Severe ME Day of Understanding and Remembrance: Aug. 8, 2017
Determined to paper the Internet with articles about ME, Jody Smith brings some additional focus to Severe Myalgic Encephalomyelitis Day of Understanding and Remembrance on Aug. 8, 2017 ...
Discuss the article on the Forums.

Insurance and proving capability

Discussion in 'General ME/CFS Discussion' started by Gary1001, Oct 23, 2015.

  1. Gary1001

    Gary1001

    Messages:
    92
    Likes:
    16
    NZ
    Hi All,

    I’m looking for advice from those in a similar situation. This is a tricky topic and every situation is different with its own set of challenges however, there maybe some aspects that members have learnt by experience.

    Simply put, I am entitled to what is called income protection insurance. You take it out in conjunction with something like a mortgage in case you become ill, cannot work and so you don't default.

    I have a clear medical history of becoming profoundly ill and disabled. In conjunction with CFS, I had aggressive weight loss, heart infection, developed a functional gait (muscular problem) and other issues.

    I submitted for income protection insurance which was held up due to reevaluating the diagnosis due to atypical features. Nothing has been identified to change the diagnosis and now the claim is progressing.

    However, I am now having issues with proving that I am not functionally capable of work. Over the last year, I have regained weight, the infections are under control and generally “look normal”.

    My GP is not an expert in this disease and while she takes my word, it is difficult for me to provide a strong medical case that I am still functionally disabled.

    I imagine “proving” what one is capable of is a common issue with CFS.

    The question is, for those that have been through an insurance claim due to this illness, what is the best way to collect evidence to support my situation. How do I prove what I can and cannot do to a third party? Outside of my GP, what type of specialist could I speak to help my claim?

    Any thoughts are kindly welcome.

    Gary
     
  2. minkeygirl

    minkeygirl But I Look So Good.

    Messages:
    4,678
    Likes:
    4,647
    Left Coast
    I'm in the US so I can't comment for you but one thing I've learned over years of dealing with disability is never talk about what you can do. It's all about what you can't do. I can't sit for more than five minutes. I can't stand for more than s minute. I can't drive, I can't lift x amount of weight. I can't bend over.

    One woman here was denied disability because she said she could walk up a flight of stairs to do laundry.

    Also here it is important to say you can't do your usual and customary job.

    There is a recent thread here about docs in New Zealand. You probably should have someone who gets it to buttress your claim.

    Also find an attorney if you have one there who understands your situation. Maybe get a free consult.

    Although she's in the is US look for Linda Nee. She gives info on dealing with places that want to deny benefits. It'll get you on the mindset.

    Good luck
     
    Valentijn and alex3619 like this.
  3. *GG*

    *GG* Senior Member

    Messages:
    6,142
    Likes:
    4,735
    Concord, NH
    The CPET (2 day in a row exercise) test might be good, but not sure of that in New Zealand?

    GG
     
    Valentijn likes this.
  4. alex3619

    alex3619 Senior Member

    Messages:
    12,489
    Likes:
    35,091
    Logan, Queensland, Australia
    There are three tests you can do, at some cost, which might help. The first is a Tilt Table Test. Not only can it show problems, they might be treatable. Do you get dizzy, or faint or light headed?

    The second, for those with major cognitive issues, might be a quantitative EEG. It is unclear how useful this is though ... we have not heard enough about them, aside from occasional anecdotal evidence and one study that I think is unpublished from Stanford.

    The third is a repeat CPET test, twenty four hours apart. This is not always a good idea, some have reacted badly to it That is part of the point, they induce a relapse then measure it. Sometimes those relapses last a long long time. It will also be difficult to arrange, few will know how to interpret it, and it will cost a lot. However a clear benefit of this test, if done right, is often definitive evidence of major disability.

    This presumes you have CFS or ME and not a misdiagnosis. However if you can find a better diagnosis it might be more treatable. Being negative on all three of the above might mean you have been misdiagnosed.

    Another test you might try is a sleep study. What is your sleep quality? Do you wake up gasping for breath?

    Finally, something that those in the US have found useful if it goes to court, is to start a diary/journal. Write down what you cannot do, how you feel, what your issues are. Be as factual as possible. Keep that going until at least all potential legal issues are resolved. If you are able to do anything major, which for me is walking a whole block, write that down too, and note how rare it is.
     
  5. *GG*

    *GG* Senior Member

    Messages:
    6,142
    Likes:
    4,735
    Concord, NH
    Oh, this reminds me. Perhaps a NeuroPsychiatric test? To show your slow cognition?

    GG
     
  6. Groggy Doggy

    Groggy Doggy Senior Member

    Messages:
    1,127
    Likes:
    4,132
    Minkeygirl,

    I was denied disability, per my rejection letter, because I could talk and move my arms. IF that was the actual criterion applied to people already collecting disability, then they would have to stop payments to millions of citizens. But of course, it appears to be the criterion (or similar criterion) just for new applicants. The people I've known for many years, that are collecting disability, are able to work part time and lead almost a normal life. They go thru the normal 3 year review cycle, show their paystubs proving they are healthy enough to work, and are still able to continue to collect disability. Its not a fair system at all.
     
  7. Gingergrrl

    Gingergrrl Senior Member

    Messages:
    9,407
    Likes:
    24,307
    USA
    Thank you and this is incredibly helpful as I have my exam tomorrow. I was planning to do this anyway and it is the truth that I cannot walk more than about one minute or a few feet without a wheelchair but the way you phrased it is very helpful.

    @Groggy Doggy Wow! Did you appeal with an attorney?
     
    Valentijn likes this.
  8. alex3619

    alex3619 Senior Member

    Messages:
    12,489
    Likes:
    35,091
    Logan, Queensland, Australia
    I tried to get one here, but not only was it hard to find, the experts being rare, its very expensive.
     
  9. ukxmrv

    ukxmrv Senior Member

    Messages:
    4,326
    Likes:
    4,394
    London
    Hi Gary,

    I have faced a roughly similar situation in the UK. It can become an adversarial contest in the end between 2 sets of medical experts. Yours and theirs.

    Can I suggest a few ideas that may help

    1. Find out the track record for your insurer. It may be an international company that has a policy for dealing with CFS. Some such as UNUM are infamous. Their policy may be available online and reports of how they treat patients with CFS.

    2. Find an expert who has experience with writing reports for insurance companies. Then you have a potential big gun on your side. I'm thinking of someone like Ros Vallings in Auckland or Prof Murdoch in Dunedin(?). If you are not able to help they may be able to suggest someone who can.

    In some cases I know if the insurance company has accepted the report from the expert.

    They may however ask you to be examined by their "expert". If that happens you meed to find out who that is and what their reputation is. They may be obstructive and demand that you undergo some sort of program before they will pay up. This is where it gets adversarial and you will need to decide if you will do this or apply to a third party to make a ruling. I'm not sure if you have a body that oversees insurance cases in NZ but that is for the future.
     
  10. minkeygirl

    minkeygirl But I Look So Good.

    Messages:
    4,678
    Likes:
    4,647
    Left Coast
    @Groggy Doggy Please put an @ sign in front of someones name so they will get an alert.

    I never said it was fair. They are in the business to deny claims so they make money. What you have to do is learn how to work the system.

    I have been on private LTD for 20 years and not once have I signed their release to have access to my financial records. I have a pat statement I send to them every year saying I'm happy to give them access to my medical stuff but they cannot see my financial is it is invasive, irrrelevant and they could not get it without a subpoena. I have never been sent to one of their docs or videotaped that I know of. The big thing is I refuse to talk to them on the phone. If they call me, I let my machine pick it up and then I fax them and say I'd be more than happy to answer questions, please submit them to me in writing.

    Linda Nee's blog saved me.

    I age out next year so I won't be under their thumb anymore.
     
    Valentijn likes this.
  11. Groggy Doggy

    Groggy Doggy Senior Member

    Messages:
    1,127
    Likes:
    4,132
    @Gingergrrl

    Yes, I had my attorney appeal the second denial letter. Was sharing to show how denials are the norm now (first and second tries). Met a woman in the doctors waiting room, earlier this year, who lost her first court hearing and was waiting at least a year to get an appeal hearing date. She looked very ill and did a poor job articulating her thoughts. She and her husband said she had many years worth of medical records clearly documenting her disability.

    I hope everyone in the US that is sick gets a absentee ballot and votes for politicians they feel care about disabled people. That's the only way things will change. I continue to ask my friends, family, and anyone that will listen to vote that way.
     
    Valentijn, ukxmrv and Gingergrrl like this.
  12. Gingergrrl

    Gingergrrl Senior Member

    Messages:
    9,407
    Likes:
    24,307
    USA
    @Groggy Doggy Thanks for your reply and am glad you won after the second appeal (or at least I think you did if I am reading it right?!) My atty said to prepare to be denied twice and win on the 3rd go-round when we go to court so I guess it is the norm now. Hoping that woman you encountered at doctor's office finally won her appeal. Am prepared for a very long process!

    PS: I love your avatar photo!
     

See more popular forum discussions.

Share This Page