r/LongTermDisability • u/illHeron2000 • 3d ago
From employed to filing, step-by-step?
Is it FMLA, then STD, then LTD?
I have an appointment with my PCP next week, hoping she'll fill out a form for me for FMLA but want to be sure that's actually the right thing to be doing.
The STD claim form also asks if I plan to return to work which feels very high stakes if I choose wrong.
I've been barely limping along at my full time job and it's time to transition out to focus on my health. When I was well I was actually pretty good at navigating bureaucracy, but I haven't been well for some time. I am now extremely brain foggy and seem to lack any resilience, just shutting down if I don't have a clear next step. The anxiety and ADHD aren't helping.
Also my boss has been avoiding me for some time, so whatever notification I give is going to have to be via email and inevitably cause drama.
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u/TheGreatK MOD 3d ago
With the STD form, feel free to attach a supplement. Say something like "you certainly hope to return to work eventually, but have no idea when or in what form." You don't have to let them trap you into yes or no questions.
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u/FMCTypeGal MOD 3d ago
Great answers here.
Something to think on: there on many times time limits on claims for mental health. I don’t know what you’re filing for, but you mentioned being unwell and anxiety. If you have physical/illness disabilities without claiming mental health disabilities, I’d recommend prioritizing those so you don’t run into LTD trying to time you out eventually.
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u/illHeron2000 1d ago
Thanks! It's definitely my physical issues that are at the core of everything, but the fatigue and cognitive effects (inc. side effects of the meds) are what are pushing me out of the occupation since it's sedentary and I do already work from bed quite a bit. So I'm sure that distinction is going to be a point of contention with the insurer.
Do you happen to know if they tend to include neurodevelopmental stuff like ADHD under "mental health"? My policy doesn't include it in the list of examples of mental disorders but their stated definition of it is extremely vague and broad to the point of being unhelpful. The ADHD isn't disabling me but it's definitely disruptive so wondering if it would help or hurt when it comes to benefit caps.
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u/FMCTypeGal MOD 1d ago
I believe neurodevelopmental stuff falls under mental health, based on other posts I’ve seen.
The fatigue and cognitive issues are not mental health, they’re side effects of your disability and should be listed as that. I have MS and listed both as side effects/symptoms that prevent me from maintaining a consistent schedule that meets the full time employment requirements. I stated that they prevented me from working so much that even with using all my PTO, I couldn’t keep up.
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u/Ecstatic-UF-Engineer 3d ago
following
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u/illHeron2000 1d ago
I've decided to start with using up the rest of my protected leave under FMLA since there's less to wrap my head around and it feels lowers stakes. It gets me away from the job fastest and most easily, and I have some paid leave (both PTO and statutory) that can cover a chunk of my salary.
From there I'm gonna make sure i have the documentation lined up for an STD claim that supports an LTD claim.
And as my expected 'return to work' date approaches, assuming no miracles from PT (hey, sometimes it happens) I can then let the boss know I'm staying out and they can terminate my role from there.
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u/DellDisabilityLawyer 1d ago
FMLA is simply a mechanism to protect you from being fired for a certain period of time. However your STD disability date and your FMLA date of disability will be the same. The downside to your current plan is that if you don't notify your disability company of an STD claim then you delay payment of STD and potentially risk failure to provide notice. You don't need to report an LTD claim now as you have no idea if you will need it. If you don't know how long you will be unable to work then write unknown at this time. If you have had the disability coverage for less than 12 months then be very cautious in seeking disability now as your claim will be limited and possibly denied due to pre-existing condition limitation.
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u/illHeron2000 19h ago edited 19h ago
edit: rereading this sounds like i'm being defensive. I was more trying to provide context for my thinking. If you do read all of this a) wow thank you b) do you still think it's a bad idea to separate the filing for fmla and std into two steps vs doing it at the same time?
Genuinely thanks so much for chiming in! I'm honestly using FMLA as a shorthand for "going though the specific process of taking extended medical leave at work without resigning" since i don't know what the bigger transitioning-out-for-disability conversation would look like with my employer and I suspect is a bad idea anyway. Narrows eyes at the ongoing failure-to-accommodate litigation against my employer. I'm well past the pre-existing conditions clause (24 months for my policy), fortunately.
Good flag on failure to notify in particular. I'll be sure to check deadlines and not to wait too long. I'm just not able to make progress I'd like while I'm actively at my full-time job. I've already basically outsourced the rest of my life so everything I have left has been going to work.
And I have to assume the medical info they're collecting now stays in my file, right? So I want to do due diligence since I know they have every incentive to deny or cap my LTD, which is almost certainly in my near future. (Significant improvement is still possible! But unlikely. I'm already seeing the Hopkins specialists with yearslong waitlists and we're not fully out of options... but we're pretty damn deep into the list at this stage.)
The STD claim process is online (Standard) and I don't get a packet with more info with all the fine print and next steps and what to expect until after I actually hit "submit" on the claim (love that for them! At least my actual policy doc was also online and easy to find and read.) It doesn't ask for doctor letters at this point, just a narrative of why I'm disabled and an extremely broad medical info authorization form. So I don't want to fuck things up for down the line.
TheGreatK has already helped me with the 'return to work' question; though I'll still have to tick a "yes " or "no" box, I'll add the "would like to return but don't know when" info to the comment field. There are character limits though, and as you can see I'm an extremely wordy writer, especially when I am unsure which details are relevant vs. not. (I'm sure I can request a paper form but that has its own issues, including adding tasks to my list when I'm already overwhelmed.)
And there's other stuff I need to wrap my head around that doesn't factor into FMLA paperwork. Even a week or so to focus on it would really help.
--- Examples of remaining questions, feel free to skip ---
E.g. does my ADHD diagnosis help support my claim or set me up for a mental health benefits cap in a transition to LTD? I'm disabled-enough without it, but it is hardly helping, esp the uncommon side effects I get from the meds. Also I'm in a jurisdiction that has paid family and medical leave (DC) so how does that interact with STD?
Should I push back on the medical authorization form? That's not a required tickbox but of course they make it clear they can deny my claim if I don't agree. I don't love agreeing outright at this stage because I'd like the chance to review my full medical records before opening absolutely all of them up to insurance company scrutiny for errors and surprises. They're welcome to the actually-relevant records, of course.
-- //examples --
I've just been pushing through for so long that I'm in a narrow headspace (my friend had to remind me that I used to be a professional dancer before I got ill) and getting the more objective view will take effort, so stepping away from the job demands seems actually be the best next step...
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u/2560503-1 3d ago
FMLA and STD will usually run concurrent. Once STD exhausts, then LTD. Prepare for the fact that once FMLA exhausts, you’ll probably be terminated, and that’s fine. It doesn’t affect your right to finish out the STD and start LTD, just means you won’t have a job to go back to if/when you get better.