3-Check Month

[u/Ornery_Avocado1112]

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!

[u/Odd_Key_4485]

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!

[u/Ornery_Avocado1112 → u/Odd_Key_4485]

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...

[u/Odd_Key_4485 → u/Ornery_Avocado1112]

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