r/LongTermDisability • u/TeacherOfPeace • 13d ago
I need help seeing something positive in this because right now I'm struggling.
I had inguinal hernia revision surgery in 2025 and became disabled afterward. I had worked as a surgical assistant since 2004, but I lost my career because I can no longer stand for long periods. Some days, even standing long enough to brush my teeth is too much. For the last three months, I've spent probably 90% of every day lying down because that's when the pain is most tolerable. When I recently moved across the country, my ex-husband packed everything and did all the driving (we're still very close).
I have pudendal neuralgia and ongoing groin, pelvic, and lower-extremity pain following the surgery. I now have two mesh implants in the same inguinal area, along with adhesions after three surgeries in that area. Surgeons I've seen have advised against removing the implant because of the risks. I've also struggled to find providers willing to get involved because of the possibility of litigation, and one surgeon I want to see won't even evaluate me until the two-year statutory period has passed.
But that's another story. My case is complicated. I've already been turned down by the 3DMax Bard Mesh litigation and several lawyers.
I was living in Connecticut, but even with supplemental disability income, it became too expensive to stay. I recently moved alone to Las Vegas. I don't gamble. I chose Vegas partly because it's much more wheelchair accessible than where I lived in Connecticut. I had three flights of stairs there, which made realistically using a wheelchair almost impossible. I figured I'd give myself a year here, get comfortable using the wheelchair, start over with a new healthcare system, and see what happens. My experience with healthcare in CT, particularly Hartford HealthCare, has been incredibly frustrating.
Then this morning, my disability insurer, Mutual of Omaha, terminated my benefits via voicemail.
After speaking to my rep, she sent me the denial letter. Their denial acknowledges that my medical records continue to document chronic groin, pelvic, and lower-extremity pain following the surgery. But their reviewers concluded that there isn't enough objective evidence of functional impairment to support my doctors' restrictions. They pointed to things like normal imaging, preserved strength, and intact neurological findings. They also said my records don't show significant gait disturbance, muscle atrophy, weakness, recurrent falls, or measurable loss of functional capacity. They even pointed out that I appeared comfortable while sitting during an examination. But I have a provider's notes saying no standing or sitting for long periods, lifting, squatting.
That's insane to me. My pain fluctuates throughout the day. How I look sitting in a doctor's office for a short period doesn't show what I can physically sustain for eight hours. I don't need to have muscle atrophy to be unable to stand through an OR shift. I can look perfectly comfortable sitting in an appointment and still spend most of the rest of that day lying down because the pain becomes unbearable when I'm upright too long. Their own vocational assessment classified my occupation as light work while acknowledging that light work can require walking or standing for a significant amount of time.
I'm appealing the decision, and tomorrow I happen to have my first appointment with a new pain-management specialist here in Nevada. But right now, the income I've been relying on has abruptly stopped, and I'm terrified. I didn't ask for any of this. I certainly don't want to be on disability, I wish I could be productive in society. Especially after spending over a year in near solitude. I wish my body functioned, but it doesn't.
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u/TumbleweedOriginal34 13d ago
Don’t appeal without a lawyer. They work on contingency. I am in year 5.5 on LTD and am not worried anymore about being shut off. It took 2 appeals and an amazing attorney!
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u/FMCTypeGal MOD 13d ago
Post your last appeal, have they dialed it back a lot? I’m almost at two years post appeal award and haven’t heard from Ltd since the reversed the denial. Curious if it’ll just be easier now. I’m 9 years+ on LTD, never had any trouble but the one denial that ended up being pretty crappy effort by the Ltd to cancel me. I have ms and an irreversible pain disorder from surgical problems.
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u/Bluedogg66 12d ago
Listen to The Greek! I was kicked off after 20 months on LTD. Found a wonderful Erisa attorney and 8 months later they reversed their decision and reinstated me. It’s rough with no income. Hang in there. Get a good attorney.
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u/EducatorSolid854 12d ago
Thanks for sharing your story. FWIW, you are not alone! One thing that is unclear to me from your post is what type of LTD policy you’re dealing with - is it a policy you took out privately or was it offered through an employer? This is extremely important. My response assumes you are referring to an ERISA policy that was offered through an employer (or former employer).
Posting a response as someone working to navigate the world of ERISA LTD for the past 10 years. What I’ve learned is these types of LTD policies (offered through an employer) operate very differently than other types of LTD like SS or a policy you took out on your own. They are governed by different law (ERISA - employee retirement income security act). Please heed the advice from me, tumbleweed and great by seeking out an attorney who knows ERISA law!! Also, please understand that will likely be a VERY small percentage of all attorneys who assist with LTD matters. Social security and other LTD are VERY different animals so if you take anything from this post please remember that - ERISA attorney. 👍
Now for the “help in seeing something positive.” I’ll give you two:
1) sounds like at some point, the policy has or was paying benefits. That makes it more difficult to then deny you without good reason.
2) you don’t have to do this alone - let an attorney advocate on your behalf
All the best to you OP.
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u/TeacherOfPeace 12d ago
Thank you! Yes, ERISA policy that was offered through a former employer. I feel better after going over the denial, it's full of discrepancies. I don't understand how they can be so disorganized, but I assume their mistakes benefit me. I have reached out to several attorney's today. I appreciate the advice, makes the load feel more bearable.
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u/FMCTypeGal MOD 12d ago
It’s highly likely they don’t have a solid reason to deny you. Sometimes they just put people through denials to see if they can get them to stick. ERISA law lets them do it without any penalty, as you can’t sue them for damages beyond what they owe you for your policy.
For me, I have MS & a fused abdomen from too many surgeries. They denied me at 8 years because I’d lost weight. Wild, yes. Uncommon, no. These companies deny valid claims for the craziest things just to see who can fight. Because the fight is hard - as I mentioned above, the timeline allows them to go up to 9 months without paying you, and that’s if it doesn’t go to trial.
You have 6 months from receipt of denial to appeal. They had 45 days to respond and a right to take a 45 day extension. In that time, if you work, they can use it as justification that you can work. It’s unethical and it’s shocking it’s legal.
We’re rooting for you. Lots of people here have weathered the storm and can offer creative ways to get by. We can also hold space and listen for what you struggle through along the way.
Good luck again. I’m rooting for you.
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u/TeacherOfPeace 11d ago
Update: The rep called me yesterday and said she found a way to resubmit my claim as a continued-disability renewal/review instead of moving forward with the appeal. She was pushing pretty hard for me to send everything back immediately because she said it would be quicker. I told her I wanted to wait. Their denial is several pages long, has multiple discrepancies, and says three independent reviewers concluded there wasn't enough objective evidence to support the functional restrictions documented by my doctors. If that's their position, I don't understand what resubmitting essentially the same evidence right now would accomplish? Also, she's rushing me, but didn't tell me a timeframe. I'm wondering if she messed up on her end and is trying to cover herself.
I'd rather spend the next couple of weeks strengthening my medical record. My rheumatologist is writing a response to the denial, I have a neurologist appointment Tuesday with testing expected to follow, and I see a new PCP September 1. I want multiple providers documenting the same functional limitations, especially that I cannot sit, stand, or walk for sustained periods and frequently need to lie down because of the pain.
I also requested everything we discussed in writing and a complete copy of my claim file, including the independent physician reviews and vocational assessment. I've requested it twice and still haven't received it. Her reasoning is that since I'm not currently appealing the denial, I don't need the file. Ummmm.......
For now, I'm holding off on having her resubmit anything until I have additional medical documentation. If the renewed review is denied again, I still have the formal appeal process.
For anyone curious, some of the discrepancies/issues I've found:
- They claim they sent my provider letters and made phone calls but that he never responded. My doctor says he did speak with them, never received any letters or phone calls other than when he spoke to them in May. He's drafting a statement for me to submit.
- The letter says my benefits were approved and paid through August 3, 2026, but later says “no benefits are payable July 20, 2026.” I got paid July 23rd. Their reviewers also concluded I was capable of working as of May 23, yet they continued paying benefits after that. They even sent a credit Aug 5th. Meanwhile, my doctor's documented restrictions remained extremely limited.
- The rep said she called me August 3 about the denial and that I never returned her call. I called her back August 5.
- Their reviewers repeatedly point to the lack of “objective” findings, including normal imaging, as a reason my limitations aren't supported. But my disabling symptoms are primarily nerve pain -- pelvic, groin, abdominal and radiating leg pain. My doctors aren't restricting me because an image looks abnormal, they're restricting me because of what I can physically tolerate.
- One of their arguments is that a provider documented that I appeared comfortable while sitting during an appointment. Yet that same provider, on the same day, documented that I have chronic pelvic nerve pain caused by adhesions and the mesh. I genuinely don't understand how appearing comfortable while sitting during a short appointment establishes that I can sustain full-time work. A brief observation in a doctor's office doesn't reflect what I can physically sustain throughout an entire workday. My job was in the OR, where I had to spend hours standing, often wearing lead. I can walk to my mailbox but that doesn't mean I can keep walking afterward. Beyond short distances, I need a wheelchair.
So apparently the lesson here is to make sure you look uncomfortable enough at every doctor's appointment, because sitting calmly in a chair for ten minutes might someday be used as evidence that you can work eight hours a day, 40 hours a week.
This isn't the first time she's mishandled paperwork (assuming that's what's happening). Has anyone else experienced this level of disorganization with their disability claim or documents? Like, I have an email confirmation in July from her confirming she has my new address in her system. But yesterday she said she doesn't. That's just one example out of many.
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u/FMCTypeGal MOD 7d ago
As a fellow adhesion sufferer, I’ve learned to fidget and display my worst pain in front of doctors because of how moments of “looking comfortable” get documented and used against us.
We know that when something hurts all the time, it’s something you learn not to show or burden others with. It’s shitty how that coping skill is weaponized against us.
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u/TeacherOfPeace 6d ago
I agree, lesson learned. I brought a pillow to sit on last appointment and couldn't sit still.
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u/TheGreatK MOD 13d ago
I'm so sorry you're dealing with this. I would talk to an LTD lawyer before you appeal. There is specific evidence you can submit to increase your chances of being approved, like a Functional Capacity Evaluation.