Long-term Disability Appeal was denied

Jarod

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It's a little late, but part of your problem was with your attourney. The other second problem might be that website you used. http://www.disabilityinsuranceforums.com/. That disability website has an agenda if you ask me, like most of the web forums/blogs on important subject matter.

You need to find an attourney upfront that fight the good fight all the way through court. This requires making numerous phone calls and interviewing these attourneys.

The attourney should say so right before he takes your case. If not, you will get hosed when they try to force you to settle in arbitration or will not take the insurace company to court lke you found out the hard way.

Regarding Hartford's surveillance. Here is an article on that.
 
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Sleepwalking, I am so sorry. It's a bit late, but I just joined here. This is so typical, and insurance comapnies are so cut-throat, immoral, unethical. I do not know how they can sleep. I can see some due dilegence to proove someone is not faking, but once that is determined, than they should own up to what they are bound to do. I was denied ST disability, (and therefore LT was out of the question), then I lost my job after the medical leave (it was like it was scripted). They first denied the claim after a 5 minute phone call... then (like a month later) after not receiving a reason for denial I called and they said it was not denied, but were waiting for more info... pretty much wanted the treatment notes during the 3 month process... well this brings everything to a head when it is time to go back to work...with no answers you are stuck..... more to the story but when I contacted an attorney, she basically said she would decide if she would work on consignment after reviewing the case, but if she worked on per-hour basis, it would cost $10,000 to appeal (and it might not be a sure thing). So my take is that attorneys will not take the tough cases on consignmemt, and even on per-hour basis is iffy. My take is that lawyers just want the slam-dumk easy cases. Ones with lots of precidence, lots of objective documentation. Anyhow, hope things worked out.
 

I AM

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This is the second time I have heard of these insurance companies using video surveillance to deny the big fat policy payouts. My therapist told me some crazy stuff that happened to her... if she wasn't my therapist I would think she was paranoid and nuts. She said they actually filmed her and her daughters in the bathroom. THAT should be illegal. She also said that they filmed her daughter going through a toll while driving her (there therapist's car) and claimed it was the therapist driving and said if she could drive then she was lying about the extent of her injuries. She pursued this legal battle for quite some time and lost her life's savings. And she never got her policy to payout.

And here I was mad that I dropped my disability policy, thinking that it would have been easier to collect than SSDI. We would have been talking a lot of money they would have to pay out, and I am sure they have LOTS of money and lawyers on staff to try every trick in the book to prove you are not disabled. I am probably better off having dropped the policy.
 

Judee

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I've read that some people with ME/CFS have done very well going to Workwell for a 2-day CPET for disability claims. It seems to work better for STD and LTD though than for SSDI.

Be cautious though because I wonder if doing so would work against you if they turned you down over that little bit of activity. Wow.

I agree with everyone else though. It is probably best to find a better attorney to help you before making any moves or decisions and I think, if you can, you should stick it out like @mtnbibliophile said.
 

prioris

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Insurance companies know people are under frail financial situations when they become sick so they just let the sick person twist in the wind financially so they move to desperation stage or commit suicide. They can now be low balled or left to twist in the wind more. There is no financial incentive for lawyers to touch these cases.

ERISA employer based disability does not allow damages so disability payments even if won only begin the day of court victory. There are no back payments so it makes better economic sense to fight you for next ten years. Tens of thousands of people have been screwed over for decades. Congress was well aware of this issue back in 80s and 90s but did nothing. I don't know if anything has much changed in last 15 years. Private disability allows one to collect back pay thru damage awards.

I remember around 20 years ago, Dr Cheney's office referred me to an attorney. I called the attorney and filled out my information for LTD as requested. The insurance company a couple weeks later wanted to ask me a question. I tried calling the attorney but never answered or called back. The lawyer had thrown me under the bus. I tried calling a few attorneys who did take on some CFS cases but they told me flat out that no lawyer would get involved and i was manure out of luck. I also needed a lawyer that would try in federal court to have any chance.

My ME/CFS began sometime before age 6 and it was severe at that time and it's nearly 60 years later. I haven't run across any cases in US that young. I think I have come across a few in the UK. My case being a rarity didn't help. I was fortunate to have very high salary when I went out so I am surviving OK. Took a lot of grueling will power to keep working for nearly 30 years.

For social security, if filing SSD for ME/CFS doesn't work if push comes to shove, one can file under depression. They pay you same amount of money. Depression is more easily approved although recent court cases in US has made approval for ME/CFS better from the impressions I get on this forum. I would have back up plans.

Some people think the more things they put down on an SSD application, the higher the chances for approval. That is untrue. They assess each one separate from the other. No bonus for multiple things. Plus it just slows down the process. Just focus on one thing. No need for any %&&#% lawyer until after the first appeal. Lawyers wouldn't help you answer the questions or even advise you on application anyway. Just go online and complete at your leisure.
 

SnappingTurtle

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Thanks everyone! I really needed this vote of confidence to keep up the good fight. I'm just so sick that finding the energy to fight is very hard. I think I'm on a time limit but have no idea what it is. I asked the old attorney (Kantor Law) and they only answered by telling me to find a new attorney ASAP.

The unscrupulous Insurance Company was Hartford for those who wanted to know.
Not sure if you are still active in this forum. Was hoping to check in with you since I am in a similar boat (appealing my STD and LTD claim).
 

minimus

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@SnappingTurtle - Most disability lawyers and disability consultants like Linda Nee (check out her blog here) advise clients to hire a lawyer after LTD benefits have been initially denied and not to file an appeal on your own without a lawyer’s help. It might be worth calling Linda Née or Andrew Kantor, as they know a lot about the process.

The reason to hire a lawyer, if I recall correctly, is that the appeal is the last point in the process to add new documentation (medical evidence, doctor’s letters, other supporting documents about your job description, daily activity level, etc.) to your claim file if your STD/LTD policy is a group policy you obtained through your previous employer.

(If it was a policy you obtained on your own, then you have more rights than with group policies, which are governed by ERISA, a law that works against the interests of the disabled.)

If your appeal is denied, you can sue the insurer, but you may not be able to submit any new evidence to convince a judge that the insurer was wrong in denying your appeal, making it harder to win a lawsuit.

Unfortunately, lawyers work on contingency, which means you pay little up front but they will take at least a third of future LTD checks or lump sum payment in return for handling your appeal and filing a lawsuit.
 
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Thank you. I just might, if the internal appeal fails.
It looks like I won my appeal. I received a letter stating the initial denial has been reversed. I am now waiting to see what happens next. Once I actually start receiving payments, I will be so relieved as this was a big PEM-inducing stressor in my life!
 

nyanko_the_sane

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The way it works with federal SSDI in the USA, is you have to be proven disabled by law. This means your RFC indicates your limitations exclude you from any kind of work. The interpretation of your RFC is also age dependent, meaning the older you are the less likely you will be able to work with your limitations. You can be bedbound and still have an RFC that indicates you can work at age 30, but at age 50 you are disabled. It is also not about $0 income, it is about not making SGA each month which is $1310 for this year. I simplified things in my explanation.

I was able to get a simple form from my county health office which allowed my doctor to declare me disabled by filling it out and signing it. While it is not deemed persuasive evidence by SSDI, it should satisfy the state and county of your disability. Benefits of obtaining such a form include: exemption from jury duty, access to disabled transit services, food aid, property tax exemptions, and etc.
 

starlily88

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I found out last week that my LTD Appeal was denied. I knew that the decision was pending and that I should have an answer shortly before XMAS.

When I didn't hear anything I started emailing my attorney who I found on the Yahoo Disinissues group site. You can imagine how antsy I was. I had a high paying salary and paid into a really good LTD policy and they cut me off with no warning last April at the 2 yr mark.

They had me under video surveillance for 2 weeks and I left the house once during that time to go to the doctor, the ATM machine to deposit a check and stopped at the grocery store for some grub. They said if I was able to do those things that I could work. Then they sent the video and their interpretation of it and sent it to every doctor I've seen in the last 2 yrs asking if after viewing it if they thought I was so disabled I couldn't work. They got a bite from my podiatrist who said I may be able to do sedentary work and walla! That's all they needed to deny my claim.

The attorney said I had a really good case. I had 5 letters from doctors that said I was disabled. The last was a physical capacity evaluation completed by a Rhuematologist. I won my SSD case in June. And the video shows me limping and using a cane and never lifting any groceries.

So over the Holiday I went into an old email account that I haven't used for 6 months and there was the email from my attorney saying that my case was denied on Dec 11. I don't rate a phone call, perhaps a letter? They suddenly forgot my current email address? Here it is Jan 7 and I still have not talked to them in person. They are avoiding me like I have the plague. Today I received my case file in a large box from Fed Ex with a letter saying that they have decided not to litigate the denial because I can't afford them. The appeal they did was on contingency. If I won they would take half of my monthly payments. Since I lost, there is no incentive for them.

Because I can't work and I'm poor I guess I can't fight this.

I'm pretty down. Any suggestions?
So sorry for what happened to you. I got mine long long time ago. I live East Coast, and got a private lawyer (he and other guy only did SSA disability claims). He was terrific, and my fee would only be a % of what I got from SSA - long story - I was on my work's disability, so I didn't apply for SSA disability. And it was past 2 years when I realized I had to - my work disability insurance company requested this.

Everyone is turned down multiple times because they just can, which is why a disability Social Security lawyer is needed to represent you. They request Zero payment - SSA must pay them money when you are awarded the SSA disability - so you can have no money at all.

You already did the PCE testing which I wasn't allowed to do, and 5 dr letters - so let the Insurance company send you to a Hospital for further testing or to be diagnosed. Most all drs/hospitals where I am told Paul Revere NO - they won't be part of this, but Johns Hopkins gets federal funding so had to say yes.
You have to take all the Dr files, and test results to 3rd party so they can tell whoever that you are too sick to work.

I just don't get if you are getting disability from work from Harford Insurance?
I understand you were turned down, but so is everyone else.
My private Disability lawyer went before a Federal Judge with all my records - and he wrote long brief
on how I can't work - I was the first one in my State that got awarded Disability only on CFS, not on mental disorder - this is main key.

My point being - I got my Disability from work from Paul Revere Ins CO - they are huge. I found out on disinissues site to be very careful - they film everyone - they hire guys to watch you come out, go to car, etc.
I was much too ill to shop, or drive, or go anywhere - so I didn't have this problem.

I had a Dr who called the leading disability drs in US - at time they were pretty famous. He studied CFS/ME.
He would yell at Paul Revere when they wanted to test me themselves - he said NO - it would ruin me to have 2 days of testing which was basically physical tasks.

I was harrased by phone for couple years by Paul Revere, not Social Security - they were sending man to my place - my home - to see I guess anything they could cut me off on. Again I threatened them - due to me living alone, and cannot let anyone in here, especially a lone male.

This was a full time job for me - and I slept 12 hrs a day for 1st 5 yrs, and lost 20 lbs too.
I would never go to huge Insurance Co to represent me - not criticizing - but they are most likely to get you denied - or is this the Ins Co that would give you disability?

As long as you are sick, and can't work - and this is big one - you must be assessed as having CFS/ME - not just by your dr, but this ins company sent me to Johns Hopkins who didn't believe in this disease, but after I took them huge file folders by my Internist - they had to agree I had it, plus I had extensive testing by Johns Hopkins themselves - which eliminated Lyme Disease, AIDS, Leukemia, MS, and one other.

It is a huge long fight to get disability for CFS/ME - I would have thought by now - it would not be, due to proof that this is real. NIH - gives 5 million a year grants to famous Drs to study this disease, and so far they have definitively seen something in our blood that non CFS people don't have, could be not causal but it's a start.

So unclear if Harford Insurance was trying to get you disability - or representing you.
One has to use private Social Security disability lawyer for this - and be very careful, you are being filmed all the time, just assume this.
Starlily88
 

gbells

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Disability lawyers work on contingency so being able to afford them shouldn't be an issue. Disability status isn't determined by one's ability to go grocery shopping. Disability means that you can't work any kind of job due to an impairment. One can be able to go grocery shopping for a few hours but still unable to do sedentary work due to cognitive issues or the ability to rest for recovery. When I applied for SSD I told them that the inflammation I was experiencing prevented me from sitting for long periods of time and during the administrative law judge hearing I made sure I got up and moved around periodically to support this claim. Denial of legitimate disability claims by ME patients is a scam insurance companies use to get out of paying claims. This was the reason these companies pressed the National Institutes of Health to classify ME a mental disorder since benefits are cut off at two years for all mental disorders. Read the book Osler's Web by Hillary Johnson for the history.
 
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Pyrrhus

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Just to clarify:

This discussion thread is only about "Long-term Disability Insurance" (LTD), which is a type of insurance provided by employers in the U.S. Not everyone is lucky enough to have LTD through their employer or their spouse's employer.

For a discussion of "Social Security Disability Insurance" (SSDI), which is a type of insurance provided by the U.S. government, see this thread:
https://forums.phoenixrising.me/threads/ssdi-resources-of-interest.81449/

Hope this helps.