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Lost LTD Insurance appeal

Discussion in 'Finances, Work, and Disability' started by Nielk, Apr 7, 2010.

  1. Nielk

    Nielk

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    It is so unfair that even when and if we finally win it's at such a high cost, whereas the insurance companies
    have nothing to lose.
  2. markmc20001

    markmc20001 Guest

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    Hey folks, I'm going thru the same thing.

    I think the insurance companies have as much oversight as the Banksters or Oil companys. So If they can screw up the whole gulf of mexico, or tank the world housing market, and get away with it, you think a few people with something with a harmless name like "CFS" makes a difference??? NOT!! 8)

    Here is my take on attys. Their are two general types of disability attys. the ones that go to bat for you and try and turn your benefits back on during the appeal process, and then ones that want to settel your case. The ones that want to get beenfits reinstated typically want to do a bunch of testing and have you pay a large retainer or hourly rate. They want to charge you a bunch of money, becuase they like making $300 or more an hour for their time. Probably some congiency guys are good, but be careful. Then you have the settlemant attys breed; Who will take your case on contignecy. However, they are aware the insurance company wants to settle and may not build a good case so they can force a settlement. Thet atty does a littel work and gets a big fat pay check for a few hours work, the insuracne gets you off it;s payroll, and the disabled gets screwed. The world we live in now unfortunately.

    Please write your state insurance depeartment and tell them how you r disability companhy lies, intentionally looses information, distorts what your docotrs say, withholds recorded phone calls, and trys to trap you, surveils you more than they claim they did, and so on. We will continue to get railroaded if we don;t speak up.

    good luck
  3. awol

    awol *****

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    If it makes you all feel better, at least you live somewhere where insurance is even possible for ME/CFS even if hard to obtain. Here no such thing. Nothing to appeal. Can't even apply in the first place.
  4. Nielk

    Nielk

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    Queens, NY
    I sent my file to a known disability lawyer who deals with cfs cases.
    After reviewing my file he said that he can't take the case because it's a hard case to prove.
    I lack documentation of functionality problems. Eventhough, he believes that I am very sick, it's too hard to prove.
    I tried to contavt other lawyers and so far have not been successfull.
    Even before seeing my file, thet reject me becuase the amount I collect is too small for them.
    The fact that I recieve payments from Social Security works against me here because that amount gets deducted from my LTD benefits.
    Lawyers have no incentive to take my case.
    I bet my insurance company took that into account when they stopped my benefits.
    They knew i would be stuck and they would win.

    This whole process is making me so upset, that I feel worse and worse every day.
    I bet my caseworker at my insurance company got a raise or bonus for declining another claim successfully!
  5. markmc20001

    markmc20001 Guest

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    I hear ya

    I get your point awol, sounds kinda funny whining about having some really nice benefit that most people could never dream of.

    Here is my point. I just hate that the way governments and coorporations do things is all a big LIE. the governement turns their heads and allows these coorporations to get away with breaking the laws. The BP oil spills, bankster robberies, LTD insurnace scams..
  6. markmc20001

    markmc20001 Guest

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    No doubt the insurance comapnes use your small pay check against you. even if you do win, you still have to split your benefits with an atty, and if you loose, I guarantee you are one out of 10 maybe that made it the distance. Stilll a win-win for insurance, no matter what. The insurance companioes have teams of laywers, doctors, case managers that sit down every week and figure out how to screw us.
  7. Nielk

    Nielk

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    So what do we do about this?

    Anyone have any advice to fight this injustice???????????????:confused::confused:
  8. Otis

    Otis SeƱor Mumbler

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    That's a point well taken. Sadly this safety net for the large majority with ME is a concrete floor, just a false sense of security.
  9. acer2000

    acer2000 Senior Member

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    I am so sorry you lost your appeal. I went through this process and it took 2 years. When I first applied, I basically had a bunch of labs and letters from my doctors claiming I was unable to do my job. I was rejected because I lacked "objective evidence" that I couldn't do my job. (plus i think they reject everyone at first because its good business for them to delay paying claims). So I hired a lawyer and he made me go get all these tests to prove my physical and mental impairment that really aren't all that helpful to figuring out treatment. I had to do a SPECT scan (it was abnormal), an exercise test with v02 max and Anaerobic Threshold, and a formal neuropsych test that took almost 8 hours. I also sent a letter from my CFS specialist. After that, it took another year of them delaying and making excuses and ultimately I had to threaten to sue them in federal court and they backed down and approved me.

    They actually claimed at one point that the laptop with my case on it was stolen, the data wasn't backed up, and such I had to re-submit my data for review - this bought them another 6 months to "review" aka "not pay". They never produced a police report about the laptop, so I think they just did this to buy time.

    There is no way I could do this without a lawyer who has taken CFS cases before. It cost me almost a year of benefits to fight them, but in the end it was worth it because who knows how long I will need it for or if I will ever be well enough to work.

    I also used a lawyer to get SSDI, and although it took almost as long it was a much easier task because I basically re-used the evidence from my ERISA case for SSDI. But honestly, the main thing I get out of it is medicare (which is no small feat) , the SSDI income goes right back to the LTD company. How they get away with this I have no idea, they are basically scamming the SS system to offset their exposure to your claim. I suspect that at some point someone will challenge this loophole in court, but until then that is the way it is. I certainly don't have the money or energy to do so.
  10. acer2000

    acer2000 Senior Member

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    Also, for anyone else looking into this:

    A) My lawyer actually said there is precedent that makes it harder for them to deny you LTD if you are approved for SSDI. And actually, they technically have to pay you less if you have SSDI because they are entitled to your SSDI income. Its a better situation for them - most LTD providers force you to apply for SSDI even if you don't want to or are not likely to get it. So if you already have it...

    B) Never settle the case if you can avoid it. You don't know how long you will be disabled, and while $100,000 or even a million dollars might sound OK right now, you don't know how long you will be disable for and their monthly benefits over your lifetime could easily eclipse that - especially if you get sick when you are young.

    C) Never accept disability for "mental illness" for CFS. There is a limit of 2 year for most policies for mental illness after which they can stop paying you, even if you are still sick.

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