I’ve had zero luck getting a lawyer to help me with my LTD appeal. One actually offered me a contract & then took it back. I’m heartbroken & hopeless. Has anyone here managed to win an appeal on their own without a lawyer? What advice can you offer?
I was denied on a technicality (hours), they never actually evaluated my medical condition so I’m sure once I appeal they’ll just deny again for that.
God forbid I tried getting help for severe mental health issues. I had trouble working, even simple easy jobs. I couldn’t make decisions. Now I’m likely getting fired. Just struggling bad right now. I get it but it just sucks. I should have just stayed working even though I couldn’t really.
Location: Florida
Recently I became disabled and transitioned from Short to Long Term Disability. During my enrollment and starting work with my employer, I was offered 4 options:
50% for 5 years
60% for 5 years
50% until age 65
60% until age 65
Enrollment was completed via guided intranet during orientation. There were no warnings, disclaimers, footnotes, or links to reference for limitations or capped amounts. Over the years working I had specifically reached out to ask for a copy of the policy or SPD which was never supplied.
Now, as I move to Long Term Disability, I am being told that the actual amount is significantly less than the coverage I purchased. (approximately 30%).
The few ERISA lawyers I have spoke with seem to be more comfortable litigating a benefit that has been denied for medical reasons, not the point of sale issue I’ve run into.
The next question from a prospective lawyers is: “What does the policy say?”
When I reply with “I wasn’t given a copy of the policy until long after I had already become disabled”, their answer is “the judge will honer the policy, you do not have a case”.
Does ERISA not specifically govern this? How can I be held to documents I was not provided and point of sale representation which I reasonably relied upon that clearly misled? How is clearly advertising a policy at 60% of pre disability income then paying out around 30% not bait and switch? Does this not violate the duties of a fiduciary? Even if I was provided policy or SPD documents (which I was not) how would a normal person know to even think to look for an item that decreases the coverage by almost half?
Thank you in advance for the help.
I have an ex employee that has gone to every government agency trying to get claims against us and every one has denied him including workers comp. He never reported any injuries at work and didn’t go to the doctor until a month after he quit. The doctors he sees only hears his lies so they say he is injured at work but workers comp denied his claim. He has now gotten a contingency attorney and has filed an appeal with the Supreme Court.
This employee has now moved to another state. There is 0% chance that he was injured at work and is now claiming long term disability. The attorney handling the claim for the state said they will be hiring a PI to follow him and see if he is really having the limitations he is claiming.
How do I prevent this fraudster from getting any benefits or settlement? This guy is out of control.
For white-collar jobs, how much more difficult it becomes to get LTD benefit after 24-months, when the change to "any occupation" occurs?
Desk Software-engineering job and wonder if I can reasonably expect the benefits to continue after 24-month mark from the insurance company Guradian.
How much more certification/documentation from a doctor would they require compared to now?
I was denied by MetLife for LTD and due to my lower salary no ERISA lawyer wants to take on my case as it wouldn’t be profitable for them.
I’ve searched high and low for free resources in my state (NY): NYLAG, Legal Aid Society, Disability Rights NY. None of them work on long term disability claims.
Everyone keeps recommending I work with an ERISA lawyer on my appeal but I can’t find anyone who will give me as much as an hour consultation.
I’m truly at a loss. Someone please help.
My husband was on Metlife STD from 9/25 to 3/26, and was finally approved for LTD in May, but was back paid to March. Today, my husband passed away completely unexpectedly. I see on Google it will make this month's payment prorated, and then I saw mention of a survivors benefit, and it said most MetLife LTD pland had this, depending upon if the company wants it. So I'm trying to find any information on this, but of course I can't see any copy of his employer LTD plan. Does anyone have a suggestion on how to figure this out?
I keep reading horror stories about MetLife — payments cut off out of nowhere, endless requests for doctor's notes and then acting like they never received them, and hiring investigators to follow claimants and catch them doing everyday activities. It's honestly nerve-wracking.
So I want to hear the other side. Is anyone out there having a genuinely good, drama-free experience with MetLife afterapproval? Payments on time, reasonable requests, no surveillance games?
If you've had a smooth experience, I'd love to hear it.
Life has been a bit of a nightmare since I got rear ended at high speed in June 2025. I've been dealing with injuries ever since, attempted and failed a gradual return to work in January 2026. Fast forward to now I'm just getting in to see the correct specialists now to treat my ongoing neurological symptoms. I had a full time permanent senior leadership position at a good company, with the best benefits package option available. LTD should have kicked in back in Oct 2025, but in December 2025 came back denied- "my leave was not medically supported". I submitted an appeal with additional doctors support- same reason cited, denied again.
I have an attorney who has filed a claim for wrongful denial. She says my case is exceptionally strong and she feels that as soon as the right person at my LTD insurer sees my file they will be forced to reverse the decision and hopefully it will be resolved quickly.
Has anyone here had an experience of hiring a lawyer after a denied LTD appeal? How long was the process until you reached a resolution? I'm mostly curious, I understand every situation is nuanced and relies on many different factors.
Husband travels for work and will likely not be able to return for a while.
He started his regularly scheduled 1 week of home leave today and will likely be hospitalized tonight for acute heart failure. He needs to be stabilized in the hospital, and then he needs some time for appointments and medication management to get back to a functional condition.
He works a very physically demanding job that he travels frequently for. So driving, flying, and day to day requirements involve free climbing wind turbines. It is possible he may be able to return as ground support only but right now we don't know.
He will apply for STD (MAX 12 weeks) and FMLA at the same time. The elimination period is 7 days.
From what I understand his LTD is 2 years max and has a 90 day elimination period. These are fully paid by his employer.
I have several question:
Should he initiate filing with HR or the insurance company?
Should he tell them he needs leave as soon as he is admitted to the hospital even though he has 1 week of normal home leave, which is paid regular salary? He has not told anyone yet that he will need leave.
Should the LTD be filed right after STD approval? To avoid or shorten a gap due to the 90 day elimination period?
I've read the certificates but am still unclear of what will happen with health insurance once the STD is exhausted.
Thank you!
So I have been on LTD for about a year. I have been out for major depression, anxiety and adhd. It was really bad when I was working and could barely function. For the past year I have had intensive therapy. Weekly.
The job I had was somewhat client facing, my mental health made it hard for me to perform my duties. Now I’m on 4 different medications, where before I was on nothing.
I want to go back to work soon. I was told I can apply to positions and I had an interview in something that is client facing but in a different organization and a different role entirely.
Can I resign from my current role and take this new one if it is in fact offered to me? I understand that my benefits will end but I don’t care. My disability benefits have a return to work program and I have already started to talk to my doctor about going back to work. What are the legal ramifications?
I have an appointment with my doctor soon, if they ok it can I make this switch?
Location: NYS, United States
Just what it says, my initial SSDI application denied was denied, which is pretty common in my state with about 70% getting denied apparently. I have my own SSDI attorney. Will MetLife terminate my claim? I am panicking about this.
It is absolute torture every month having to worry about this plus my health.
Hello new friends,
I recently applied for SSDI. I'm 42 and my primary condition is PTSD/MDD, so I know I have the "young age" and mental health factors going against me. I get that. I've also not been able to make more than $8000 in the last twelve months.
In additional to PTSD, I am cancer survivor and have several medical conditions that are secondary to the treatment of my cancer treatment such as: gastroparesis, impaired immune system requiring me monthly IVIG infusions, Chronic Iron defiency anemia recently diagnosed and looking at needing Iron infusions, ADHD, hypothyroidism, migraines and high blood pressure.
Over the last 18 I've had approximately 224 unique health appointments. An average of more than 3 appointments a week. Some total appointment volume slightly skewed due to a 28 day inpatient stay at the VA, but regardless I will likely continue to have 1-2 appointments a week for the rest of my life.
My question is, has anyone had the experience of having significant appointment volume helping their case?
One I have a hard time being a good employee due to my psych and physical health conditions and two I can't maintain a productive work schedule due to the frequency of Dr's appointments.
I was on SDI for my maternity but now have a new disability. Any advice appreciated.
I sent in all my stuff last month. How long before a decision has been made? I only have three medical records. Guess someone is already looking at it?
So I’m trying to figure out how my premium tax credit (PTC) on my marketplace health insurance plan is going to affect my taxes next year and if there are any changes I should make now or ways I can prepare. I recently saw something that said if someone’s income turns out to be too low to qualify for the plan and the PTC, they may have to pay all of it back when they file their taxes.
As of last year, I’m on Long Term Disability (LTD) and that income is completely nontaxable, as I paid for the premiums with after-tax dollars through payroll deductions. This year, 2026, will be my first full year on LTD (unless something changes) with it being my only source of income and I expect it to come out to about $36,620 for the year. So when I signed up for my health insurance plan last December, I didn’t know exactly how it would work with my taxes yet. I thought I might still get some sort of form to file with my tax return for the portion of 2025 that I was on LTD, but I didn’t. I also didn’t know at the time if I would still be on LTD this whole year, so my income estimate on the marketplace was a wild guess and I put it just over the FPL, which was close to last year’s taxable income. I definitely didn’t want to overestimate things, because my premium was already more than doubling due to the changes last year, so it was already more than I could afford.
So my concern is, if none of my income is going to be reported to the IRS, will I have to pay all of the PTC back??? That would be around $6k and I cannot pay that! Is there a way to report it or a different way around this? If there is a way to report my income, would it be worth going back to the marketplace application and increasing my estimated income to what I think it will be now? Or would I be significantly increasing my premium for no reason if I’m just gonna have to pay everything back anyway?
I do not qualify for Medicaid because of my LTD income and I also have a small amount of money saved in case the LTD insurance company decides not to extend my claim at any time.
I hate the state of healthcare in this country, it should not be this way at all. I could go on a whole rant about that, but I won’t. I just really need some advice. I HAVE to have good health insurance to pay for my continuous doctors visits, tests, medications, treatments, etc. I am already struggling to get by as is, I can’t afford anything else. If I can’t use the PTC because my income is nontaxable, I don’t know what I’m supposed to do. Not having health insurance isn’t an option for me and I cannot pay any more than I’ve already been paying. Please help!
it has been five months since I submitted my LTD claim after the 6 month waiting period, and the insurance company still hasn’t responded to my claim. They have all the info they need from me and Drs. Time to get a lawyer involved?
If you were required to get objective testing for a mental health STD/LTD claim, what type of testing did you have done?
Was there testing other than a full neuropsychological evaluation that could show what the impairments were, how significant they were, what might be contributing to them, and how they affected your ability to work?
With no income coming in after a denial, the thought of spending $4K–$6K on an evaluation is overwhelming, so I'm trying to understand what other options people may have had.