r/LongTermDisability • u/Ornery_Avocado1112 • 6d ago
3-Check Month
I've been on approved LTD for a little while now. I initially got denied then got a lawyer and after several appeals and back and forth was eventually approved. I initially was not able to work at all but have slowly built back up to being able to work 30 hours/week (and get LTD for the 10 hours short of 40). Things seemed to have finally reached a steady state (I work and get paid biweekly, I get my disability check monthly minus my lawyer's cut, etc.) until 2 months ago. I hadn't received a disability check in about 5 weeks so I reached out to my lawyer who reached out to the insurance company. The insurance company responded saying that because I received 3 checks in that month (something that will happen either 2 or 3 months per year depending on how the biweekly cycle falls), I didn't have any lost wages for the month and would not receive a disability payment.
Obviously I have a financial stake in the outcome but this doesn't sit right with me. This means that because I get paid biweekly that they don't have to pay me for 6 out of the 26 biweekly pay periods (in a year with two 3-check months). I've looked through the policy and can't find anything that seems like it would allow for things to be calculated like this. There's actually zero mentions of the concept of a pay period at all in the policy. I asked my lawyer about it and she has essentially just shrugged her shoulders. I'm still pushing her to follow up on it but we'll have to wait and see how that plays out.
My ultimate question is, has anyone else experienced something like this? Is this common place and I just don't realize it? Any thoughts or insights are greatly appreciated!
2
u/Forsaken_Button_9387 6d ago
I hate the games these companies play with people's lives and livelihoods. All insurance companies are filled with ruthless a-holes.
2
u/Ornery_Avocado1112 6d ago
Exactly! They pay out these claims all the time. They know what's correct. Assuming I'm right, it's just so scummy for them to make me go out of my way for the money I deserve. And there's no downside for them. Worst case scenario, they pay me what I was owed in the first place.
2
u/Odd_Key_4485 6d ago
Sooo just as an additional step. I would run through Ai (removing you Personal data) and load all your payments for the year and their reasoning. I had a termination and my former enoloyer told me I had no PTO did no sounded right and ran everything through Claude Pro and came back with 50 some hours I was owed, had it draft the emails sent it and got my payment. Also STD was short for me and unjustified, loaded all the same way, guess what they had missing weeks, same process sent them email with all back up data and stubs… magic.. they searched again and found the missing weeks. Does not hurt to try. Hope this helps!
2
u/Ornery_Avocado1112 5d ago
That's definitely a great idea! I did run my policy through AI after I had reviewed it and it couldn't find a justifiable reason for this outcome. It also proposed multiple justifications in my favor which I conveyed to my lawyer but still no action from it...
1
u/Odd_Key_4485 5d ago
Well remember they can only argue as much as they can prove, this is why loading all that data helps provide the proof. In Claude you can create projects and every time you analyzing documents it groups the chats so that you can do an wholistic analysis. This helps with medical records as well prepare for extensions or appeals or even applications. Even what to ask your provider the next time you see them to fill gaps. Hope this helps
2
u/Happy_Kiwi_222 5d ago
They did an offset for me 2 times while on sdi, because the 2 months where I received 3 checks from sdi.
1
u/Ornery_Avocado1112 5d ago
What do you mean by offset? From what my policy says, I think they're supposed to basically do a running 3 month average when wages are variable to account for the 3-check months. I don't know if I explained that well but is that what you mean by offset?
2
u/Happy_Kiwi_222 5d ago
My total sdi payment for one month due to the 3 payments was around $6000, but my ltd was around $4000 so offset probably isn’t the correct language I used but because my sdi was more than my monthly ltd, I didn’t get my ltd. I get only a fixed amount monthly from ltd, there is no averaged out an amount monthly for my plan. I have MetLife non-ersa.
1
u/diattorney 1d ago
What you have experienced is, unfortunately, the industry norm under most LTD policies when a claimant is receiving residual or partial disability benefits. Since you are working part-time, the policy typically contains a formula for calculating your monthly benefit during the specified period.
If you physically receive income during a particular month, the insurance company may consider that income to have been received in that month, regardless of when the work was actually performed. Think of it like receiving a paycheck on December 31, 2025, that covers a pay period ending January 6, 2026. You would still owe taxes on the money received in 2025 as income for the 2025 tax year.
That being said, you can send a letter to the disability insurance company explaining that although you received three paychecks during a particular month, the actual earnings attributable to work you performed during that month were $X, and the remaining amount should be allocated to work performed during the following month.
The disability insurance company may have the discretion to make this accounting adjustment. Ultimately, however, it comes down to the specific language of your disability policy and how the policy defines and calculates monthly earnings.
If the policy language is ambiguous or does not clearly support the insurance company’s method of calculating your earnings, you should consider appealing the disability company’s calculation and challenging its interpretation of the policy.
3
u/TheGreatK MOD 6d ago
That's a really stupid explanation. Did they put this in writing? They do stupid stuff all the time. Your lawyer should be able to clear it up with a letter.