Steve,
Start now--it takes a long time.
Most insurance companies require you to also apply for Social Security. If
yours does, get a lawyer for the Social Security part immediately. If you
hire him at the end, it costs the same amount of money. If you hire her at
the beginning, she fills out all the Social Security forms for you (and
there are pages and pages). Social Security denies more than 90% of cases
initially. It approves about 70% by the hearing stage 18 months later (at
which time about 70% of folks are represented by lawyers--but Social
Security won't release the statistics on the correlation, although they have
the information). My case manager at SS tried to imply that a lawyer at the
beginning was totally unnecessary (what if I got approved on the first go
round--yea right!). He further lied and said I would owe the lawyer if I
did get approved right away because there would be no back entitlement for
him to get 25% of (up to $4,000 under federal law). My lawyer got a copy of
the medical records gathered by SS to make the first appeal/request for
reconsideration. Guess what--the doctor the SS sent me to said I couldn't
sit very long because of my lymphedema. To overcome this problem in denying
my claim, SS left lymphedema out of the list of medical problems and said I
could walk short distances unassisted, not do heavy work, and omitted any
mention of whether or not I could sit (I've done sedentary office work my
entire career).
My private insurance pays the SS share while I go through the appeal
process, if they approve me. They still haven't made a ruling, although I
became eligible February 1--which does mean they haven't said "no" (they
also pay back entitlement--in the meantime, I have a month's worth of
severance pay left, maybe why I've been having stress related chest pains).
There is also an appeal process for the insurance company, but I've held off
hiring the lawyer for this because it's on an hourly rate, hoping they'll be
more honest and fair than our government is to its citizens. My SS lawyer
did advise me to get a copy of the master policy that lays out the rules,
etc., of the LTD plan (some companies charge--mine didn't). This spells out
the appeal process and time frames. He also advised me to not answer
questions about how I'm feeling to non-medical personnel. The insurance
company staff is much nicer than the government folks, but be careful--their
interests do not coincide with yours.
Develop as much information as possible, like a detailed description of a
typical day that lays out rest periods for fatigue and pain management, any
meditation, physical therapy, strength training, and other exercises done on
your own, all the millions of little things that you do because of TM and
other medical problems (exercises or movement you do because of being
confined to a wheelchair--whatever is appropriate to your case), therapy
visits of all sorts, time management that has you cooking and doing other
personal care activities as your major activity on days you don't have
therapy sessions. Any information developed for the LTD insurance claim
should be passed to your lawyer for SS use. A complete list of doctors and
all therapists is usually needed for both claims as well.
My therapist encourages me to call and check on the insurance case manager
periodically, and she's right, because sometimes they don't follow through
on getting medical reports or have mislaid medical reports already sent.
The insurance company sent a rehab nurse to evaluate me. She turned in a
report, and now they've sent my case out to independent doctors for peer
review, so I'm hoping for a favorable ruling soon, but it's very nerve
wracking.
Good luck!
Aurore
aurore(AT)erols.com