browser life

Been meaning to post about this for several days but kept getting distracted. The excitement I initially felt faded pretty fast as I began to realize that this has very little impact on my daily life, at least it won't for a very long time. And the higher I get my hopes, the more they could be crushed.

Anyway, a few weeks ago, when organizing my medical records from the Mayo Clinic, it occurred to me that I hadn't heard from my lawyer in at least six months regarding my case against the long term disability insurance company that terminated my benefits last October. I thought it odd that I'd received no response from the company about my filing suit, so I checked into it.

Last week, the lawyer finally got back to me. Turns out my lawsuit had never been submitted! I was pissed at first, but that turned to gratitude when I found out why.

Over the summer, there was a significant case ruled upon by the Supreme Court regarding long term disability insurance companies and denial of benefits. Now, I didn't quite understand all the legalese, but the general idea was that the burden of proof of the validity of a claim was shifted from mostly the claimant to the claimant and insurance company being roughly equal. In other words, a claimant's evidence of disability must be given more consideration.

In the past, the insurance company could choose (and usually did choose) to ignore valid medical evidence of disability and pay a so-called expert of their own choosing to contradict those findings in order to facilitate a denial of benefits. That's what happened to me. The Supreme Court found this to be a conflict of interest.

Knowing the Supreme Court's ruling was forthcoming, my lawyer chose to hold off on filing my suit, and it's a good thing he did, because any case filed before the ruling is subject to the old law that heavily favors the insurance companies. He will be filing my lawsuit sometime in the next few weeks. And he will be citing the ruling of MetLife v Glenn when arguing that I had more than substantial proof of significant disability which was capriciously disregarded by my insurance company.

I found a summary of the ruling on a message board:
Disability Insurance Forums: Positive developments
To clarify, my case does fall under ERISA.

One unknown is whether the local court in Denver will interpret this ruling to mean that anyone paid by an insurance company to perform an "independent medical exam" is suspect. If so, it could lead to a discovery process regarding the background of these examiners, how many denials they recommend, how much they get paid, etc. This would be good news for me as the folks who did my neuropsych exam and my functional capacity exam are already famous in Colorado, even nationally, for stating that every single claimant they examine is capable of working no matter how severe their impairment.

But while this news is exciting, it also means that my lawsuit has not even started yet and will not likely be resolved anytime soon; in fact, I could still be a couple of years away from a decision. And even if the burden of proof has shifted to 50/50, I still have those horrible "mental impairment" and "self-reported symptom" limitations in my contract, and a judge could take one look at those and throw my case right out. It also does not help whatsoever that I did go to three rheumatologists last year who said neither Sjogren's syndrome nor fibromyalgia are ever disabling.

I just hope that a judge will give more weight to the opinions of my excellent rheumatologists in Denver and the Mayo Clinic as it is highly unlikely that all three of them could be wrong. Also, Social Security found me disabled, and their criteria is extremely strict. And if a judge would allow discovery on those bogus "independent medical exams", it would become obvious that the insurance company was engaging in fraudulent termination of benefits.

The best case scenario would of course be that the insurance company decides it's not gonna be worth their time to fight me in court and just settle to get me out of their hair. They may do that anyway when they see my lawyer's name on the suit. They have lost many times to this man in the 27 years he's been practicing law.

For now, though, I'm trying to not get my hopes up too much because I need to focus on how I'm going to survive financially without those benefits, either temporarily or permanently. It has been pretty rough going since October, and if I start counting on a settlement or reinstatement of benefits, I will not be prepared emotionally or financially to cope should things not work out in my favor. Even if I do get a settlement eventually, I'm going to have to make that last me until retirement age, which is still 23 years away, so I'm never going to be a rich woman.

But I am pleased the situation is no longer as dire as it once was. And even if it doesn't work out for me, the Supreme Court ruling will probably result in justice for lots of disabled people who would otherwise be out of luck.

Wish it wasn't such a waiting game, though.