First meeting with LTD disability lawyer

[Nielk]

Tomorrow I am meeting with the first laywer willing to see me regarding filinf a lawsuit against my LTD carrier.
I was denied by so many before so I don't have high hopes but he is actually interested to sit down with me so I have some hope.
My LTD coverage was abruptly stopped after 5 years.

They denied my appeal and my only option left under Erisa law is to take them to court.

I hope it goes well.

I was actually inspired by J.K. Rowlings: the write of the Harry potter books.
I saw an interview with her where she shares that 12 publishers declined her untill finally the 13th was interested.

Hopefully this lawyer is my charm.

 

[Esther12]

Good luck with it.

 

[Nielk]

Good luck with it.

Thanks.
I'll let you know how it went

 

[Nielk]

I just got back from the attorney and hired him!
It's the first one who is willing to take the case.
I know it's still a long road ahead and things might not go well, but at least there is some action.
I really hope I can win here.
For me, my family and mostly to get back at my insurance carrier who has acted so unfairly.

 

[Esther12]

Sorry to hear it's turned in to a battle for you. Hopefully your lawyer will now be able to do most of the leg work for you.

 

[Nielk]

Thank you.
I feel like a load ha been lifted from my shoulders.
I've been seeking an attorney for the past year.
My Ltd carrier has played so many games with me that it made my (already difficult)life, impossible.

I'll let you know what the results will be.
I think many of us are in similar situation.

My ltd carrier paid my disability for 5 years (they didn't make it easy at all throughout) and then abruptly stopped.
I've appealed on my own their decision and of course lost.
Now my only option is litigation, hence the search for an attorney.

As an aside, Social security, approved me on my first try and is continuing to pay me.

Nielk
I

 

[caledonia]

That's unusual to pay for 5 years, then stop. Usually it's at 2 years when your policy changes from "own occupation" to "any occupation". Unless you happen to have a 5 year clause for that.

My insurance company denied me from the outset. Just letting you know that it could be a long haul. It took me 4 years to get a settlement from them.

But it was worth it. I'm sure they spend more money on me trying to deny my case, than if they had just paid it outright.

Plus it sends a message that we can't be messed around with. In the middle of my case, my insurance company sold off their disability division - I like to think that I had something to do with that

 

[Nielk]

My policy does change after two years from "own occupation" to "any occupation" and I was approved at the time.
They stopped paying me just because they can.
I've heard from others that 5 years is kind of a benchmark for them because that's when they assume this disability is not going away.
With ERISA governed policy (which mine is), they have nothing to lose by dropping you and denying your claim, appeal etc.. because
at the end of the day, even if you win at federal court, all they are liable for is the backpay and the money they should have paid you to begin with.
You can't sue them for any other damages.

 

[helen41]

I hope you are successful, it's such a nasty situation to have to expend what limited energy you have on proving you you have no energy.
I just finished that same journey with my LTD company, although I was refused from the get-go. I was on another thread about the Pacific Fatigue Lab and the testing I had done which made the company change their mind. ggingues posted, saying she had the same testing done in New York. It might be another avenue to explore if you need to prove your limitations.

 

[Nielk]

Thanks for your advice, but it this point in my case I'm unable to add anything to my file.
There are a lot of things I wish I would have known before I embarked on this fight for my LTD rights!
They approved me and paid me for 5 years and out of the blue one day I received a letter from them that
they reviewed my file (which they have done a few times before) and came to the conclusion that I am not disabled at all. (nothing had changed with
my health or prognosis)
Furthermore they (the insurance hired medical experts) decided that I can go back full time at my previously held (7 years ago) job.
It sounded so ludicrous to me that I decided to appeal their decision on my own. (with my doctor's support)

That was a mistake, I learn now since only seasoned lawyers know how to do that.
Of course the insurance company denied my appeal. (with two new insurance hired "experts" who never saw me)

At this point ERISA law dictates that all I can do is bring suit in Federal court. My case will go in front of one judge who will review whatever is in my file currently.
I can't add any information at this point. I can't bring any witnesses nor my doctor to testify for me.

I'm not a fool (I think). I know that these cases are almost impossible to win. I also know the outcome financially will not make my illness better.
Yet, I can't describe how important this is to me. I guess it's a combination of validation of my illness and just fair judgement.

I will keep you posted as to the outcome.

For others who are at an earlier stage of your claim, I strongly advise hiring a lawyer if you can. In addition to a supportive doctor, take as many tests possible to try to prove your disability.

 

[helen41]

Oh my. That actually sounds like abuse. So, so hard to be sick and have to demonstrate it as well. Please do make sure to post your progress

 

[urbantravels]

ERISA is pure evil. I suppose in Canada they don't have anything quite so draconian in place for employer-provided disability policies.

 

[Nielk]

I believe that ERISA is against the constitution!
It takes away our rights to a fair court system that will not be biased against us and that will give us the right to representation.

 

[mojoey]

Nielk,

Take some consolation in the fact that even if you had a waterproof appeal, it's highly likely it would've been denied. Like you said, there is no incentive for them not to deny it. However, I would echo your suggestion to hire help during the appeals process because, as you pointed out, we can't add evidence beyond the appeal. This doesn't necessarily have to be a lawyer, but at least a consultant who has vast experience in these types of cases and advising the client on what types of medical evidence are more important to have and how to properly refute the ridiculous reasons used by the insurance companies and their crony doctors to deny the disability. Although if you could find a good lawyer that works entirely on contingency basis on both appeal and the subsequent lawsuit, I would definitely go with that route.

The last few years have been by far the most promising for patients involved in ERISA cases. There have been a few huge rulings of companies abusing their fiduciary responsibility. Hopefully going forward, the patients with XMRV will be that much harder to deny and the exercise tests will become standard fare. Hopefully there will be some class action lawsuits as well.

Best of luck. It ain't over til it's over!

 

[markmc20001]

ggod luck

One thing to keep in mind.

Read all the insurance claim file for yourself and help your attourney understand how their docotrs twisted what your doctor said on the telephone calls, or what you said on the telephone to them. Point out how they lost notes and letter you mailed, or they didn;t consider them in their determination. Look and see how they surveilled you for may days, but claim they only surveilled you for four days and how you were busy three out of four days. Pojnt out how they exaggerate to your docotrs the actual time you were busy on the days they catch you on film. Point out how your docotr says bending over or using your hands is not out of your ability. Watch how you communicate by computer and on facebook because they will look at all of that and more. Dont let them bully you in to giving them tax returns, and don;t let them force you to contiually sign ever greater permissions to release you rprivate inforamtion. SHould I go on.. then when you call the insurance comissioner don;t be suprised when they are on the insurance companies side.

Be thankful that barack obama put in the new health care law that a seperate panel will be used in the future to review any denaisl under ERISA, and it will not be up to the insurer to decide who they want to cut off without another panel looking over their shoulder.

good luck

 

[Nielk]

Great advice mojoey:

I also agree that XMRV will be a great way to prove our illness to the insurance company.
Unfortunately for me I am still waiting for my results and obviously it doesn't appear in my file.

But in the future for other patients it will be a great tool. I wonder though what will happen with those who do not show positive results?
Will they try to refute the fact that they have MR/CFS? I hope not.

 

[Nielk]

"Be thankful that barack obama put in the new health care law that a seperate panel will be used in the future to review any denaisl under ERISA, and it will not be up to the insurer to decide who they want to cut off without another panel looking over their shoulder."

I didn't hear about this, if it comes to fruition, it will make a major difference for people fighting ERISA disability claims!

 

[mojoey]

"Be thankful that barack obama put in the new health care law that a seperate panel will be used in the future to review any denaisl under ERISA, and it will not be up to the insurer to decide who they want to cut off without another panel looking over their shoulder."

I didn't hear about this, if it comes to fruition, it will make a major difference for people fighting ERISA disability claims!

I also heard nothing about this... if true it would be a complete game changer. The inherent problem with ERISA is that the the same agent deciding your disability is the same one paying your disability. Until that conflict of interest is fixed, we'll always get screwed.

Do you have a link to this Mark?

 

[markmc20001]

I was able to dig it back up

Hey Guys,

I was able to dig up this link. Looks like it will not apply retroactively to plans before before setp 23 2010. But at least it should certainly help those in the future. About time someboyd goes to bat for the disabled.

http://www.eric.org/forms/documents/DocumentFormPublic/view?id=1FC4D00000031

Effective for plan years beginning on or after September 23, 2010:

"Coverage of preventive services: Plans must provide certain preventive services and may not impose cost-sharing on these benefits;

No discrimination based on salary: Plans other than self-insured plans are prohibited from discriminating on the basis of salary with respect to health coverage; and

Appeals and review: Group health plans must implement an appeals process for appeals of coverage determination and claims that will, among other things, include a binding external review process. Employees who appeal a decision must receive continued coverage pending the outcome of the appeal. "

 

[Nielk]

"Appeals and review: Group health plans must implement an appeals process for appeals of coverage determination and claims that will, among other things, include a binding external review process. Employees who appeal a decision must receive continued coverage pending the outcome of the appeal. "

This is major.
Are you sure it includes the disability section? because the disability has it's own policy.
The external review is essential.

Also, the fact that they have to keep on paying you while they review is major.
I tried to fight this point with my carrier but they said they have no responsibility to do that.

I hope this will pave the way for the future for pwcs to have a fighting chance to get what they duly deserve!!!!!!!!!!!!!!!!