Long Term Disability Stopped

[A Mom on Spin]

Hi all,

I'm particularly upset right now because my appeal to reinstate my private long term disability was recently denied.  I have applied for Social Security Disability but am stuck in a 2-year wait to get a hearing.

I really thought I had a good appeal but when I read through their decision a couple of things keep popping up over and over again.  It appears that from now on I should attend all drs appointments unshowered, unkempt, and perhaps fall asleep midway through the appointment because they keep citing the fact that I was "pleasant and oriented and alert to the conversation ". This, according to them, is inconsistent with the way a patient in real pain would behave.

They refer to my overwhelming fatigue as "self-reported" even though I have made it a point to mention it at each and every physician appointment I go to.  Is there a objective way to test for fatigue that I'm not aware of?

At any rate, does anyone know what my next steps might be?  I live in the states, so is it an appeal to the state insurance and banking commission?

I'm just tired of others making negative decisions on medical treatments, tests, and now my livelihood without meeting or examining me.

Liz

[Kristian]

Your next step is to hire a  LTD attorney in your state (laws very by state and region).  The attorney will normally work for a percentage of back pay and should be able to get the insurance company to pay if they are ruled against.

You can normally appeal two times, just very important to hire the attorney and move quickly so you don't miss any deadlines for filing.

Sorry you are going through this, I am in the same scenario and the attorney has helped a ton.  Unfortunately LTD carriers regularly shut off the payments to see if they can get out of their policy obligations as they have almost no penalties for doing this  whereas it causes irreparable damage to the insured individuals like us with no other sources of income due to disability.

Good luck with the attorney, that should turn things around for you including getting your doctor's notes straightened out.

[araminta]

I can't help with this as I live in the UK, however I wanted to say I find the way a lot of doctors go simply by how well someone looks to be amazing.   My mother's neighbour has rheumatoid arthritis, she has had it for about 20 years, has had numerous operations on various joints, has such damage to her tendons that she has at times been prescribed morphine to take when the pain gets unbearable, yet when she went to a hospital in agony recently, they told her she looked well and that they didn't want her turning up there again.

Not as extreme as that, but after I saw a rheumatologist a couple of years ago to discuss my symptoms, I received a copy of her letter to my GP in which she mentioned how well I looked.   What on earth has that got to do with anything?   As you say, I think if we try to be fairly brisk and cheerful at our appointments, we're viewed as being just fine and dandy.   I'll try the unwashed hysterical look next time.

[A Mom on Spin]

Unfortunate my insurance company only allows one appeal and so I'm out of options with them

I do have a lawyer who has been working for me pro-bono so far.  He is not a LTD lawyer but used to sit on my state's banking and insurance commission.  Im afraid he will charge me if I want to move on to some next steps.

[irish]

Another thing to hone in on is your activities of daily living. This means that you must list what tasks you do are limited or your ability to do them cease. This is dressing yourself, bathing, toiling, shopping, attending church or other social functions hampered because ofo pain. I think that you would need to also involve the diagnoses that you have. There might be other physical issues that are involved in this also. You can do a search on activities of daily living as all nursing homes, hospitals, and other medical facilities use this list of personal tasks on their insurance forms, unemployment, etc. Good luck. irish

[Carolina]

Dear Mom,

When I had my second child, my OB-GYN stopped by early morning, and said I looked 'terrible'.  I said I just didn't  have my makeup on.

He stopped by two hours later, after I put on make up, and he said 'you look so much better"!

So much for doctors knowing a darn thing about anything beyond how we look.

And "we don't look sick" of course.

Sigh,

Regards, Elaine

[warmwaters]

The relevant law is ERISA.  You need to find an ERISA lawyer, who knows the ropes on this issue. Most of them work on contingency, so you pay them if they win.

There are tests for fatigue/ability to work. One is the Functional Capacity Evaluation, which tests physical abilities. Things like can you stand, sit, walk, carry 10 lbs, etc. The other is Work Tolerance Screening. This one focuses on can you perform the tasks needed for your job.  It will vary by person, but might include some physical elements, can you do math, can you do word processing, and other job related tasks.

These provide an outside evaluation of your situation.

Of course, I hate that fatigue is "self-reported". Of course it is - there you are, sitting there, telling the doctor you feel tired.  Who else do they think is going to show up and report your fatigue?  Ditto with pain.

[SunshineDaydream]

Your next step is to hire a  LTD attorney in your state (laws very by state and region).  The attorney will normally work for a percentage of back pay and should be able to get the insurance company to pay if they are ruled against.

+1 on this advice. Many attorneys provide free initial consultations and LTD attorneys often work on contingency basis. Find someone who concentrates in the LTD dispute area of law.

And stop looking so good! <sarcasm>