SISIP APP (Assorted Topics)

hey ttt, thanks for that...our situations are just a bit different but what you said helped me to understand it more, and no need to apologize for not replying last night...i really would be lost if it wasnt for guys like you on here...thanks everyone who contributed to this post

TTT you nailed it, so dzanzio is getting all of what sisip asked and sending asap, keep him updated RUCKSACK031

To dzanzio

I apologize for leaving you hanging there, I had to leave. I just read your post after my post and you said something that made your situation slightly different from mine. You mentioned that you were told by SISIP that you were not deemed tpi and that you had 1 year to appeal that decision. Correct me if I'm wrong, but did SISIP send you a letter stating that you continue to meet eligibility for continued benefits, and that you have to send updated physician statement and financial info? If you did not get that letter of request then I am guessing you fall into the group of vets who were zero summed and were "NOT" asked to send updated physician statement at the end of the initial 24 month's.(group 3 ?) So they had already reviewed your file and you didn't meet their eligibility requirements and your file was closed. You were given 12 month's to appeal that decision. Due to the courts decision, you are now being given the opportunity iaw the proposal to appeal this decision through the adjudicator on the assumption that had you not been zero summed during the initial 24 month period and in receipt of cold hard cash each month from SISIP, then at that time, if they told you that you aren't deemed tpi, and that you stood to lose that cash every month, then it would be logical to assume that you would have appealed this decision long before the 12 month's had expired. In your case you did not appeal because your VAC benefits offset your SISIP LTD and you stood to gain nothing from this decision anyway.

Where our situations are different is I WAS asked to send updated medical and financial info at the end of the 24 month's but "failed to comply"!(group 2) SISIP had informed me in that letter that a complete review of my file had been completed and continues to support my eligibility for continued LTD benefits. Because, like you, my VAC offset SISIP so I didn't bother to comply with request for that Physician's statement and my file was closed. In both our situations, updated medical and financial info is required to determine eligibility so "DO NOT DELAY"!

Sorry, I couldn't stop typing. 

TTT

P.S. It's a pleasure to help.

You flicking guys need a GPS alright lol, and some damn t-shirts with our faces on them we will wear a shirt with some one else's face think that should work lol.

hey rucksack, doesnt your 360 hp cadillac have gps....we dont need a 12 fig grid

Nice try helping one another is allways free, we will wait until the DZ/Lz from RR and recon, hope itS not a 12 fig grid been using a gramin LOL

Dzanzio here you go brother alot of help, well i wont take up anymore time my jumper friend you are in great hands, i shall let the wisdom of others on here pass on far more than myself on this subject, PS Call when it canteen time cheers, again thanks to all Rucksack over but never out. tks bigrex

ok thanks trooper, ttt and bigrex and to rucksack who got this all started...i will call mc first thing in the morning...rucksack i will buy you dinner at the casino for all your help...

Dzanzio, SISIP does not want you to appeal. They are an insurance company and will do almost anything to reduce their liability. But the Lawyers have specifically stated that the adjudicator will be available for any class member who failed to appeal a TPI decision, based on the clawback. Let the law firm know that you intend on using the adjudicator, and I'm sure things will work out for you.

Hey there TTT ,and other thanks so much for jumping on board to help dzanizio and others that maybe going through this, dzanzio we will get this rectified take TTT advice and ensure both party get the info required from the doc and call MC am tomorrow brother as suggested, got to love it Vets HELPING vets. rucksack 031 thanks all

ok thats great ttt, i appreciate the info, does dan wallace have his own number or do i just call mc and ask for him...but you know what i dont get, is why after my 24 months they told me that i am not tpi and i have 1 year to appeal, when it didnt matter if i was tpi because my pensions were to much and there was no point in appealing and also my family doctor who stated i was able to work was referring to my knees and he stated that in a letter to vac ref a reassessment on my knees, dont you think someone would have looked at it and said wait a minute, this letter is referring to his knees only, we need more info....but they probably said, ok forget about his other injuries this is all we need to declare him non tpi

Well, after I sent e-mail to MC informing them that I intend to appeal through adjudication, I received a phone call a few days later from Dan Wallace(MC) asking me to send in all my documents to him. I actually didn't send SISIP my docs until a few days ago when I received letter from Manual Life requesting updated Physician statement and financial info. So, I'm thinking MC contacted SISIP and told them I would be appealing and SISIP sent me letter requesting info. But they want all paperwork as well. Send SISIP AND MC the doc's. Your right to adjudication is certain iaw settlement proposal. If SISIP gives you problems, Dan will straighten them out.

TTT

hey triple t, that is one thing i forgot to mention that she told me that i would get no retro until a decision is made if i am tpi...so should i wait until after i send them my doctors report and then if they say i am only 24 months, then contact mc and tell them i intend to appeal

Just to add a little bit of info to this post. It appears that if your file number has not been passed to MC as of yet, then that is the response you will get. I was given the same story from Manual Life, that my right to appeal had expired long ago and that I would have to appeal through the adjudication process. Since hearing this, I e-mailed MC and informed them that I believe I fall within group 2 and that I intend to appeal. I anticipated that SISIP would want Physician Statement and financial information so I put it all together and when I received the letter from SISIP last week requesting the info, I fired it off the same day. 

I will add that after I did this, I questioned the response that I was getting from the app. I was getting "file not found" as well. I had been informed previously that I would be sent the 24 month retro and when I received it, I would be required to appeal at that time to be re-instated. This was incorrect. The nice lady at SISIP told me 3-4 days ago that I would not be receiving any retro until it was determined if I qualify for on-going benefits. If I am denied, they will send me my 24 month's at the time. If I am approved, they will send me 10 years worth of retro, but she was certain that they will not be sending retro to anyone more than once. She also emphasized that until they have received all the info, and have made a decision, then and only then would my file be going to MC. She was also kind enough to point out to me that IAW judges decision, Manual Life has 6 month's from the date my file goes to adjudication to process any potential refund, so as I suspected, should be around Christmas if I'm lucky.

Not sure about the time frame involved but I would recommend getting all your doc's mailed to SISIP AND MC. Regardless whether you received a recent letter asking for them or not.. Get the info to them. Tell MC formally you intend to appeal. I have been corresponding with Dan Wallace. He said he would be handling my case personally...along with everyone else who is appealing.

TTT

oh ok then that would explain it...but still i told her about the appeal process and she said yes but you are still not allowed to appeal it...anyways thanks for that info trooper, you have been a great help..hope this helps someone else also