LTD forms submitted

[roxie60]

It has taken me over a month to comply with filling out all the forms and a statement of daily activities. I called last Friday to let them know I was working on it but taking much longer than I had hoped. I really struggled with the dya ot day activities narrative. No matter how much time I spent onit I felt I wa rammbling and could never quite get my thoughts right. I have no idea if I met their requrieiments. I aksed a couple f amily members to review and they always found I had repeated my self, typing and grammr errors. Written and verbal communication use to be one of my strngths. Now I feel like a babling idiot. I have everything in an envelop and just got an email from relative that I wrote too much and still have many errors. Oh well, already i the envelope. I have been working on this for thre weks when I could. I am tired of looking at it. No idea what will happen. See neurologist tomorrow and he wants to do nurapathy test but I am more concerned now about my memory and cognitive abilities. Anyone else find they have trouble doing the 'paperwork' associated with getting benefits? keeping everything straight, being timely, being confident in conveying points?/?

 

[*GG*]

Are you working with a lawyer on this? (Would seem to be a good idea, but I am not certain).

GG

 

[Kati]

Best of luck, Roxie, amd in my case, any mental exertion especially when performed vertically makes me worse. the fact that it took you a month to fill them out speaks volumes and should be mentioned/recorded/shared with the disability people.

do make sure you keep a journal of symptoms/activities, expect to be surveiled if you step out of your home, and make sure you have a supportive physician who documents each amd every visit with you accurately.

 

[roxie60]

Thanks everyone. A lawyer only gets involved if the LTD is denied. I'm learning so much. I struggle with journalling. Like today, I was able to work on the LTD and go to pay a couple of bills. Took a shower. Then by 330PM had to lay down for a couple of hours due to fatigue. I struggle with this because I can have hours or a day when I can do more tasks but I am never free of symptoms, I'm alone so I have to push myself. I get sick of focusing on all my 'issues' and I know journaling would be a good think but it is one more thing todo I have to do and still do so many other things. I'm not optimisitic cause I just try to do what I can each day. I have become numb, lost the determined individual I use to be. That is why I am graetful to PR people, when I dont feel like I can do one more thing you guys give me a nudge, encourage me to keep trying. I judge myself cause I think I dont have cancer(gratefully, I'm not a broken or injured soldier, so why do I think I deserve disability benefits. I just struggle with the unpredictability of these conditions. I am graetful the IBS, diarhea and joints on fire have abated with the change in diet (food sensitivities). I think after so many years of dealing with so much physically, mentally and emotionally I am just beat up, feel like walking dead. I did see a small part of Dr Oz today before I fell asleep. Something about dopamine (mine is very low) and tyrozine and that it takes over a month of treatment to see improvement. I need to try and be more consistent. When I dont feel well I get real inconsistent.

 

[Jarod]

Hi there,

The Linda Nee Blog can be helpful.

There is also a disability insurance forum that is occupied by a bunch of insurance reps, so I would not recommend taking their advice seriously.

Likely you will get denied and be forced in to appealing. Then you will need a good ERISA attourney. Some of these attorneys are real sharks looking to cash in on your policy. It's important to find one that will go all the way to court if necessary.

Their strategy is to get you in arbitration and give you pennies instead of battling them in court.

You will need supportive doctors and good evidence to get and maintain benefits.

It's a total uphill battle, They don't care if you are disabled, only if they can cut you off.

If you get approved, only deal with them in writing and ask your doctor if he minds doing the same.

It's a double edged sword. You need to money, but the process will make you more ill and stressed. I would suggest to try and not them rule your life.

Good luck.

 

[caledonia]

Yes, the whole disability thing is a big ball of cr*p. I learned so much I never knew about LTD and SSDI. The main thing is, if you get denied (high probability), never give up, get a lawyer, and keep appealing until you win. At one point, I had two lawyers, one for LTD and one for SSDI.

If you haven't already applied for SSDI/SSI, you should do that now. You can use the same medical evidence over again. Start a special folder for all papers associated with your claim. This will help keep you organized over the long term. Make copies of everything you send in and put them in your folder. I'm still pulling out my old copies of how my symptoms prevent me from working from years back, whenever I come up for a review - big time saver and stress reliever.

For SSDI/SSI, you can also use a service such as Allsup, which aren't lawyers, but are well versed in how SS works. They can help you prepare your initial claim. Some lawyers are also starting to do this, due to competition from Allsup.

 

[Jarod]

Sorry if my posts sound dry on this topic, but it is not fun.

One point I didn't explain well, but is important to understand.

The insurance company does not care what you say or write down in those applications. As strange as it sounds....

What they care about is what your doctors say in your notes or the symptoms they observe.

If you have multiple doctors, it matters if they agree.

What objective tests and evidence you have is also very important. Hard to come up with objective evidence, but they will want it if possible.

Good luck!

 

[Ema]

Their strategy is to get you in arbitration and give you pennies instead of battling them in court.

THIS! I had no idea it worked this way until I went (naively) through it (and lost).

Of course the lawyers want you to settle for a lump sum payment as well because their percentage is based on this. It does them no good for you to receive a monthly check. They want the "big" payoff to pay their fees.

My lawyer tried to get me to accept an offer that would have essentially paid me nothing after taxes and their fees were deducted. I said no and made them take it to court where the judge ruled that my board-certified doctors were quacks and didn't treat my conditions with the "standard of care". What? Last time i checked there was no "standard of care" for ME/CFS...it still boils my blood.

Still, my advice would be to get a lawyer as soon as possible because they know what types of evidence and testing you need in your file to be successful. It's the lesser of two evils.

Ema

 

[roxie60]

Thanks everyone. I am also learning alot and seeking disability is a crappy experience on top of what we are already dealing with. I'm trying not to let the process get to me since I am just starting it all but it is no fun. No one would go through all these tests, poked, prodded, spend money and time and fill out paperwork constantly. Worrying if they are going to take a word out of context or take you having a good day as how you always are... I got the IME results back, it had errors which I am seeing quite a bit. All I can say after going through this experience is it seems almost irresponsible for ones company to take the opinion of a Dr who has not seen me repeatedly over time to draw medical conclusions. Apparently I do not have the following: CFS, FM, RLS, cognitive problems, no muscle strength or range of motion problems (should have seen me the next 24 hrs after all his manipulation that I did so well on), I was unable to recite symptoms for CFS or migraines. He said none of my tests, labs or imaging supported diagnoses for fatigue, depression, RLS, fibro, hyperthyroidism (never said I had this), depression, joint pain/medial lateral epicondolytus , sacroilitis, dysmetabolic syndrome(?), no cognitive issues. But said I did have sleep apnea (but noted he did not have any tests to support this either), said I appeared very anxious (but also stated he was not qualified to give this diagnosis - maybe it had more to do with getting lost, almost being late as a result, being in unfamiliar town and seeing unfamiliar Dr, the person drving my car run over a glass bottle, ya think those might contribute to anxiety, not to mention this is an IME which is notorious for negative findings), conductive hearing loss unilaterally (how did he determine this?), positive empty can test (no idea what this is), all the described symptoms and complaints w/o medical exams and tests are quite undifferentiated sonataform disorder (had to look this up, looks like he is saying most of my complaints are phsychological (is he qualified to make this statement?). So basically most of it is in my head...... gee I can sleep better knowing tomorrow I will jump out of bed healed from years of symptoms. I should have seen him 7 years ago and could have avoided all the problems. I need to rest.

 

[roxie60]

Thx camas for the Mast Cell pdf's.

The Dr in my recent IME has decided the majority of my 'complaints' are due to somatoform syndrome so he has concluded based on a 30 minute eval that I all my issues are in my head and that I dont need a Dr I need a psychiatrist. The more I think about his recap the angrier I get. Has anyone written a rebuttal to an IME evaluation they received?

 

[Jarod]

Not surprising, the insurance company obviously gives this Doctor alot of business for his "independent medical evaluations"

Look at your policy. Likely there is a two year limit on psychiatrict diagnosis. Sounds like you might be catching a bad case of the psychiatric plague with the way this IME went.

That Linda nee does consulting. I would suggest paying her for an hour or so to figure out your best strategy. She used to work at one of those major insurance companies and knows how to navigate it.

The only way you are going to win this is spend some money.

 

[Kati]

Also consider going for exercise testing in California.

 

[Ecoclimber]

There should be no illusions – most disability insurance claims are hotly-contested adversarial proceedings from the moment a claim is filed. The best time to hire a lawyer is before filing a disability insurance claim. This helps avoid needless mistakes in dealing with a carrier, mistakes which can be fatal to a claim, and have tragic consequences for your future.

Disability insurance companies will usually require you go to through their 'hired' guns - so-called Independent Medical Examination (IME), bought and paid for by the insurance carrier. Is there a conflict of interest which is prejudicial to the insured? You betcha, otherwise the doctor is stricken from their referral list. The question is whether you are required to go to their doctor, a matter that can disputed.

The medical evidence necessary to establish such disability claim for a private insurance policy or under ERISA, is far more stringent than required for proving a physical disability. ME/CFS is not always easy to diagnose, and can be even harder to prove.

So-called “objective evidence” requirements give insurance company claims processors and administrators huge discretion and latitude in denying claims. Many claimants are forced to cope with arbitrary and capricious denials just when they are least able, emotionally and medically, to cope with adversity. They are experts in denying claims.

Some useful sites on disability insurance cases
http://www.lawyersandsettlements.co.../unum-life-insurance-provident-long-term.html

http://caselaw.findlaw.com/us-9th-circuit/1128258.html

http://openjurist.org/482/f3d/254/weiss-v-first-unum-life-insurance-company

http://www.leagle.com/xmlResult.asp...1652.xml&docbase=CsLwAr3-2007-Curr&SizeDisp=7

http://www.advocacyforpatients.org/

Eco

 

[caledonia]

Yes, it sounds like they're going for the 2 year mental health exclusion. You can hire doctors to do an Independant Medical Exam too, to refute their exam. Also a neuropsych exam to show brain fog, but that you don't have a somatoform disorder. I was also seeing a psychologist who wrote a letter for me that said that my illness was physical and and any psychological problems were secondary.

If you do your own exams, then you won't have to go to their doctors for exams. I did this. Same thing for SS. But they can be expensive. Luckily, I still had insurance at that time which paid for most of it.

I would start talking to lawyers. Interview three if possible, and go with your gut as to who to pick. The lawyer should have a good idea of where to get your own impartial exams, or if that's even necessary.

I did extra super human efforts with medical evidence, and still got denied by the LTD, appealed citing illegal things they did, went to court, won my case, they appealed, then right before it was going back to court again, we settled. I think this is pretty typical.

On the other hand, SS was almost piece of cake by comparison. The evidence my judge liked the best was a record of continuing disability - which we did by me seeing my doctor every three months and him filling out a nifty little form from my lawyer, that I was still disabled. We had two years of these records by the time I saw the judge.

 

[roxie60]

Thx everyone. I'm starting to understand this is the process and try not to take it so personally, this is just such an awful experience, not being believed, worrying about my financial future (I never thought I would be in this kind of situation). I have researched the legal process, thanks to everyone's input. If they try the mental health 2 yr restriction then I guess that would get me to my retirement (I think once I hit retirement they would want to move me to that since it is less expensive; smaller than I was planning on but the way things have been going health wise if I can get my minimum retirement and healthcare I will feel blessed - 19 more months). I just need to be patient and the days I feel like not fighting just dig down deep and try not to give up.

What I struggle most with is the wax and wan of 'this condition'. This good days bad days stuff has me fearful, since I can't predict what days I will be more functional I am afraid of making mistakes and no longer having a chance at being successful at my job like I have been for nearly 20 yrs (never symp free but now realize I have been dealing with various symps for years but pushed through except for what I'll call flare ups when I am mostly house bound and at times mostly bed bound). Yesterday was a good day, had not had a 'good' day in a long while (weeks). Good day means the symptoms are not impairing me as much and I can push through doing some tasks, although yesterday I did mostly admin type tasks (paperwork, bills, phone calls on LTD, etc.). I felt more social (when I do not feel well it really impacts my desire to be around people, I think it is because engaging with people takes so much energy and now my social confidence has been damaged, when symptoms are high I have been put down cause I didn't find the right word to say, I've been excluded. One time at work, the guys usually take breaks and walk to the cafeteria. For years I would go with them but the past few years I only did if enough energy and not working on a task. This one time I saw them pass for their break but I was finishing a task. I finished faster than I thought so I caught up to them then one of the guys that has been surly and mean towards me over the years said "we didn't invite you go back to your desk". I asked the other guys if they had an issue with me walking with them and all said of course not, I was planning to continue anyway but wanted him to hear how normal people behave. So many examples over the years have just broke me down, when your body is not well you just cant stand up for yourself like when you are well, then I think I started feeling fearful of trying to stand up for myself even on better days for fear I would not be able to respond fast enough (I use to be a good communicator, written and verbal).

See I'm rambling again ;-)

 

[Ecoclimber]

Depression, Bipolar, Post Traumatic Stress Disorder (PTSD) and General Anxiety Disorders, ME/CFS Do Not Show Up On X-Rays or MRIs But They Are Serious Disabilities

Mental and nervous disorders, including depression and addiction, are similar to other disability insurance claims in their effect on a person’s ability to work. But, the medical evidence necessary to establish such a psychiatric disability claim for a private insurance policy or under ERISA, is far more stringent than required for proving a physical disability. Mental illness is not always easy to diagnose, and can be even harder to prove

The nature of medical reports which should be furnished with the original claim documents. Lack of precision in these reports can make or break a claim. Personal information, especially concerning psychiatric or emotional disability, should not be given to an insurer unless it is absolutely essential and even then with very limited restrictions. Full, complete and relevant medical information must be provided right from the start of the claim, but the insurance company should get nothing it is not entitled to.

Insurance companies are likely to deny psychiatric claims for three main reasons:

1. Insurance companies love to deny claims and keep the money they would otherwise have to pay out.
2. People under mental pressure are usually easier to push around and insurance companies love to bully disability insurance claimants.
3. The “wimp” factor which applies to all disability claimants, but especially to those with mental illness.

You need an advocate on your side to understand the nature of these illnesses and effectively interacts with a treating psychiatrist or psychologist, to help prepare a claim competently and effectively. He also knows how to evaluate a so-called Independent Medical Examination (IME), bought and paid for by the insurance carrier, and can size up the validity of personality test results such as the MMPI.

There should be no illusions – most disability insurance claims are hotly-contested adversarial proceedings from the moment a claim is filed. The best time to hire a lawyer is before filing a disability insurance claim. This helps avoid needless mistakes in dealing with a carrier, mistakes which can be fatal to a claim, and have tragic consequences for a claimant and a family’s future. No where is this more obvious than in the area of mental/nervous disabilities.

So-called “objective evidence” requirements give insurance company claims processors and administrators huge discretion and latitude in denying claims, especially in psychiatric cases. A competent, aggressive legal advisor is a must to stand between the you and the carrier. Such an advocate knows how to cut through the endless paper chase and the many nonsensical insurer reasons for delay or denial of benefits. Remember this will effect you the rest of of your life!


Eco
.

 

[roxie60]

My lawyer has been on vacation for two weeks, he wont be back until 5/26?