Thursday, August 24, 2006
Latest in the LTD saga.....
Got a call today from a lawyer I'd contacted about my long term disability insurance company's decision to limit my benefits to a maximum of 24 months. He's the partner of the guy who helped me win my SSDI case. Both lawyers are well-known locally and rarely if ever lose a case.
Anyway, he's pretty confident I can get the 24 month limit lifted, even if I have to sue the LTD company to do it. Either that, or get them to settle. The company in question has been in a lot of legal hot water lately for limiting legitimate claims and was forced recently to re-open some 200,000 claims.
Both the functional capacity exam and the neuropsych evaluation the LTD company made me undergo were performed by "independent" examiners who have been proven in the past to have given biased or even completely bogus reports on claimants. The functional capacity exam states that I was not exerting maximum effort, and from that statement, the LTD company decided I could do sedentary work. The neuropsych evaluator threw out my entire exam because she claimed I was not making an effort, and then added that I had somatoform disorder. The definition of somatoform disorder is illness in the absence of any physical cause. I have Sjogren's syndrome, which is a physical cause, so it's impossible for me to have somatoform disorder. Because both of these evaluations contain exaggerations and outright falsehoods, they do not constitute valid proof of my ability to work.
The clause that is the most problematic is the LTD company's policy of limiting claims to 24 months if the disabling condition is based upon "self reported symptoms" such as pain, fatigue, headache, dizziness, etc. California, I believe, has ruled that clause to be illegal, and it cannot be applied in that state. Here, unfortunately, there is no such protection. But how can a disease be considered self reported if a biopsy proves it's there? Obviously, I wouldn't get plugs in my eyelids if I just told the opthalmologist my eyes were dry and he didn't verify it. I wouldn't have extensive dental work if x-rays hadn't shown the decay. The gastroparesis and reflux were proven in multiple tests. And the x-rays show real arthritis, not just self reported joint problems. The neuropathy and carpal tunnel were demonstrated in my EMG. The edema is a visible, not self reported, problem. The thyroid disorder and diabetes were verified in blood work. And my sleep disorder is recorded in a lengthy study. Yes, I have fatigue, pain, headache, dizziness and other complaints, but so do most people who have real diseases. If the "self reported" clause were applied to every LTD claim, probably only one in ten would be approved past 24 months (I imagine some things they can't deny like loss of a limb).
So the first step is to send a letter of appeal to the LTD company's decision to limit my claim. Of course, by hiring the lawyer, I'm gonna have fees to deal with, but I don't know of anyone who has won a case against this LTD company without representation. And I have to be prepared for the LTD's inevitable rejection of the appeal. This is pretty much standard. In fact, I may go past the 24 month mark and have my benefits cut off before the matter is resolved. That is common. I may have to sue in court, which could take years, or the LTD company could decide to settle with me to get me off their backs. In any case, I may be in for a long, difficult and possibly expensive fight. But I think it's necessary.
It's not just the paltry amount they owe me each month. It's nickels and dimes to them. It's the idea that they can just sweep me under the rug and then keep doing this to other claimants who are disabled through no fault of their own. If I don't put up a fight, then the next guy will certainly be treated the same way, and that guy may decide that if no one else is standing up to the company, he won't either, which perpetuates an awful precedent. If I stand up for myself, I am also standing up for other disabled people who are being robbed by greedy and unscrupulous long term disability insurance companies. I'm not basing this on some heroic dream. The fact is that two people in my fibromyalgia/CFIDS support group had their benefits terminated on the basis of the very "independent" medical examiners I had. They both used the same lawyer I've hired. They both won. They are a big part of the reason my lawyer feels strongly that I can retain my benefits. Without their victories, my case would be much harder to prove.
We have to keep fighting LTD companies who use bogus termination clauses, who hire biased examiners, who kick the disabled when they're down. It's humiliating enough to lose your job, your friends, your independence due to disability. When dishonest LTD companies get into the mix, then you may lose your house and your ability to pay for medical care. Or worse.
It's a lot more than nickels and dimes to us.
Anyway, he's pretty confident I can get the 24 month limit lifted, even if I have to sue the LTD company to do it. Either that, or get them to settle. The company in question has been in a lot of legal hot water lately for limiting legitimate claims and was forced recently to re-open some 200,000 claims.
Both the functional capacity exam and the neuropsych evaluation the LTD company made me undergo were performed by "independent" examiners who have been proven in the past to have given biased or even completely bogus reports on claimants. The functional capacity exam states that I was not exerting maximum effort, and from that statement, the LTD company decided I could do sedentary work. The neuropsych evaluator threw out my entire exam because she claimed I was not making an effort, and then added that I had somatoform disorder. The definition of somatoform disorder is illness in the absence of any physical cause. I have Sjogren's syndrome, which is a physical cause, so it's impossible for me to have somatoform disorder. Because both of these evaluations contain exaggerations and outright falsehoods, they do not constitute valid proof of my ability to work.
The clause that is the most problematic is the LTD company's policy of limiting claims to 24 months if the disabling condition is based upon "self reported symptoms" such as pain, fatigue, headache, dizziness, etc. California, I believe, has ruled that clause to be illegal, and it cannot be applied in that state. Here, unfortunately, there is no such protection. But how can a disease be considered self reported if a biopsy proves it's there? Obviously, I wouldn't get plugs in my eyelids if I just told the opthalmologist my eyes were dry and he didn't verify it. I wouldn't have extensive dental work if x-rays hadn't shown the decay. The gastroparesis and reflux were proven in multiple tests. And the x-rays show real arthritis, not just self reported joint problems. The neuropathy and carpal tunnel were demonstrated in my EMG. The edema is a visible, not self reported, problem. The thyroid disorder and diabetes were verified in blood work. And my sleep disorder is recorded in a lengthy study. Yes, I have fatigue, pain, headache, dizziness and other complaints, but so do most people who have real diseases. If the "self reported" clause were applied to every LTD claim, probably only one in ten would be approved past 24 months (I imagine some things they can't deny like loss of a limb).
So the first step is to send a letter of appeal to the LTD company's decision to limit my claim. Of course, by hiring the lawyer, I'm gonna have fees to deal with, but I don't know of anyone who has won a case against this LTD company without representation. And I have to be prepared for the LTD's inevitable rejection of the appeal. This is pretty much standard. In fact, I may go past the 24 month mark and have my benefits cut off before the matter is resolved. That is common. I may have to sue in court, which could take years, or the LTD company could decide to settle with me to get me off their backs. In any case, I may be in for a long, difficult and possibly expensive fight. But I think it's necessary.
It's not just the paltry amount they owe me each month. It's nickels and dimes to them. It's the idea that they can just sweep me under the rug and then keep doing this to other claimants who are disabled through no fault of their own. If I don't put up a fight, then the next guy will certainly be treated the same way, and that guy may decide that if no one else is standing up to the company, he won't either, which perpetuates an awful precedent. If I stand up for myself, I am also standing up for other disabled people who are being robbed by greedy and unscrupulous long term disability insurance companies. I'm not basing this on some heroic dream. The fact is that two people in my fibromyalgia/CFIDS support group had their benefits terminated on the basis of the very "independent" medical examiners I had. They both used the same lawyer I've hired. They both won. They are a big part of the reason my lawyer feels strongly that I can retain my benefits. Without their victories, my case would be much harder to prove.
We have to keep fighting LTD companies who use bogus termination clauses, who hire biased examiners, who kick the disabled when they're down. It's humiliating enough to lose your job, your friends, your independence due to disability. When dishonest LTD companies get into the mix, then you may lose your house and your ability to pay for medical care. Or worse.
It's a lot more than nickels and dimes to us.
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