Invest in ME Conference 12: First Class in Every Way
OverTheHills wraps up our series of articles on this year's 12th Invest in ME International Conference (IIMEC12) in London with some reflections on her experience as a patient attending the conference for the first time.
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ERISA -- how many appeals have you done?

Discussion in 'Finances, Work, and Disability' started by Silencio, Jun 30, 2017.

  1. Silencio

    Silencio Senior Member

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    i just won my third appeal in 3 years for my LTD benefits with Cigna. The first year, I appealed, won and was immediately cut off again. Second year, I appealed again, won, and got a year reprieve before being cut off again. This last appeal, I think I've finally figured out that I must be more proactive next year with getting cognitive tests, eeg reports etc, in advance before being cut off, since they never look at the whole case history and context of my illness, and just doctors letters and consistent appointments isn't enough. I basically have to prove it as if they've never heard of me and have nothing on file for me each time.

    I'm curious about what it's going to be like going forward, will I end up appealing every year or two? Is there anyone here on ERISA plans for longer than 3 years who has experience fighting with them for the long haul? Do they eventually make a settlement offer, and if so after how many years? Is there anyone who's been cut off and then lost in court, and got nothing more? I have 25 years left on my policy.. the thought of going through this every year or two is nauseating..
     
    Last edited: Jun 30, 2017
  2. ScottTriGuy

    ScottTriGuy Stop the harm. Start the research and treatment.

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    Toronto, Canada
    Just a thought, but I'd guess you're not the only with this experience with that company - perhaps there is already a class action lawsuit against them, or lawyers with experience fighting Cigna.
     
    Dechi likes this.
  3. Silencio

    Silencio Senior Member

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    Yeah, I do have a very good lawyer that a number of ME patients use. They are well versed in our disease. And I feel very lucky that I have won anything at all.. 2 other patients I know are going as far as court, and are in the same stage as I (first 3 years).

    Generally, bad behavior and unfair practices is their business model, but they are largely protected by the ERISA law. A year or two ago, there was an effort to reform ERISA, but I never heard the result. There was some sort of class action in 2013 also but it doesn't seem to have altered their behavior for the better. I'm mostly curious to hear from people who have been receiving LTD for 5, 10 years.. I don't know any patients at that stage.
     
    ScottTriGuy likes this.

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