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Sjogrens Topics => Living With Sjogren's => Topic started by: Shade on June 09, 2011, 05:30:59 AM

Title: Initial Consultation with Attorney
Post by: Shade on June 09, 2011, 05:30:59 AM
Hi Everyone,  ;D

I'm having an initial telephone consultation with an attorney this morning.

I want help in dealing with the insurance company that is handling my short-term disability.  I have found the insurance/disability company to be less that straightforward in their dealings and they have cut-off my benefits.

Do you have any idea what the attorney will be asking in deciding if I have a case?

Thanks so much,


Title: Re: Initial Consultation with Attorney
Post by: warmwaters on June 09, 2011, 06:42:11 AM
First round is probably basic facts:

When did you first get sick, when did you tell your employer, what are your key symptoms, when did you got out of work onto short term disability, when did they stop payments, and what did they give as a reason.

Plus stuff like: are you seeing doctor(s), what kind how often. What medicines do you take? Do you have any medical tests that help support your claim (positive test for ANA, SSB, thyroid, or things like that) Did your doctor say you stay out of work?

Try to stay focused on facts - it's easy to get swept up in the emotions you have towards the insurer (I know this from experience), but what the lawyer is trying to assess is: do I have enough here to possibly make a legal case?

Whether you end up with this lawyer, or another, you'll need pull all your medical records together so that you have info. You'll also want to pull together all the interactions/correspondence with the insurer, and possible put together a timeline of what happened when.
Title: Re: Initial Consultation with Attorney
Post by: Meld256 on June 09, 2011, 07:16:01 AM
Hi Shade,

Have no idea on specifics of what the attorney may ask.  As I'm sure you will do, just have ALL the information about what your disability issues have been and any documentation from your employer and the insurance co. regarding your termination of benefits.

I applaud you going this route! I researched getting legal help when this happened to me, but the few attorneys I spoke with felt that basically my case would not make enough for them to bother. Of course, they put it more "PC" than that, but that's what it meant.
I struggled making it to my job for a year before I finally went on medical leave, and had FMLA for the last 6 mths. before that. At the start of Feb. 2010 I left work in pain and with awful eye problems. From there, I became sicker and weaker. I requested short-term disability, with my doctor's notes that he agreed, and it was granted for 8 weeks. ( I thought I would recover by then but didn't) I had to have it certified again for another 8-12 weeks, which my doctor requested. Back then he had diagnosed me with fibromyalgia, depression and chronic fatigue syndrome, and I had a chronic dry eye dx from the eye doc.

To my shock, my continued request was denied. I couldn't believe it. My denial actually stated that while they did not dispute my claim of extreme fatigue, eyesight problems, focus and concentration issues, and muscle pain the medical findings did not illustrate functional disability which would preclude me from performing the duties of my sedentary job.  ??? HUH? I couldn't drive to my work, much less perform it.

Sorry to give you all that; guess I'm still upset. May I ask what happened in your case? I've read quite a bit about how STD cases are even harder to prove nowdays, partly because of the economy and the insurance companies are not wanting to pay off. There have been several civil suits against some of the largest ones in the last few years, and employees have won!
I'm so glad you are going forward with the attorney.  I hope they are a great help and give you some encouraging info.

Please keep us posted. (and go get 'em)  ;)
Title: Re: Initial Consultation with Attorney
Post by: Shade on June 09, 2011, 07:58:54 AM
Thank you Warmwaters and Melinda.  My consultation is in 35 minutes and I'm still pulling everything together in chronological order.

Melinda, a short and sweet answer, since I'm still getting organized.  I was going to the different docs and rehab to get info for disb ins company when the Nurse Consultant says, don't worry about doing that, I'll take care of it.   Yeah, she took care of it.  Only got from 1 doctor and rehab and decides you have improved so no reason you can't do your sit down job. 

My job had me traveling 6 mos. out of the year.  She made some other untrue statements and said go back to work.

Since then, what they say on the tele and what they put in writing are two different things.  Very irritating.

Okay, not so short.  As you can tell, I'm also emotional.  I'll let you know what the atty says.

Title: Re: Initial Consultation with Attorney
Post by: Shade on June 09, 2011, 01:25:45 PM
Talked to the atty. for under 10 minutes.  He got tied up earlier and when I called to reschedule because I had to leave for an optometrist appt. they put me through to him.  So I was really pressed for time.

Warmwaters:  You were right, very brief.  Actually, extremely brief since I had to leave.

The atty said our next step since continuation of my STD was denied, we would file for LTD with same ins/disb company and also file for disability (SS).  After that, then we would go back at getting the STD that I'm owed.

For now, I have several tasks to complete before I meet with atty. again.

Warmwaters and Melinda, thank you so much for your help and encouragement.  It means a lot.  There is so much we have to do at a time when we're really not able to function at our best.

Title: Re: Initial Consultation with Attorney
Post by: Pisces24 on June 09, 2011, 04:59:27 PM
I would say you need plenty of paperwork, doctor(s) findings & assertions to back up your claim of disability and that type of stuff. You need to prove you cannot handle 8 hours worth of work.

Good Luck.  Hope you have an attorney that is part bulldog!
Title: Re: Initial Consultation with Attorney
Post by: Meld256 on June 10, 2011, 12:24:14 AM

That is such encouraging news; so glad for you!  ;) This attorney sounds as if they going about this in the most common-sense and beneficial way to you.
warmwaters was right. They need facts, and documents, not emotion as was what I showed in my little rant.

I know getting all this paperwork together is difficult when you're not functioning at 100%, but with the help of the attorney I feel you'll do just fine.
Keep us posted; sounds like you're on your way to some redemtion that you deserve!
Title: Re: Initial Consultation with Attorney
Post by: Shade on June 10, 2011, 06:51:32 AM
Thanks Melinda for your words of encouragement.

I am so glad I consulted an atty.  I would never have thought to skip over the STD continuation denial and go for the LTD and SS. 

The way it is explained by my company, is after being out for 6 mos. on STD the ins/disb company is supposed to help with the LTD and filing and getting approval for SS benefits.  The atty. said, Excuse my non-legal terms: They're not going to do that; they're out to "screw you".  I told him that's exactly why I called.  After 30 years of working for them, I did not want to get screwed.

I know I will be posting more questions as I go through the approval process.  I appreciate everyone's help and words of wisdom.  It really is great to have this forum.


Title: Re: Initial Consultation with Attorney
Post by: warmwaters on June 10, 2011, 07:16:34 AM
I'm in the middle of filing an appeal for my LTD benefit, which were cut off after being paid for 1 1/2 years. I have been avoiding going into details here, as I am feeling a wee bit paranoid about the insurer involved and don't want to give much detail, even anonymously.  But I'll say that I'm having to do a lot of additional testing and documentation, even though all my doctors are in agreement that there is NO way I can go back to work at any job, let alone the one I used to do. They had a doctor who read my records and said, in essence, well, her doctors are incorrect and she can go back to work. (Though he's never seen me, and at least one of those doctors had seen me 30 times). And though I have qualified for SSDI.

What my lawyer focuses on is facts, facts,facts. You say you are exhausted after doing a task? Great, lets send you off to a testing place that will measure how exhausted you are after you do a task. You say you have brain fog. Ok, lets do a test that measures cognitive function. 

I was telling my rheumy about a physical test that I was going to do, and she laughed and said, "You'll fall over after two hours". And I said, "Yes, but they need pictures of me falling". And we had a good chuckle. Because that's kind of how this game goes.

This is all about money - the insurance companies would prefer not to pay it, so they choose cases with some element of doubt (which autoimmune cases are full of), and say "no we won't pay". Then it's up to you to prove that you are sick. Not fair, but it's how the laws around this stuff are written. 

Best of luck....
Title: Re: Initial Consultation with Attorney
Post by: Meld256 on June 10, 2011, 07:47:33 AM
Right, Shade, most companies seem to have this policy of going out on 6 mths. of STD, then even though it's another process you go to LTD.  With mine, it was set up that I could ultimately have been out on LTD for years (until I turned 62) or until my SS Disability was approved.

At least, that's what the paperwork stated.

Of course, what I found out was that many, many times the insurance company cuts someone off before the 6 months. They don't allow the LTD to even begin, therefore saving them a huge amount of cash. For them to deny someone who has worked for a company a long time (like you) and paid into this many years, infuriates me!  At least, you can file a civil suit under ERISA, the Employee Retirement Income Security Act of 1974.

If you can prove the company wrongly denied you, it is not only immoral, it is illegal. I wish you much luck!

warmwaters, I just saw your post. Great tips on facts and more facts and how we need to prove every tiny thing. Unbelievable, but like you say, what must be done. And blows my mind that SS can approve our cases, but we have such a hard time with an insurance company.  Good luck in all your testing, and hang in there!
Title: Re: Initial Consultation with Attorney
Post by: Shade on June 10, 2011, 07:55:43 AM
Thanks Warmwaters, I glad I'm not the only one here with concern about what lengths companies will go to avoid paying.  They play this game everyday and are very good at it.

Take care of yourself,

Title: Re: Initial Consultation with Attorney
Post by: Shade on June 10, 2011, 08:24:08 AM
Thanks Melinda...I certainly hope this goes smoothly, money's running low. And then we have all these doctor bills to pay.  :(

Thanks Warmwaters for the insight on testing.

About all the testing:  My Rheumy doesn't appear to be one that refers (to early to tell).  Rheumy's practice is very busy.  An appt. takes about 3 hours to get in and out, with a short face time.  The office staff are very competent and extremely busy.  So, I'm figuring they don't set up referrals.

I've made an appt with a neurologist on my own because of the neuropathy.  Are they also the one's who would order the cognitive function testing?  I was thinking I needed to be tested due to the brain fog, talking to people and the word you meant to say isn't the word that comes out of your mouth, typing on the computer and when you look at the screen what you were attempting to type is not what's on the screen, short-term memory is MIA.

I'm trying to move things along so I can get approved faster.  These specialists take months to get in to see.
Title: Re: Initial Consultation with Attorney
Post by: Carebear on June 10, 2011, 10:04:35 PM
Hi Shade,

I had neuropsych testing done about six months ago, and it was my neurologist who referred me to the neuropsychologist.
Title: Re: Initial Consultation with Attorney
Post by: Shade on June 11, 2011, 09:55:09 AM
Thanks Carebear for the info.  I see a neuro next month.  I read some on the testing, looks like you had to go through a lot.