're applying for disability benefits or help people that are, the path to success has never been more complicated.
[0:06] Welcome to the Disability Expert Podcast, where we tackle the difficult issues and interview the country's top experts to help you better navigate the disability process.
[0:15] Winning a disability case is hard and keeps getting tougher every day.
[0:19] We can't promise you'll win your case by listening, but we sure think it's going to help.
[0:24] This really isn't that complicated. I mean, you want to win your case, don't you?
[0:29] Well, then listen to what I say.
[0:31] Hey, it's Chad Brown. Welcome to another episode of the Disability Expert Podcast, where we talk about all things Social Security Disability and today long-term disability and how they interact and what you need to know about how they work together so that you don't absolutely screw up your Social Security case or your LTD case trying to win one without understanding the other.
[0:55] I'm once again with my senior associate here in the back.
[0:59] I didn't forget your name, I promise, dramatic pause.
[1:06] And candidly, here's to it, all the heavy lifting today, he runs our federal court, a pellet division, he also, because the LTD most LTD work is federal related work here and also runs our LTD practice, so we're going to rely on him heavily today.
[1:24] But one of the things it's, I think misunderstood is how different disability programs interact together.
[1:34] I know recently we did an episode on veterans disability, not talking about veterans disability benefits, but talking about how veterans engage the Social Security disability process, how the programs are different, how they're similar, how things can work in one and work in the other.
[1:53] We've shot episodes on LTD, you have an LTD claim and have specific issues about the process or whatever all that check those episodes out.
[2:03] But today, what I want to do is sort of co-through and look at many people have Social Security disability and LTD cases that are really running parallel.
[2:16] They have either private long term disability insurance that they have bought on their own or given to them through their employer.
[2:27] And it requires them to apply for Social Security disability, which most LTD policies have a, there's some high end sort of specialty type policies that don't.
[2:38] But the average run of the middle LTD policy, long term disability, I'm saying LTD, that's long term disability, which is private, is typically going to require you to apply for Social Security disability.
[2:49] Or you're going to have someone who goes out of work and they are going to basically simultaneously come into both systems, are going to take short term disability, then they're going to go into long term disability.
[3:04] At the same time, they'll have already started the Social Security process. And because of that, they end up sort of having to handle two disability cases at once.
[3:14] Yes. They end up with different rules, different requirements, and they often get confused.
[3:21] So I thought it would be helpful to sort of walk through and say, hey, let's take this hypothetical person who is engaging with both systems and sort of walk them through and understand.
[3:32] These are some of the similarities and differences. These are things to think about as they interact with each other because having an LTD policy can be one of the most beneficial factors in the weight or Social Security disability because it provides income.
[3:48] So you don't end up having to navigate these long weight periods without any money at all, which can be used to do all kinds of things like pay your power bill and keep the light zone and keep a roof over your head and pay for your medications.
[4:01] And those things. So it's important. So on the back end of the process, you end up with all kinds of issues because typically there's overpayment issues when you win both cases.
[4:10] Sometimes you win one and not the other people don't understand that. That's when it's that little bit. But to start with, just sort of walk through broadly, if someone's trying to apply for both at the same time.
[4:22] So they have an employer-based LTD policy. They're going into the Social Security disability process. What are some of the main differences that they need to understand just from the very beginning?
[4:32] I think the first thing is to talk about is the timeline. Timeline for long-term disability, timeline for Social Security disability, look very different. Typically on an LTD case, assuming there's not going to be a denial that you end up having to appeal or something like that, assuming they approve you right off the bat.
[4:51] It doesn't take very long to get approved. Usually you're on short-term for three to six months and then you transition over to long-term. And it might only take the long-term disability carrier 30 to 45 days to process your application and get you in pay status.
[5:08] And then if you have short-term disability, all times you'll actually start the process for LTD and sometimes there's really limited to no weight in between. Sometimes you can have just a continuation almost to benefit from short-term and you roll straight into long-term and you really don't have a period of time where you don't have income.
[5:25] And then it always happens. But certainly that's a little different than Social Security.
[5:31] Yes.
[5:32] What are you expecting? Generally with Social Security, I try to prepare clients. It could be two to three years that you're waiting to get those benefits.
[5:40] It might not. You might be one of the lucky few who get approved at initial or reconsideration. But generally I try to prepare people to expect to go to hearing with a judge and to get that decision is probably going to be two to three years for Social Security.
[5:53] Well, and there's a huge difference there because even if you're initial application, I think recent numbers, I think four last numbers, numbers of 32%, I think if people get approved initially on their social disability, even if your case is approved initially, it's highly unlikely you're going to see any money before probably five to six months.
[6:14] That's quick because they're going to take several months because you're basically going to fall in a queue.
[6:20] It's not like you file your application and they say, stop.
[6:23] Top priority right now.
[6:25] Yeah, that doesn't happen.
[6:27] And then there's also state by state issues.
[6:30] You know, we had a lot of cases in North Carolina and a lot of cases in South Carolina.
[6:33] And South Carolina wait times DDS or substantially longer than they are in North Carolina.
[6:38] Yeah, and so you could win your case in South Carolina currently and it might be 12 or 14 months before you're approved.
[6:48] But even in the very best scenario, it's highly unlikely you're going to see any money in probably six months.
[6:55] Even if you win your case and everything goes away, it's supposed to.
[6:58] Yeah, so you have differences in wait time. What are some other, what are some other differences?
[7:02] Next big difference would be money, how are benefits calculated?
[7:06] Generally with short and long term disability, those are calculated as a percentage of the job that you have the policy through.
[7:14] Generally 60 to 80% of that of your income from that job before you became disabled.
[7:21] Social security has a much more complicated way of calculating benefits, but suffice it to say it's generally going to be less than what you're getting from shorter,
[7:31] long term disability because it's looking at your lifetime earnings history and it's it's usually not 60 to 80%.
[7:39] Yeah, and so they're going to they're going to calculate your, your PIA, your primary insurance amount.
[7:44] Based on your work history, how many total years you've worked, how much you've made in the last number of years, whether zeros in your work history,
[7:52] whether years where you were out of work and out reporting income at all.
[7:56] And by and large, there's something most people don't know when they come into the process, where with an LTV policy, most people are going to have a reasonable idea how much money they're going to make.
[8:10] Okay, so there's differences in time, there's differences in money and how it's calculated, what are some other differences?
[8:16] LTV, we don't have hearings with ALJs, basically with LTV, it's all paperwork filing, so you may not get your day in court with LTV, where social security sort of, we're building up towards getting to that ALJ hearing.
[8:32] Right, and so you're typically, you know, they're either going to review your case and they may pay it without you doing, without you doing an interview, you may do an interview with a claims rep type person for the insurance carrier who will do.
[8:45] What feels like an informal interview, so to speak, very different than the social disability process in the event you lose your LTV claim.
[8:56] There is a process where you can't appeal to a federal court, there's watched the episode, if you have an LTV case, and you've received an initial now, you need to watch that episode and understand, there's a limited window of time to build the administrative record.
[9:11] There's a limited amount of time to get things into that record that could be considered by a federal judge, if you actually file an action in federal court.
[9:22] But even then, it's going to be an administrative review, you're not actually going to have a hearing, like you said, you're not going to have a day in court in an LTV case.
[9:32] And there's much smaller room for error in building your LTV case because there's a much tighter window that you have to establish what the evidence is and get that evidence to the carrier wearing the social security process.
[9:49] Literally, as long as you comply with the five-day rule, you're going to be able to put evidence in as recently as at the hearing and sometimes with the facts mandate, you'll be able to put an evidence after the hearing.
[10:02] Don't do that, get your evidence in beforehand, judges do not like putting cases in post where they have to wait and come back in review or case a month later.
[10:10] You've had three years to get here, why is the evidence not yet?
[10:13] Yeah, and then there's reasons it happens, but it is not ideal.
[10:17] Judges do not like that off the record, they will tell you do not send your case to post because I do not want to come back a month from now and have to renew all the facts in my mind when I've done 60 hearings.
[10:26] It's then and that's that's not ideal in any other significant differences.
[10:32] I'm sure there's a few, but those are the top ones that I usually hit.
[10:35] Yeah, and so I think one other thing though is there is this issue in your LTD, initially most policies are looking at an old occupation versus any occupation period.
[10:47] So there's really in most LTD policies going to be sort of a bifurcated decision making.
[10:52] Initially, they're just looking at can you do the job you were doing at the time you became disabled, where usually there's like a two-year window and you can vary based on policy.
[11:01] It was usually two years where they're going to come back now and say can you work at any occupation, where you can make typically it's a percentage of the amount of money you were making at the time you went out of work.
[11:12] So if it's say you were making $30,000 and it's 80%, they're going to say are there other jobs you can do where you could make $24,000.
[11:21] I think that's a difference that also can be confusing to people because sometimes they'll win their initial LTD claim for their own occupation.
[11:31] Then they'll get into the social security disability process and they're like well you have past relevant work at step four of the squintial evaluation process.
[11:39] You have any other work at the step five is that sort of the same thing and the answer is no, it's not the same thing.
[11:47] There's a five-year window for past relevant work that's not the same as the any occupation.
[11:53] Any step five other work you can do on a sustained basis where there's reasonable number of jobs exist.
[12:02] That's a very different test than whether you could find another job with your limitations and earn a certain percentage of your prior income.
[12:09] There's a very different test but to the sort of untrained year they sound a lot alike.
[12:16] I think there's some differences there.
[12:22] There are some similarities.
[12:25] Obviously you're looking at medically determinable severe impairment requirement for social security.
[12:31] You're not going to win an LTD case by and large without a medically determined severe impairment.
[12:37] In the LTD world by and large you're going to have to have a doctor sign off on not only the existence of your impairments but the limitations that come from them where you very easily could win a social security case without having a doctor ever write a letter of support.
[12:55] I would say the majority of cases we win don't have a letter of support in there.
[13:00] There are some similarities and differences.
[13:04] The main thing I think the person who's navigating both systems needs to understand is you have to understand a separate set of rules, a separate set of guidelines, a separate set of requirements.
[13:15] Yes, there will be overlap.
[13:18] The same medical records may be in both files but beyond that the differences may exceed the similarities.
[13:26] One of the issues I think is really important for people to think through though is there's sort of a window of time when you leave work and you come into the social security disability process and you have the opportunity to use LTD benefits, short term disability benefits as well.
[13:44] But when you have those benefits, those LTD benefits, there's really decision making that needs to be going on.
[13:55] The home before you ever leave work.
[13:58] Yes, sort of walk through that, why that's important, how we help, because that's a common issue, like a lot of times we help people call us and they're working a lot of times we can't help them.
[14:10] One of the real big exceptions is that people are calling us who are working saying, I've got to come out of work but I've got LTD, I've got short term disability, I don't know how they work, I don't know how they interact.
[14:20] So, sort of walk through that person who's, they're contemplating leaving work, they have LTD benefits.
[14:26] What sort of that decision making process look like in terms of, how do you capitalize on the fact that you do have these benefits that can be really helpful in the disability at least process?
[14:37] Yes, so this can be a really tough spot that people find themselves in because nobody really wants to throw in the towel and say, well, I can't do this anymore.
[14:46] So, I'll say sort of the ideal progression of events is your at work, you realize your health conditions are just getting to the point where you need to quit.
[14:57] Don't go into human resources and quit that day.
[15:00] Use your family medical leave act, FMLA time, not to get into a totally different area but generally FMLA is going to give you 12 weeks of protected leave a year.
[15:12] Fortunately, that tends to coincide with your short term disability pay.
[15:16] So, when people go in with a really good plan, usually what that looks like is you start the FMLA, you start the short term disability, those are running concurrently.
[15:26] And then at the end of that 12 week or so period, then you can switch over to long term disability and hopefully not have any interruption and benefits.
[15:37] Now, the tough part for folks is usually around the time the short term is ending.
[15:42] You typically run out of your FMLA and now you're starting to get threatening emails from human resources that says, hey, are you coming back to work or do we need to fire you?
[15:51] Right. I think one of the mistakes people make is often people are hiding their disability at work.
[16:05] Are there understanding employers who work with people who accommodate work who provide assistance? Yes, sure.
[16:14] But it's also very common for someone to really sort of try to hide their disability.
[16:22] Now, whether they're actually hiding it from their supervisors and the people they're working with is a different discussion often they think they're hiding it but they're really not.
[16:30] Everybody really knows that they're having the issue or maybe some people really do know.
[16:34] But they're very skeptical of going in and telling HR, telling management in effect, hey, I have these issues but the problem is often when people are suffering with disabilities, they are exposing themselves termination.
[16:50] And once you're terminated, it can be very difficult if not impossible to now claim that you're eligible for your short term and long term disability benefits.
[17:02] And so it's one of these situations where you candidly are going to have to probably have a conversation with someone in HR, with someone in management, depending on the size of your company and where you work, the nature of your employer.
[17:20] Because you need to make sure that you are engaging the HR tools that are available to you, the short term disability and the long term disability, so that you can access them.
[17:33] Getting mad, quitting, getting fired are problematic and then coming back and saying, whoa, but I want to use my LTD benefits.
[17:42] It's like, well, if you're not employed here anymore, right now, the sudden you're not employed.
[17:47] Not that some of those things can't be fixed, but generally, I think sort of the takeaway is, one, you should know if you have those benefits.
[17:56] Never ceases to maze me, how many of our clients come to us with SS, you know, disability claims.
[18:03] And sort of, you know, we're engaging them and like, what do you have LTD? And they're like, I don't know.
[18:08] And we're like, well, you work for an employer that we're pretty sure provides those benefits.
[18:13] You know, you're working for UPS. We're pretty sure UPS. Historically, those employees have had LTD benefits. And they just don't even know.
[18:23] And then you get in these other issues of whether you can actually go back and retroactively apply for benefits and there's usually...
[18:29] There's deadlines.
[18:30] There's deadlines and sometimes you can and sometimes you can't be on the scope of the conversation here.
[18:34] But I think it's important, you need to know if you have those additional benefits.
[18:38] If you do have them, you need to understand that there's not unlimited sort of use their rules about their usage.
[18:47] And usually that conversation is when you're going to have to have, but candidly, in my experience, by and large, when you've reached the point that your disability is keeping you from working, pretty much everybody knows.
[19:03] It's hard to hide.
[19:04] It's very hard to hide. And so it actually becomes a relief because the supervisor is like, I'm not going to have to fire you.
[19:11] But you've sort of given them this, get out of jail free card. We're not going to have to terminate you.
[19:17] And if you're a good employee and you have that good relationship, they don't want to fire you.
[19:21] No one likes firing people. It's not any fun.
[19:23] Yeah, so I think in terms of transitioning, you know, those are sort of the main takeaways. Let's talk about what happens during the claims.
[19:34] So let's talk about ways that the policies work, the ways that the claims sort of work together and a couple of things to be weary of.
[19:43] First thing, let's talk about are the long term disability free disability rep that will give you for your social security disability case.
[19:53] Can you talk about that a little bit?
[19:54] Sure. Everybody gets excited when they hear free.
[19:57] Basically, like we talked about earlier, almost all LTV policies, except maybe the very, very upper echelons of them have offset language.
[20:06] And what that means is if you start getting social security benefits, the long term disability company gets to pay you less money in the amount of what you're getting from social security.
[20:16] So the long term disability folks do have an incentive to help you get approved for social security.
[20:24] Along those lines, they have sort of, I guess, preferred vendors would be the right term that they might recommend you work with to help you on the social security side.
[20:33] And they'll say, you know, if you if you use these folks, we'll pay their fee for helping you so they're free.
[20:40] In the generosity of the heart of the large corporate insurance company, they have graciously giving you a free representative to help you navigate your social security disability case.
[20:54] It's a disaster.
[20:56] Like, I don't, I'm not saying they're bad people. Don't, don't, don't miss hearing me.
[21:03] I'm sure that many of those rep, most of which are not attorneys, also not saying that you can't have non attorneys that aren't going to rip.
[21:10] That whole two part episode with Jane Johnson, a number of months back, non attorney rep, excellent rep, many of them are excellent.
[21:18] But the reality is most of the reps who work in conjunction with the LTV companies are non attorney reps.
[21:26] And they, at one level, my personal gripe with them is, I think it's an inherent conflict of interest.
[21:34] Yes.
[21:35] To be paid by the LTV carrier and at the same time represent you.
[21:42] I mean, that's a major red flag if you're an attorney.
[21:47] It can be done as an attorney, you can be paid by a third party, but there are a ton of rules.
[21:52] It's highly suspect in most scenarios.
[21:57] This one included.
[21:58] And the main thing is when you get to the end of this process and we're not going to talk a lot about this, but when you get to the end of the process, if you win both cases, the LTV company wants to be paid back, your back pay.
[22:10] Yes, they're going to send you a letter that says, hey, you owe us some money.
[22:13] And to my knowledge, I've never known a representative who was working at the rest of the LTV company for one who ever told that client they shouldn't pay that money back.
[22:26] Whether you're required to pay it back, whether you're contractually obligated to pay it back, whether you signed a thing saying you would pay it back.
[22:34] Practically, there are scenarios where paying back the LTV carrier is probably not the right decision.
[22:43] There's risk with that.
[22:44] You risk having things following your credit.
[22:46] You risk being sued.
[22:48] That's why we're not digging deep into this, but I'll just tell you.
[22:51] Yeah, just case by case, but practically after doing this for a really long time, there are scenarios where it doesn't make sense to pay them back.
[23:00] It's not unethical. It's just practically, it makes sense based on future benefit or whether there's a lump sum payment that should come out.
[23:08] Sometimes you pay the money back and then they stop your benefits.
[23:10] So in case recently that actually happened, we had a lead came in and they paid the money back and they stopped their benefits.
[23:15] And it's just doesn't, it doesn't work in the clients best interest typically to have that them represent them.
[23:25] You want somebody completely independent giving you advice on this area?
[23:29] Let's talk just briefly about some of the ways that the LTD case can help us us through disability case.
[23:35] So in terms of like doctors, letters, let's talk about that specifically.
[23:37] Here's other ways, but in an LTD case, almost universally you're going to have a letter of support from your doctor.
[23:44] What is the benefit of that other than just having a letter of support?
[23:47] But the nature of LTD letters of support I think really helps in this is the cases.
[23:51] Yes, typically the LTD carrier has their specific form and it does a pretty good job of breaking down.
[23:58] Functional limitations and you know, listing out the exact reasons why your doctor is supporting your claim.
[24:05] Which coincidentally are very similar to the RFC, the judge may be writing in your case.
[24:10] And sometimes the doctors are on the LTD side will fill out the same form two, three, four times before you ever get to a Social Security ALJ.
[24:19] So it really documents very well over the months or years.
[24:23] How is your condition progressed?
[24:25] Yeah, I think the other big takeaway is we talk a lot on these episodes about this golden chain of evidentiary progression where you go from diagnosis to symptom to limitation.
[24:36] And what you find a lot of times in SSD letters of support is the doctor sort of tells you the diagnosis and says you're disabled or they tell you the diagnosis and they give you some additional evidence that supports the diagnosis.
[24:47] Whereas in an LTD letter of support, almost universally there's going to be a requirement that they talk about functional limitation.
[24:54] So what you have is in one document, your doctor giving your diagnosis, giving your symptoms, giving the functional limitation, they built the chain for you.
[25:03] And that evidence is just as easily used in a Social Security case, this is the LTD case.
[25:08] Yes.
[25:09] If you take aways for people, even when you win both one, we've hit on this, you're going to probably have to repay the LTD company or we told you have to repay them.
[25:17] That's a whole set of considerations.
[25:20] The other thing though, I think it's important to do is understand when you get that, there needs to be a very close assessment of how they actually calculated your benefits because they do make mistakes.
[25:33] I know that they necessarily make the most purpose, I'm not saying that, I'm saying that, but the LTD companies will make mistakes and you need to be very close.
[25:39] You need to look very closely at what they're saying they owe you back because there are policy by policy, there are exceptions for maybe auxiliary benefits, but maybe another policy doesn't have that exception benefits for your children.
[25:51] Sometimes they, when you have a private attorney, they exclude the attorney fee, which is sort of negates the whole free thing because if they don't negate it, they ask for all the money back.
[26:02] So, but they may forget to do that.
[26:05] I've seen that happen many times, so like, well, you owe us $20,000 back and you're like, hold on, they only got 15 because we had a $5,000 attorney fee, right?
[26:12] So, it's important when you get to the end of the process to understand that there's a review that needs to be done.
[26:19] And then finally, even though they're not the same, we didn't have said on continuing disability reviews, there are continuing reviews of the LTD.
[26:28] So, when you have both, it's really important that you maintain your medical treatment.
[26:32] Absolutely.
[26:33] I'm sure there's more of that.
[26:35] There's always more.
[26:36] We're out of time.
[26:37] LTD can be one of the biggest beneficial factors in an associated disability case because it gives you that income in the interim.
[26:45] But if you have both cases, they are going to be different. They're going to have different rules.
[26:49] They're going to be different processes. They have different deadlines. They have different timelines.
[26:54] And you can't just assume one knows what the other one's doing. They're sort of separate process.
[26:58] And you have to keep them that way.
[27:01] That's it.
[27:04] So, disability, LTD, they run parallel just like a railroad track.
[27:08] And you need to understand them both. If you have both, you need to be engaging both differently.
[27:16] And understanding how they overlap because it can really benefit, you know, each other if you do it correctly.
[27:22] But that's all the time we have.
[27:24] Subscribe, and until next time, take care of things.
[0:06] Welcome to the Disability Expert Podcast, where we tackle the difficult issues and interview the country's top experts to help you better navigate the disability process.
[0:15] Winning a disability case is hard and keeps getting tougher every day.
[0:19] We can't promise you'll win your case by listening, but we sure think it's going to help.
[0:24] This really isn't that complicated. I mean, you want to win your case, don't you?
[0:29] Well, then listen to what I say.
[0:31] Hey, it's Chad Brown. Welcome to another episode of the Disability Expert Podcast, where we talk about all things Social Security Disability and today long-term disability and how they interact and what you need to know about how they work together so that you don't absolutely screw up your Social Security case or your LTD case trying to win one without understanding the other.
[0:55] I'm once again with my senior associate here in the back.
[0:59] I didn't forget your name, I promise, dramatic pause.
[1:06] And candidly, here's to it, all the heavy lifting today, he runs our federal court, a pellet division, he also, because the LTD most LTD work is federal related work here and also runs our LTD practice, so we're going to rely on him heavily today.
[1:24] But one of the things it's, I think misunderstood is how different disability programs interact together.
[1:34] I know recently we did an episode on veterans disability, not talking about veterans disability benefits, but talking about how veterans engage the Social Security disability process, how the programs are different, how they're similar, how things can work in one and work in the other.
[1:53] We've shot episodes on LTD, you have an LTD claim and have specific issues about the process or whatever all that check those episodes out.
[2:03] But today, what I want to do is sort of co-through and look at many people have Social Security disability and LTD cases that are really running parallel.
[2:16] They have either private long term disability insurance that they have bought on their own or given to them through their employer.
[2:27] And it requires them to apply for Social Security disability, which most LTD policies have a, there's some high end sort of specialty type policies that don't.
[2:38] But the average run of the middle LTD policy, long term disability, I'm saying LTD, that's long term disability, which is private, is typically going to require you to apply for Social Security disability.
[2:49] Or you're going to have someone who goes out of work and they are going to basically simultaneously come into both systems, are going to take short term disability, then they're going to go into long term disability.
[3:04] At the same time, they'll have already started the Social Security process. And because of that, they end up sort of having to handle two disability cases at once.
[3:14] Yes. They end up with different rules, different requirements, and they often get confused.
[3:21] So I thought it would be helpful to sort of walk through and say, hey, let's take this hypothetical person who is engaging with both systems and sort of walk them through and understand.
[3:32] These are some of the similarities and differences. These are things to think about as they interact with each other because having an LTD policy can be one of the most beneficial factors in the weight or Social Security disability because it provides income.
[3:48] So you don't end up having to navigate these long weight periods without any money at all, which can be used to do all kinds of things like pay your power bill and keep the light zone and keep a roof over your head and pay for your medications.
[4:01] And those things. So it's important. So on the back end of the process, you end up with all kinds of issues because typically there's overpayment issues when you win both cases.
[4:10] Sometimes you win one and not the other people don't understand that. That's when it's that little bit. But to start with, just sort of walk through broadly, if someone's trying to apply for both at the same time.
[4:22] So they have an employer-based LTD policy. They're going into the Social Security disability process. What are some of the main differences that they need to understand just from the very beginning?
[4:32] I think the first thing is to talk about is the timeline. Timeline for long-term disability, timeline for Social Security disability, look very different. Typically on an LTD case, assuming there's not going to be a denial that you end up having to appeal or something like that, assuming they approve you right off the bat.
[4:51] It doesn't take very long to get approved. Usually you're on short-term for three to six months and then you transition over to long-term. And it might only take the long-term disability carrier 30 to 45 days to process your application and get you in pay status.
[5:08] And then if you have short-term disability, all times you'll actually start the process for LTD and sometimes there's really limited to no weight in between. Sometimes you can have just a continuation almost to benefit from short-term and you roll straight into long-term and you really don't have a period of time where you don't have income.
[5:25] And then it always happens. But certainly that's a little different than Social Security.
[5:31] Yes.
[5:32] What are you expecting? Generally with Social Security, I try to prepare clients. It could be two to three years that you're waiting to get those benefits.
[5:40] It might not. You might be one of the lucky few who get approved at initial or reconsideration. But generally I try to prepare people to expect to go to hearing with a judge and to get that decision is probably going to be two to three years for Social Security.
[5:53] Well, and there's a huge difference there because even if you're initial application, I think recent numbers, I think four last numbers, numbers of 32%, I think if people get approved initially on their social disability, even if your case is approved initially, it's highly unlikely you're going to see any money before probably five to six months.
[6:14] That's quick because they're going to take several months because you're basically going to fall in a queue.
[6:20] It's not like you file your application and they say, stop.
[6:23] Top priority right now.
[6:25] Yeah, that doesn't happen.
[6:27] And then there's also state by state issues.
[6:30] You know, we had a lot of cases in North Carolina and a lot of cases in South Carolina.
[6:33] And South Carolina wait times DDS or substantially longer than they are in North Carolina.
[6:38] Yeah, and so you could win your case in South Carolina currently and it might be 12 or 14 months before you're approved.
[6:48] But even in the very best scenario, it's highly unlikely you're going to see any money in probably six months.
[6:55] Even if you win your case and everything goes away, it's supposed to.
[6:58] Yeah, so you have differences in wait time. What are some other, what are some other differences?
[7:02] Next big difference would be money, how are benefits calculated?
[7:06] Generally with short and long term disability, those are calculated as a percentage of the job that you have the policy through.
[7:14] Generally 60 to 80% of that of your income from that job before you became disabled.
[7:21] Social security has a much more complicated way of calculating benefits, but suffice it to say it's generally going to be less than what you're getting from shorter,
[7:31] long term disability because it's looking at your lifetime earnings history and it's it's usually not 60 to 80%.
[7:39] Yeah, and so they're going to they're going to calculate your, your PIA, your primary insurance amount.
[7:44] Based on your work history, how many total years you've worked, how much you've made in the last number of years, whether zeros in your work history,
[7:52] whether years where you were out of work and out reporting income at all.
[7:56] And by and large, there's something most people don't know when they come into the process, where with an LTV policy, most people are going to have a reasonable idea how much money they're going to make.
[8:10] Okay, so there's differences in time, there's differences in money and how it's calculated, what are some other differences?
[8:16] LTV, we don't have hearings with ALJs, basically with LTV, it's all paperwork filing, so you may not get your day in court with LTV, where social security sort of, we're building up towards getting to that ALJ hearing.
[8:32] Right, and so you're typically, you know, they're either going to review your case and they may pay it without you doing, without you doing an interview, you may do an interview with a claims rep type person for the insurance carrier who will do.
[8:45] What feels like an informal interview, so to speak, very different than the social disability process in the event you lose your LTV claim.
[8:56] There is a process where you can't appeal to a federal court, there's watched the episode, if you have an LTV case, and you've received an initial now, you need to watch that episode and understand, there's a limited window of time to build the administrative record.
[9:11] There's a limited amount of time to get things into that record that could be considered by a federal judge, if you actually file an action in federal court.
[9:22] But even then, it's going to be an administrative review, you're not actually going to have a hearing, like you said, you're not going to have a day in court in an LTV case.
[9:32] And there's much smaller room for error in building your LTV case because there's a much tighter window that you have to establish what the evidence is and get that evidence to the carrier wearing the social security process.
[9:49] Literally, as long as you comply with the five-day rule, you're going to be able to put evidence in as recently as at the hearing and sometimes with the facts mandate, you'll be able to put an evidence after the hearing.
[10:02] Don't do that, get your evidence in beforehand, judges do not like putting cases in post where they have to wait and come back in review or case a month later.
[10:10] You've had three years to get here, why is the evidence not yet?
[10:13] Yeah, and then there's reasons it happens, but it is not ideal.
[10:17] Judges do not like that off the record, they will tell you do not send your case to post because I do not want to come back a month from now and have to renew all the facts in my mind when I've done 60 hearings.
[10:26] It's then and that's that's not ideal in any other significant differences.
[10:32] I'm sure there's a few, but those are the top ones that I usually hit.
[10:35] Yeah, and so I think one other thing though is there is this issue in your LTD, initially most policies are looking at an old occupation versus any occupation period.
[10:47] So there's really in most LTD policies going to be sort of a bifurcated decision making.
[10:52] Initially, they're just looking at can you do the job you were doing at the time you became disabled, where usually there's like a two-year window and you can vary based on policy.
[11:01] It was usually two years where they're going to come back now and say can you work at any occupation, where you can make typically it's a percentage of the amount of money you were making at the time you went out of work.
[11:12] So if it's say you were making $30,000 and it's 80%, they're going to say are there other jobs you can do where you could make $24,000.
[11:21] I think that's a difference that also can be confusing to people because sometimes they'll win their initial LTD claim for their own occupation.
[11:31] Then they'll get into the social security disability process and they're like well you have past relevant work at step four of the squintial evaluation process.
[11:39] You have any other work at the step five is that sort of the same thing and the answer is no, it's not the same thing.
[11:47] There's a five-year window for past relevant work that's not the same as the any occupation.
[11:53] Any step five other work you can do on a sustained basis where there's reasonable number of jobs exist.
[12:02] That's a very different test than whether you could find another job with your limitations and earn a certain percentage of your prior income.
[12:09] There's a very different test but to the sort of untrained year they sound a lot alike.
[12:16] I think there's some differences there.
[12:22] There are some similarities.
[12:25] Obviously you're looking at medically determinable severe impairment requirement for social security.
[12:31] You're not going to win an LTD case by and large without a medically determined severe impairment.
[12:37] In the LTD world by and large you're going to have to have a doctor sign off on not only the existence of your impairments but the limitations that come from them where you very easily could win a social security case without having a doctor ever write a letter of support.
[12:55] I would say the majority of cases we win don't have a letter of support in there.
[13:00] There are some similarities and differences.
[13:04] The main thing I think the person who's navigating both systems needs to understand is you have to understand a separate set of rules, a separate set of guidelines, a separate set of requirements.
[13:15] Yes, there will be overlap.
[13:18] The same medical records may be in both files but beyond that the differences may exceed the similarities.
[13:26] One of the issues I think is really important for people to think through though is there's sort of a window of time when you leave work and you come into the social security disability process and you have the opportunity to use LTD benefits, short term disability benefits as well.
[13:44] But when you have those benefits, those LTD benefits, there's really decision making that needs to be going on.
[13:55] The home before you ever leave work.
[13:58] Yes, sort of walk through that, why that's important, how we help, because that's a common issue, like a lot of times we help people call us and they're working a lot of times we can't help them.
[14:10] One of the real big exceptions is that people are calling us who are working saying, I've got to come out of work but I've got LTD, I've got short term disability, I don't know how they work, I don't know how they interact.
[14:20] So, sort of walk through that person who's, they're contemplating leaving work, they have LTD benefits.
[14:26] What sort of that decision making process look like in terms of, how do you capitalize on the fact that you do have these benefits that can be really helpful in the disability at least process?
[14:37] Yes, so this can be a really tough spot that people find themselves in because nobody really wants to throw in the towel and say, well, I can't do this anymore.
[14:46] So, I'll say sort of the ideal progression of events is your at work, you realize your health conditions are just getting to the point where you need to quit.
[14:57] Don't go into human resources and quit that day.
[15:00] Use your family medical leave act, FMLA time, not to get into a totally different area but generally FMLA is going to give you 12 weeks of protected leave a year.
[15:12] Fortunately, that tends to coincide with your short term disability pay.
[15:16] So, when people go in with a really good plan, usually what that looks like is you start the FMLA, you start the short term disability, those are running concurrently.
[15:26] And then at the end of that 12 week or so period, then you can switch over to long term disability and hopefully not have any interruption and benefits.
[15:37] Now, the tough part for folks is usually around the time the short term is ending.
[15:42] You typically run out of your FMLA and now you're starting to get threatening emails from human resources that says, hey, are you coming back to work or do we need to fire you?
[15:51] Right. I think one of the mistakes people make is often people are hiding their disability at work.
[16:05] Are there understanding employers who work with people who accommodate work who provide assistance? Yes, sure.
[16:14] But it's also very common for someone to really sort of try to hide their disability.
[16:22] Now, whether they're actually hiding it from their supervisors and the people they're working with is a different discussion often they think they're hiding it but they're really not.
[16:30] Everybody really knows that they're having the issue or maybe some people really do know.
[16:34] But they're very skeptical of going in and telling HR, telling management in effect, hey, I have these issues but the problem is often when people are suffering with disabilities, they are exposing themselves termination.
[16:50] And once you're terminated, it can be very difficult if not impossible to now claim that you're eligible for your short term and long term disability benefits.
[17:02] And so it's one of these situations where you candidly are going to have to probably have a conversation with someone in HR, with someone in management, depending on the size of your company and where you work, the nature of your employer.
[17:20] Because you need to make sure that you are engaging the HR tools that are available to you, the short term disability and the long term disability, so that you can access them.
[17:33] Getting mad, quitting, getting fired are problematic and then coming back and saying, whoa, but I want to use my LTD benefits.
[17:42] It's like, well, if you're not employed here anymore, right now, the sudden you're not employed.
[17:47] Not that some of those things can't be fixed, but generally, I think sort of the takeaway is, one, you should know if you have those benefits.
[17:56] Never ceases to maze me, how many of our clients come to us with SS, you know, disability claims.
[18:03] And sort of, you know, we're engaging them and like, what do you have LTD? And they're like, I don't know.
[18:08] And we're like, well, you work for an employer that we're pretty sure provides those benefits.
[18:13] You know, you're working for UPS. We're pretty sure UPS. Historically, those employees have had LTD benefits. And they just don't even know.
[18:23] And then you get in these other issues of whether you can actually go back and retroactively apply for benefits and there's usually...
[18:29] There's deadlines.
[18:30] There's deadlines and sometimes you can and sometimes you can't be on the scope of the conversation here.
[18:34] But I think it's important, you need to know if you have those additional benefits.
[18:38] If you do have them, you need to understand that there's not unlimited sort of use their rules about their usage.
[18:47] And usually that conversation is when you're going to have to have, but candidly, in my experience, by and large, when you've reached the point that your disability is keeping you from working, pretty much everybody knows.
[19:03] It's hard to hide.
[19:04] It's very hard to hide. And so it actually becomes a relief because the supervisor is like, I'm not going to have to fire you.
[19:11] But you've sort of given them this, get out of jail free card. We're not going to have to terminate you.
[19:17] And if you're a good employee and you have that good relationship, they don't want to fire you.
[19:21] No one likes firing people. It's not any fun.
[19:23] Yeah, so I think in terms of transitioning, you know, those are sort of the main takeaways. Let's talk about what happens during the claims.
[19:34] So let's talk about ways that the policies work, the ways that the claims sort of work together and a couple of things to be weary of.
[19:43] First thing, let's talk about are the long term disability free disability rep that will give you for your social security disability case.
[19:53] Can you talk about that a little bit?
[19:54] Sure. Everybody gets excited when they hear free.
[19:57] Basically, like we talked about earlier, almost all LTV policies, except maybe the very, very upper echelons of them have offset language.
[20:06] And what that means is if you start getting social security benefits, the long term disability company gets to pay you less money in the amount of what you're getting from social security.
[20:16] So the long term disability folks do have an incentive to help you get approved for social security.
[20:24] Along those lines, they have sort of, I guess, preferred vendors would be the right term that they might recommend you work with to help you on the social security side.
[20:33] And they'll say, you know, if you if you use these folks, we'll pay their fee for helping you so they're free.
[20:40] In the generosity of the heart of the large corporate insurance company, they have graciously giving you a free representative to help you navigate your social security disability case.
[20:54] It's a disaster.
[20:56] Like, I don't, I'm not saying they're bad people. Don't, don't, don't miss hearing me.
[21:03] I'm sure that many of those rep, most of which are not attorneys, also not saying that you can't have non attorneys that aren't going to rip.
[21:10] That whole two part episode with Jane Johnson, a number of months back, non attorney rep, excellent rep, many of them are excellent.
[21:18] But the reality is most of the reps who work in conjunction with the LTV companies are non attorney reps.
[21:26] And they, at one level, my personal gripe with them is, I think it's an inherent conflict of interest.
[21:34] Yes.
[21:35] To be paid by the LTV carrier and at the same time represent you.
[21:42] I mean, that's a major red flag if you're an attorney.
[21:47] It can be done as an attorney, you can be paid by a third party, but there are a ton of rules.
[21:52] It's highly suspect in most scenarios.
[21:57] This one included.
[21:58] And the main thing is when you get to the end of this process and we're not going to talk a lot about this, but when you get to the end of the process, if you win both cases, the LTV company wants to be paid back, your back pay.
[22:10] Yes, they're going to send you a letter that says, hey, you owe us some money.
[22:13] And to my knowledge, I've never known a representative who was working at the rest of the LTV company for one who ever told that client they shouldn't pay that money back.
[22:26] Whether you're required to pay it back, whether you're contractually obligated to pay it back, whether you signed a thing saying you would pay it back.
[22:34] Practically, there are scenarios where paying back the LTV carrier is probably not the right decision.
[22:43] There's risk with that.
[22:44] You risk having things following your credit.
[22:46] You risk being sued.
[22:48] That's why we're not digging deep into this, but I'll just tell you.
[22:51] Yeah, just case by case, but practically after doing this for a really long time, there are scenarios where it doesn't make sense to pay them back.
[23:00] It's not unethical. It's just practically, it makes sense based on future benefit or whether there's a lump sum payment that should come out.
[23:08] Sometimes you pay the money back and then they stop your benefits.
[23:10] So in case recently that actually happened, we had a lead came in and they paid the money back and they stopped their benefits.
[23:15] And it's just doesn't, it doesn't work in the clients best interest typically to have that them represent them.
[23:25] You want somebody completely independent giving you advice on this area?
[23:29] Let's talk just briefly about some of the ways that the LTD case can help us us through disability case.
[23:35] So in terms of like doctors, letters, let's talk about that specifically.
[23:37] Here's other ways, but in an LTD case, almost universally you're going to have a letter of support from your doctor.
[23:44] What is the benefit of that other than just having a letter of support?
[23:47] But the nature of LTD letters of support I think really helps in this is the cases.
[23:51] Yes, typically the LTD carrier has their specific form and it does a pretty good job of breaking down.
[23:58] Functional limitations and you know, listing out the exact reasons why your doctor is supporting your claim.
[24:05] Which coincidentally are very similar to the RFC, the judge may be writing in your case.
[24:10] And sometimes the doctors are on the LTD side will fill out the same form two, three, four times before you ever get to a Social Security ALJ.
[24:19] So it really documents very well over the months or years.
[24:23] How is your condition progressed?
[24:25] Yeah, I think the other big takeaway is we talk a lot on these episodes about this golden chain of evidentiary progression where you go from diagnosis to symptom to limitation.
[24:36] And what you find a lot of times in SSD letters of support is the doctor sort of tells you the diagnosis and says you're disabled or they tell you the diagnosis and they give you some additional evidence that supports the diagnosis.
[24:47] Whereas in an LTD letter of support, almost universally there's going to be a requirement that they talk about functional limitation.
[24:54] So what you have is in one document, your doctor giving your diagnosis, giving your symptoms, giving the functional limitation, they built the chain for you.
[25:03] And that evidence is just as easily used in a Social Security case, this is the LTD case.
[25:08] Yes.
[25:09] If you take aways for people, even when you win both one, we've hit on this, you're going to probably have to repay the LTD company or we told you have to repay them.
[25:17] That's a whole set of considerations.
[25:20] The other thing though, I think it's important to do is understand when you get that, there needs to be a very close assessment of how they actually calculated your benefits because they do make mistakes.
[25:33] I know that they necessarily make the most purpose, I'm not saying that, I'm saying that, but the LTD companies will make mistakes and you need to be very close.
[25:39] You need to look very closely at what they're saying they owe you back because there are policy by policy, there are exceptions for maybe auxiliary benefits, but maybe another policy doesn't have that exception benefits for your children.
[25:51] Sometimes they, when you have a private attorney, they exclude the attorney fee, which is sort of negates the whole free thing because if they don't negate it, they ask for all the money back.
[26:02] So, but they may forget to do that.
[26:05] I've seen that happen many times, so like, well, you owe us $20,000 back and you're like, hold on, they only got 15 because we had a $5,000 attorney fee, right?
[26:12] So, it's important when you get to the end of the process to understand that there's a review that needs to be done.
[26:19] And then finally, even though they're not the same, we didn't have said on continuing disability reviews, there are continuing reviews of the LTD.
[26:28] So, when you have both, it's really important that you maintain your medical treatment.
[26:32] Absolutely.
[26:33] I'm sure there's more of that.
[26:35] There's always more.
[26:36] We're out of time.
[26:37] LTD can be one of the biggest beneficial factors in an associated disability case because it gives you that income in the interim.
[26:45] But if you have both cases, they are going to be different. They're going to have different rules.
[26:49] They're going to be different processes. They have different deadlines. They have different timelines.
[26:54] And you can't just assume one knows what the other one's doing. They're sort of separate process.
[26:58] And you have to keep them that way.
[27:01] That's it.
[27:04] So, disability, LTD, they run parallel just like a railroad track.
[27:08] And you need to understand them both. If you have both, you need to be engaging both differently.
[27:16] And understanding how they overlap because it can really benefit, you know, each other if you do it correctly.
[27:22] But that's all the time we have.
[27:24] Subscribe, and until next time, take care of things.
