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Sjogrens Topics => Living With Sjogren's => Topic started by: ignatz on November 14, 2018, 09:10:03 AM

Title: Denied disability from CIGNA - how to show fatigue and lawyers
Post by: ignatz on November 14, 2018, 09:10:03 AM
Hello all,

Background: I work at a university where I've been for 18 years. I'm 57, male, primary SLE with secondary Sjo and Raynauds finally diagnosed 2013 after several years of symptoms.

My LTD app was denied by cigna 4 weeks ago and I'm planning my appeal. Fatigue and brain fog are the main reasons I can't do my job anymore and while I have had cognitive testing that clearly indicated deficient short term memory how do I go about substantiating the fatigue to their satisfaction?

Also I'm thinking a lawyer is a good idea. There's a firm I found with a google search that appears to specialize in private disability insurance claims, Dell & Schaefer Law Firm, has anyone had experience with them? How about other lawyers? Can anyone recommend one? I'm going to have a telephone conf consultation with them Friday so I'll know more then.

Thanks in advance for any help/advice.

Title: Re: Denied disability from CIGNA - how to show fatigue and lawyers
Post by: irish on November 14, 2018, 10:42:50 PM
Fatigue is so hard to explain. I remember when I had to fill out for my disability that my husband got a sheet and had to answer questions about my activities of daily living. He was able to give info about my ability to do chores, how much I needed to rest, how hard bathing, walking, shopping was, etc. One thing yu might do is explain how you feel in the morning, at noon, afternoon, bedtime and how your ability to do your job and house chores is affected at these times of the day.

I got to the point that I had enough weakness to affect my ability to sit up long enough to drive any distance. If you have muscle weakness at all fatigue will enter into the picture. Opening jars, another example is having to rest while doing a chore such as standing to wash dishes. Also, fatigue can affect the speed at which you are able to do projects at work. Have you had to ask your employer to change your job description at all due to your fatigue. Also, there are meds available that can decrease your fatigue and maybe they are thinking you should try these.

Plaquenil decreases fatigue for some people and one drug called Provigil can decrease fatigue. You will have to ask your doctor cause there are probably some newer ones on the market. Also, are there any other symptoms that you have that are bothersome that your failed to mention. If you have muscle weakness of any kind this can be a significant issue can it can also impact standing, walking, sitting. Just holding ones body erect can be work and fatiguing. Hope this helped some. Good luck Irish .....yes, a lawyer will probably help. Most people don't get it the first time around.
Title: Re: Denied disability from CIGNA - how to show fatigue and lawyers
Post by: Judes on November 15, 2018, 07:44:01 AM
I wish I could help but haven't been down that road yet, though I am fearful of the day if /when it comes. I wish you all the best. I do know if you search this site on "disability" you will see a lot of good information including some lawyers that specialize in it. Good luck.
Title: Re: Denied disability from CIGNA - how to show fatigue and lawyers
Post by: ignatz on November 15, 2018, 08:07:08 AM
Thanks for the ideas Irish. I take vyvanse (its like adderall) daily for the fatigue at pretty much the maximum dose but that still only gives me a few good hours and sometimes, like when I'm flaring, not even that. I wasn't clear enough about that on my disability questionnaire. I wrote how 'on my good days I have enough energy to manage the housework' with the clear implication that I use all the energy I have just to maintain but they seemed to read that as 'I have enough energy to work'.

I'm in IT so my job doesn't involve much physical activity but I find some of the mental repetitive tasks to be more exhausting than any physical work. Additionally the effort to get to work quite often takes all the energy I have that day. This is especially true in winter which has come early to upstate NY this year.  :(

It's frustrating because I really liked my job and if I could still do it I would! I hated to give up that position but I just couldn't keep up with the work anymore.

One thing my university rep suggested is a Functional Capacity Evaluation (FCE). Apparently there's one that focuses more on mental tasks. Have you heard of this?

thanks again.
Title: Re: Denied disability from CIGNA - how to show fatigue and lawyers
Post by: warmwaters on November 18, 2018, 10:45:10 PM
When I first filed for LTD, my insurer ok'd it, but after about 18 months claimed that I could return to work. Their assessment was based on their doctors, none of whom had ever talked to me or examined me.  I did have to file an ERISA lawsuit against them, which I eventually won. If you happen to be CA, send me a message, and I'll give you the law office's name.

Fatigue is a tough one to document. But here's some ideas. First, get a copy of your medical records (you can get them directly from your various doctors). Since you are doing adderall, you've been to some doctor, you've said you've had problems with fatigue, and the doctor's records will document that!

Whenever you are filling out forms, don't be general, be specific. Don't say "I get tired easily". Say, I get up a 6 AM, go to work. After my drive to work, I sit and rest in cafeteria for about 15 minutes, as I find focusing on driving draining. I review my tasks for the day, and am productive til about 10 AM when I need a break to clear my head. I find constant interruptions hard, which didn't use to be a problem for me.  (Obviously I'm making this up, but you get the idea) Continue through the highs and lows of your day. Also any details around home, like my son now mows the grass, and my wife does the groceries, both of which I use to do. On the weekends I take long naps, which help me recover somewhat from the work week.

If you've had any complaints from work about your performance, which used to be good, worth mentioning.

The functional testing can be useful. My lawyer in the ERISA suit sent me to functional testing. I spent two days in the testing, which touched on a variety of tasks, from physical things like stacking objects and carrying relatively light loads (5-10 pounds) to math tests and word processing and writing. They tend to customize the testing based on your occupation. I was deeply embarrassed by the math tests, as my background was as a software developer, and I tested out at 10th grade level, with lots of basic errors. Part of my short term memory issues!  I also had a meltdown on the second day, as I was so tired at working and pushing that hard on the tests (I'm one of those folks who always wants an A), that I was just exhausted by about 2 PM on the second day.  My former employer certainly wouldn't have wanted me in the tired weepy phase I was in.

The appeals process is long, and complicated. But it's worth doing. If you are 57, Medicare won't kick in for another 10 years. Getting a part of your salary for those 10 years is going to make a big difference in your finances.  You may also consider whether you should consider whether you should apply for Medicare disability. If approved, you will get Medicare health benefits 2 years after the date they think you became disabled. Which does two things: gives you insurance, and points out that if Medicare things you are disabled, it's a bit odd that your insurer doesn't. (Typically Medicare standards for disability are higher, but they "get" that older people become disabled for health reasons.)
Title: Re: Denied disability from CIGNA - how to show fatigue and lawyers
Post by: eye2dry on November 19, 2018, 08:20:35 AM
I too was 57 when I became disabled and filed for SSDI and after 2 years I was placed on Medicare A&B. I have
RA and Sjogrens since diagnosed in 2010.

I got to the point with my joint and muscle pains, terrible sensitive eyes and fatigue I just blew up at work at
everyone and anyone b/c I was miserable. I gave notice that day and quit my job.....I had no plans.....

I had a physical and mental evaluation by a psychologist. I was approved first go around.

I tell my story b/c as the previous reply suggested going the Medicare route if you have to.

Title: Re: Denied disability from CIGNA - how to show fatigue and lawyers
Post by: ignatz on November 20, 2018, 07:02:26 AM
Thanks warmwaters, lots of useful info. Yes I need to document more and make sure my doctors are also. In talking to the disability rep at the university it was clear from the feedback she had from Cigna that my rheumy's input was not as helpful as it could be. The denial letter quotes him as saying I have 'occasional flares of fatigue'. Occasional?? I live with fatigue every day of my life, how does he not know that? 

I was very interested to hear about your functional testing. As a system admin so much of my job is dependent on my ability to remember details, something I just can't do anymore. If they include mental tasks they should see that. Was it 8 hours a day for 2 days? If so I'm sure I'll be done in by the 2nd day like you were. When I did my cognitive testing I was pleading for a break and that was just 2 hours long.

Shelly: I'm very lucky in that I get health insurance from work for life since I've been there so long. My last year at work was miserable; I was tired, moody, and failing at a job I used to be good at. Finally last march I admitted to myself that I couldn't do it anymore. I had such a feeling of relief at that moment and I knew it was the right decision. Now I just have to get my insurance company to understand that.

I had a consult with a lawyer Friday and he feels like its a winnable case but his fees are 33% and that includes the back pay and all future payments! No wonder he was 'chomping at the bit' to get started (his words). My inclination is to try this first appeal on my own and if I'm denied I'll get a lawyer for my last appeal.

Ugh this whole process is exhausting plus winter came early this year and that makes everything more difficult for me. But as much as I'd like to 'cut and run' I know that I really need this for my health and future so I'll suck it up get through it.

Thanks so much for the help here it's been very useful.
Title: Re: Denied disability from CIGNA - how to show fatigue and lawyers
Post by: warmwaters on November 20, 2018, 09:55:56 AM
Look around for other disability lawyers - there are a variety schemes for payment.

My functional testing was 2 days, but of course, yours might be different.

My lawsuit focused on the fact that I'd been high functioning in some pretty responsible roles for a long time and now my cognitive testing was showing me in the bottom quartile for a bunch of things, like executive function (ability to organize a sequence of events mentally) and short term memory. Essentially the argument was: there's no way she could have held those previous jobs if she was this disabled.

I also had a doctor who said something vague that the insurer used as a basis for going back to work. So I got letters from all my key doctors with them stating that they felt I was unable to return to work. I wasn't even seeing the doctor that said the vague thing anymore, and the insurer hadn't contacted my new doctors, even though they had contact info. (The judge really didn't like that!) One of the doctors I was was a well known Sjogren's expert, and my lawyers argued pretty effectively about who should be believed - an authority on Sjogren's who saw me regularly or a non-rheumy who had merely read my records, and was employed by the insurer.

The downside to all of this is that you (or the lawyer) will pay for all this additional testing and records.

One thing, regardless, is only go with a lawyer who will work on contingency - i.e. s/he only gets paid if you win.
Title: Re: Denied disability from CIGNA - how to show fatigue and lawyers
Post by: irish on November 20, 2018, 10:16:05 PM
Remember that we always try to put on our happy face when we talk to people. We speak of the "good things" in life so that we don't embarrass ourselves.....cause we really want to be better in health than we are.

When we apply for disability we need to be emphatic about the bad stuff and the not so good days. Yes, we may talk of fatigue and it may sound like it is a nuisance once in a while. Actually the fatigue of autoimmune and chronic disease is all day every day. It goes up and down from one minute to one hour and is totally unpredictable but it is always there.

The fatigue affects the way we walk, talk, shop, make meals, plan our days, do our wash, clean the refrigerator ( if we are able to get at it sooner than later). All of us know that we get the chores done but not every day and often cant finish the task. Throw a load of clothes in wash and may not throw in dryer for 2 days due to fatigue.

Get up in the morning with a planned list of things that need to be done and by the time we are dressed, eaten breakfast and thrown the dishes in the dishwasher we have to lay down and rest. Some days that is it for the day due to weakness and inability of push through the fatigue. Other days we may sleep for several hours and wake up and feel able to go grocery shopping.

I have lived with fatigue for so long that I don't remember not having it. I have been known to get my grocery shopping almost done ad be so overwhelmed by fatigue that I just pushed my cart out of the way and walked out of the store. I got in my car and was barely able to drive home.

My life way planned around my fatigue and my list of work changed most every day. I generally had to leave out chores, etc and do only very little or nothing at all. Heck of a way to live but you all know the drill. This is what we need to get across to the feds. There is no way anyone can understand unless they have experienced it, is or was up to us to find the words to form a mental picture in their minds that they can understand.

This also includes all the tasks that we need to do involving out bathing eating, fixing meals, getting to the doctor, dealing with stress of the fatigue and describing how this all influences our life. How does it affect your ability to go to a movie, go out with friends. I don't know about you, but making small talk with even a beloved friend is more than I can bear much of the time due to fatigue and other issues.

Also, many of us have problems with proprioception which is sort of knowing where our body is in relation to the rest of the world. In other words, I would get dizzy and spacey when walking in certain areas like large rooms or outside. The flourescent lights in Target and Walmart would cause me to feel almost disoriented and my neurologist told me to go in the store, shop quite and get out as soon as possible as it was stressful to my body.

I tried to think of a few things that might help some of you in filling out your applications for disability. Good luck .And keep us updated. Irish
Title: Re: Denied disability from CIGNA - how to show fatigue and lawyers
Post by: vrystaat on November 29, 2018, 07:40:15 PM
It's very simple to know why Cigna comes up so frequently. They seem to be in the Disability Insurance field primarily to deny claims.
I was extremely disabled, even in the early stages of Sjogrens Syndrome. I started the disease with intense foot pain due to Polymyopathy. I could hardly walk or stand.
All my claims were initially denied by Cigna.

It took me nearly 5 years to get my claims approved. Even the Attorneys and doctors laughed at me. I was fired from four jobs due to my poor performance.
My work became impossible due to inability to stand and also my Sjogrens Fog.
My take away advice is:
1) Get the best specialized disability attorney.
2) You will have to give up to one third or more of your settlement to the Law Firm.
3) Don't wait. As soon as you have difficulty with work, file your claim.
4) Sue the Insurer if they have not settled in one year.
5) Don't trust any insurer, attorney and even physicians. Sue them too if they are incompetent.
6) Don't forget to file for Medicare Disability. The compensation is short, but you can receive Medicare Insurance at any age.
    Getting proper Medical attention early is of supreme importance.
6) Get a Disability Specialist to evaluate your illness and provide a detailed report to the Insurer, Attorney and even your Doctors.

It's a hard road. Depression and hopelessness are common. Get a mental health professional early.
Title: Re: Denied disability from CIGNA - how to show fatigue and lawyers
Post by: warmwaters on December 02, 2018, 10:36:49 AM
Several insurance companies are famous for denying coverage. The Hartford is one.

Here's one of the craziest stories - a guy who was denied disability because he could get in and out of a car and eat salsa with chips. (
Title: Re: Denied disability from CIGNA - how to show fatigue and lawyers
Post by: irish on December 03, 2018, 11:57:30 PM
A good trick to use is too do a mental play back of your daily life and activities from morning to night. When I got my disability info to fill out back in 2004 I went about answering the questions. Make sure to make copies of all these sheets in case you need a new copy. I also used my computer and filled in any info that was not addressed in their questions. I ended up with many extra sheets of information and I know it helped as it was more in depth than questions they asked.

Also, I was astounded when I read the sheets that my hubby had filled out. They sent sheets for my husband to answer questions and fill in other info. He put down things that I never thought of. This was usually some things that were such a part of my life as ways to do a task that was less stressful for me. When one is feeling weak and ill we learn to come up with shortcuts in order to do our daily living activities. This is to save energy and just help us manage out life

We often are not even aware that of many of these shortcuts that we come up with. Good luck. Irish
Title: Re: Denied disability from CIGNA - how to show fatigue and lawyers
Post by: ignatz on December 04, 2018, 06:35:46 AM
Thanks for all the advice. I've found a law firm to represent me that specializes in disability and has more reasonable fees.

I've come to realize that I've been suppressing a lot of the negative consequences of auto-immune because if I start thinking about it I get seriously depressed. I have a spare copy of the Disability Questionnaire here that I'll re-submit to correct this. 

Irish: It would be very telling to have someone who's observed you closely describe the changes. I'm sure there are things that I won't even admit to myself. I don't have a live-in (except my dog and he can't write very well ;D) but I can ask my close friends and siblings what they've noticed.

Vrystaat: Thanks and yes I've had my eyes opened to the fact that this is going to be a battle with Cigna and I need to use every tool in the shed including a some expensive testing and specialists. It's going to be exhausting but it has to be done.

Warm: Videotaped eating a taco so obviously he can work?!? I loved the retort 'if there's a job eating tacos then he could do that' hah!  When I heard of a person here at the University who had had a stroke, was in a wheelchair, could barely speak, and was still denied by Cigna(!) I realized I had definitely better 'lawyer up'.

Thanks again. I'll let you know how it goes.