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Lessons from ME/CFS: Finding Meaning in the Suffering
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First meeting with LTD disability lawyer

Discussion in 'Finances, Work, and Disability' started by Nielk, Nov 1, 2010.

  1. urbantravels

    urbantravels disjecta membra

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    I don't believe the health care legislation has anything at all to say about employer-provided and private *disability* (i.e. income replacement) insurance. The language quoted above has to do with appeals of coverage decisions for health care.
  2. Nielk

    Nielk

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    Hi marcmc2001,

    I read the link you kindly provided and saw the clause for group coverage external appeals, but
    are you sure that this applies to disability too? It seems to apply to health coverage.

    Thanks,
    Nielk
  3. markmc20001

    markmc20001 Guest

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    private disablity is different than ERISA. Private doesn;t have the ERISA premption.

    "GROUP PLAN", is usually code for "protected by ERISA". The law applies to group plans.

    I did go around and do some reasearch awhile back and my impression was that the health care bill changed the way the process will be handled and it applies to disability and ERISA.

    Please check it out for yourself.
  4. Nielk

    Nielk

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    My disability lawyer called me and said that he is negotiating a settlement for me with the insurance company.
    But the amount he is talking about is minimal. It's about 15% of what they would have paid out over ten years till I reach
    the age of 65 when they are not responsible to pay me anymore.

    In addition, he wants to take 50% of the amount recovered. He said that I should just settle it because if we actually go to court, we would lose because the Erisa laws are stacked against us.

    This has been such a dark cloud over me for the past a5 months of fighting. this was the only lawyer that I found who was even willing to represent me.

    In a way I just want to get it over with and settle out and forget about it. At the other hand I feel that it is a defeatist attitude.

    If I can't win in front of a judge I'm pretty much need to just accept the crumbs they are throwing at me. I just feel
    that the whole situation is so unfair. I would want the claim administrator of my insurance company to come to my house and spend a week with me and see what he would say then or better yet, I would want to volunteer to donate blood to one his relatives. What would he say then?

    I'm sure he is getting a nice bonus for making another claim disappear. Does he go home to his wife and boast about how many legitimate claims he has been successful in grabbing away from ill people?
  5. helen41

    helen41 Senior Member

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    Sleepy Hollow Canada
    There is a cost to that too.
    I'm so sorry this is happening. I know you were really excited when you met the lawyer. This sucks.
  6. Nielk

    Nielk

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    Thank you for your empathy. It's good to hear from people who care!

    Nielk:hug:
  7. markmc20001

    markmc20001 Guest

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    Hi Neilk,

    Sorry to hear the your lawyer feels you don't have a good case. I think that is true that it is hard to win the cases. However, it also depends on the judge. Some judges are so tuned in to the trickery you could have a good chance with the correct judge I've been told. However, I think only the hardcore lawyers (the ones that want $8000 up front and $15000 in tests) will be confident enough to take it all the way through to the end.

    As far as the insurance company rep coming and staying with you for a week. Wouldn't that be great fun! I'm sure I could bore the crap out of them real good.

    Unfortunately it is an impossible battle to beat the insurers. I hope you don't let it get to you and can find some good in it and move on. Maybe just be happy it is over with and realize you are not alone. Plenty of support here.

    Take care.

    Mark
  8. Crappy

    Crappy Senior Member

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    Neilk,

    Yea, unfair doesn't begin to describe it does it? The words f&%#ed up don't describe it either. I fact I'm at a loss of words for a way to verbally describe it, sh^t!!! I will never get how people justify treating others, the way we're treated.

    Boing ^*&%, #$% *$%^&#!!!! (think I blew a gasket)
  9. Nielk

    Nielk

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    I feel better now. You got it out of my system.
    I'm just going to accept it and try to move on.

    Thanks,

    Nielk
  10. Nielk

    Nielk

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    Thanks for your wise words and empathy!
    the problem with the judges is that you really don't know who you are going to get and once you are there, you are stuck.

    Looking back now, I realize that my mistake was not to hire a lawyer right away when I got my denial letter.
    I thought that I had such a strong case with an expert doctor in the field supporting me that I could just handle the appeal myself. How naive I was. Reality has nothing to do in this venue, you have to know how to play the game and apparently
    I didn't. No matter what I wrote to them or my own doctor, they refuted it by PAYING for "independent examiners" who are just looking at the paperwork and slanting and lying about your case. when I say lying, I am not exaggerating. They lied about my bloodwork results when it was in my file in black ink.
    I won't bore you with all the details. I'll just give you one example. The "independent examiner" stated that my c-Reactive Protein Test always came back normal. Lie - lie - lie. My C-Reactive Protein Test ALWAYS came back elevated, sometimes in the critical area. (This shows that there is inflammation in the body somewhere) There is nothing that I can do about it because apparently they can lie and cheat and thereby win their cases and n one does anything about it. Erisa law protects them. They can not be touched.

    Okay, I need to take a big breath and relax. I can't change the system. Maybe if enough people would complain to their government representative about this bias law, other people in the future will not have to go through this ridiculous experience.

    Thanks Mark
  11. markmc20001

    markmc20001 Guest

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    I here ya, and a good rant is definitely called for on this one!

    Good luck.

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