My Lessons Learned regarding Disability Claims

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CONSIDERING LEAVING OR CHANGING WORK?
If still full-time employed, don't quit work, make work changes, work accommodations or apply for disability benefits before you (1) research and understand your benefits and employer's and Social Security's disability, absence and leave policies. I am referring to: ADA/work accommodations, terminations, short term disability, long term disability, and leave policies such as unpaid leave, compassionate leave, Family and Medical Leave Act (FMLA) leave.

Why? Because you might not be able to maximize the use of or even may lose your benefits!

(2) Decide if you are staying at work. I urge you to discuss with your doctor(s) the likelihood of remaining at work and returning to work given your current condition. If you request accommodation that results in lesser hours, will the off-times be enough to help your body recover so that you can eventually go back to your full-time schedule? I was told that even mild ME/CFS patients may take 1-2 years for improvement...and that is with aggressive rest.

With ME/CFS being so unpredictable, remaining at work can be a gamble, since the opposite can easily happen: you might not get enough rest, deteriorate and be forced to stop work permanently. If that happens, and if you had switched to less hours as an accommodation, you should recognize that your potential Social Security Disability Insurance (SSDI) and Long Term Disability (LTD) benefits will be reduced. These payments are based on your current (lesser) work hours/salary. Additionally, most ADA/work accommodation requests imply an intention to remain working, in spite of disability.

If you think you cannot work anymore and have already gone on leave from full time employment, it is possible to request as additional unpaid leave as a work accommodation, rather than requesting a different work arrangement in terms of flexible time, less hours, or work-from-home.

(3) If you have decided to stop work-even temporarily-and file for disability, get help right away
Get your caregiver or a trusted friend/family member to assist you in your disability claim. You will need it. There is a lot of paperwork, research and reading...and stress. This is especially important because you don't want to trigger a relapse. While I might recommend taking your time with the filing, time may be of the essence in getting the best possible outcome, so a helping hand can ensure you get things done thoroughly and on time. I relied on my husband for this help. He spent a lot of time reviewing with me and hand-writing my forms. He took care of mailing and requesting my records, too. He did most of the phone follow-ups to ensure receipt of paperwork.

(4) prepare for disability application by first checking your doctor's and his/her office's policies regarding disability claims and review for yourself your full medical records.
There are several reasons why:
a) your doctor's office policy may forbid them from support disability claims and file disability paperwork
I learned too late that not all clinics do this. I wasted 2 years with my primary care physician (PCP) and nearly jeopardized my disability claims because his clinic policies do not support my needs. This is the reason I eventually switched to a different clinic for most of my healthcare needs.

b) your doctor personally may not like to fill out disability forms and/or may not support your claim
Best to know this up front because lack of support and even reluctance on the medical providers part will hurt your claim. He agreed to submit FMLA paperwork but not any disability forms.

I was careful in choosing my new PCP. He assured me at our first meeting that he would take supportive notes and assist me with my disability paperwork, if needed. Ultimately, I waited 3 months for an ME/CFS specialist and the specialist took over my disability form filing. But it is good to know that my new PCP is supportive when needed.

c) your doctor may not be taking the right kind of notes in your medical record
Even if your doctor verbally says they support your disability claim, there may be inconsistencies and even contradictions in his clinician's notes that will damage your claim. By requesting your full medical record (must include clinician and treatment notes), you can get a better picture of what he/she really thinks about your illness(es).

I learned that my previous PCP of 2 years (while decently competent) wasn't noting in my record the progression of my symptoms and how these made me functionally impaired. In fact, I saw that he put very little in his notes in spite of my thoughtful recounting of my issues. On the other hand, I learned that the pulmonology nurse practitioner (NP) took copious relevant notes. She was a keeper, I decided and by including the records she filed, she helped balance out my previous PCP's lack of notes.

I suppose it was possible to request that the doctor be more detailed in his notes, but in my experience, doctors tend to take offense. It will up to you to gauge if your doctor-patient relationship is open enough to make such requests. Of course, if a record was glaringly wrong, you have patient rights to have the record corrected.

(4) if filing for disability, decide if you need to and when to engage a lawyer
Hopefully by now, you would have reviewed your medical records and shored up support from your doctors. This will give you a feel of how strong your future disability claim may be.
Obtain consultations with a couple of lawyers, who may review your medical records and give you an opinion. on your prospective case. Some if not all give free consultations! They may say your records look fine but need more objective evidence. Watch on the internet their free talks. They give some very helpful information and that should give you an idea of the type of lawyer they are.

A successful ME/CFS disability claim is supported by objective medical evidence. Right now, a 2 day Cardio-Pulmonary Exercise Test (CPET) is the gold standard for confirming the presence of Post-Exertional Malaise (PEM). PEM is the cardinal symptom of ME/CFS and functionally renders an ME/CFS patient unable to work. If you have cognitive issues, a neuro-psychological exam confirms cognitive deficits. Some people, like myself, had brain QEEG performed to confirm cognitive impairment.

These types of test can cost a lot of money (I estimate ~$2k for CPET and neuropsych, $1k for brain QEEG), although prices depend on your area. Believe it or not, some doctors may be willing to give you a discount. You just have to ask.

If money is tight, and you are considering hiring a lawyer anyway, the cost for the above tests may be covered by the legal firm. However, they have to make a living, so make sure you understand their fee structure, since that is how they will recoup the cost of your tests. These fees can be as high as 25% of your backpay and in some cases (not SSDI), 25% of your pay in perpetuity. Please also note that hiring a lawyer does not excuse your from the mountains of paperwork. You still have to file forms, talk to your doctor to enlist their support, etc. SSDI lawyers may have a cap of $6k from your backpay but there may be exceptions to pay them more if allowed by judge.

Lawyers are often engaged only after an initial denial. Lawyer or not, make sure you launch an appeal after a denial. Ensure you meet all deadlines for forms and documentation.

In my case, my husband and I had awesome free consultations with a LTD lawyer after my initial LTD denial. By then, however, and after waiting being on a waitlist for many months, I had already met my ME/CFS specialist who conducted my 2 day CPET, which we paid for out of pocket. So, with a strong case, my husband and I decided to attempt the LTD appeal myself. I am one of the lucky ones who have so far got the initial decision overturned.

I was required by my LTD insurer to submit a SSDI claim. This is because they can offset what I get from SSDI. Even with a strong case, as reviewed by two SSDI lawyers, my husband and I decided this time to hire an SSDI lawyer because the LTD company credits us the lawyers' fees (effectively free legal service). I waited for written confirmation of their LTD procedure on lawyer's fees before signing the legal retainer. I was again lucky, that my initial application for SSDI was approved.

I'm very tired now. It's taken all day to type this. Will continue some time hopefully soon.
 
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Alvin2

The good news is patients don't die the bad news..
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Very well done.
In ways not dissimilar to how to apply in Canada (which i did a writeup for for my website but an working on editing).
In the end its about playing their game and winning. And you need to know the unwritten rules to play your best game.
 
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WHEN APPLYING FOR DISABILITY
So you've decided to stop working and apply for disability coverage.

(5) Prepare to do a lot of reading. See pinned articles in this sub-forum. See also the excellent articles at http://howtogeton.wordpress.com. There is a lot of advice. Best to have those tips in mind now, and learn from other's mistakes!

So, by now, you should have:
a) reviewed your insurance policies (STD, LTD, SSDI)
Most of the disability advocates' online presentations strongly encourage that you review the eligibility rules and exclusions in the policies. Know the policy definitions for "disabled". Be able to distinguish if the policy is based on "own occupation" vs "any occupation". Be mindful of any time limits for conditions like "mental" or "nervous system" disorders.

If you don't understand the verbiage, make sure you ask a lawyer.

b) enlisted the assistance of your doctor(s)
Again, very important. A letter of support from your doctor: summarizing your medical history, progression of illness, reporting objective medical evidence, and assessment of your functional impairment, goes a long way. The lack of support, is also very telling.
I got 3 letters of support: 1 from my previous PCP of 2 years (very weak letter), 1 from my pulmonologist NP (excellent letter, co-signed by pulmonologist, not enough objective medical evidence), and 1 from my ME/CFS specialist (perfect letter with objective medical evidence). Letters 1 and 2 were not enough and my LTD claim was denied. After submitting letter 3, my LTD appeal was approved.

c) studied your own medical records
Ensure you request the FULL records; use the terms "clinician's notes" or "treatment notes". Visit summaries are no good.

d) enlisted the help of a friend or family member or disability advocate
It is a lot of exertion. Exertion is harmful to us. Save yourself by allowing someone to share the burden early on. I didn't mention this previously but you can request for assistance from a social worker or disability advocate.

I actually tried to request help from a free disability advocate but that person didn't actually provide any benefit to me. I was counting on an assessment of the strength of my evidence but she didn't meet my expectations. My husband and I still did all the paperwork ourselves. Anyway, your results may vary.

e) had free consultations with a lawyer
I got better advice from ERISA and Social Security lawyers or their paralegals. I had also consulted with a for-hire disability advocate, who also gave great free advice.

(6) Some tips on form-filling and phone calls
a) Answer questions in forms that you or your doctor(s) are to fill in as if it's your worst day. We all know our ME/CFS symptom severity goes up and down. We tend to unconsciously put on a brave face when we answer questions about our daily living activities. This will give the insurer's examiner a false impression that you are fine. If you were fine, you wouldn't be stopping work and applying for disability! So, make sure to describe your bad days.

b) Detailed answers or short answers?
In both STD/LTD and SSDI, I was warned that I must pass along as much evidence as I can, in the form of medical records, test results, affidavits. This is because no new evidence may be submitted by the time you can sue in court (if it gets to that). I took this to mean that my own supplied answers should be long. After all, I do want my voice heard. However, I was told this can be a double-edged sword: my own words could be used against me, especially if this contradicts something in my medical record.

I got too late this warning to make my answers concise but straightforward; I had used the backs of the forms to continue my answers from previous pages. Fortunately, in spite of the long answers, my claims were successful. I believe it was because of my 2 day CPET, brain QEEG, doctor's and husband's letters of support.

However, if I were to have my husband help me fill out those forms again (especially for SSDI), I would only use the space allotted for answers and save the detail in affidavits (see below).

There are forms that your doctor needs to fill out. Ensure that you review the questions together with your doctor and that what he enters in the forms is consistent with what you think is your functional capacity. If you cannot lift 20 lbs, make sure he knows that. If you take multiple naps in a day, just to get by, make sure he is aware.

c) Phone calls from insurer (private or Social Security)
If you are like me and even talking on the phone is exerting, you may want to limit your phone conversations with the insurer (if SSDI, I am referring to Social Security as the insurer). You can either designate someone to receive/make your phone calls, or request all communications in writing, or both. Whatever the method, you should send in writing indicating your representative and/or how you want the insurer to communicate with you. You can frame your request as a "disability accommodation".
I also find it is best if I have time to think over my answers, as my cognitive deficits affect my ability to concentrate and lower my speed of thinking. I find I often miss one or two items. So, for me it was necessary: I made the request to have my LTD and SSDI examiners contact me by letter; else, my husband answered the phone calls.

(8) Affidavits
I read that it would be a good idea to get affidavits from your caregiver and employer, besides those from my doctor(s). I asked my husband to write one, describing in detail my struggles on a typical bad day. He described how my activity level changed from pre-illness and the different things he has had to take on, now that I am ill. He also indicated how often I had bad days versus good days; and what types of tasks I could do and not do on bad days and even on good days.

I agree that having someone else describe your day-to-day is more impactful than saying it yourself. I would have asked my recently former manager to write something similar, if my LTD appeal was also rejected. I imagine my manager would mention that I would more and more announce that I had to lie down and go offline but that I was a diligent worker and tried not to let my work suffer.

I actually included in my evidence a couple of my previous years' performance reviews, which established my reputation as an exemplary employee. I was doing very well in my career and had no reason to leave such a satisfying job, except for this debilitating illness.

While it was heartfelt, I decided not to include my mother's affidavit because it did not provide enough of a description of my functional limitations.

(9) SSDI application
a) I followed advice at HowToGetOn by starting my SSDI application online but my husband and I took a long time to fill in the rest of the forms, about 4 weeks. By starting the application online, you establish your application date early. This matters because the application date (along with your disability onset date) will determine how far back you might receive back pay. Additionally, once you stop working, you should not wait too long before applying. Otherwise, you may not be eligible.

b) I also sent a letter asking for extensions to any forms deadlines as a disability accommodation. From start to my approved initial decision, it took 5 months. About 2-3 of those months were spent taking the time to complete the forms.

(10) 2 Day CPET, Neuro-Psychological, QEEG
a) Paying and reimbursement for the tests
One advantage of paying out of pocket is if the test results are not convincing or contradict the claims in your case, you might consider leaving it out of the evidence you submit. This might be something you can do for STD/LTD but for SSDI, I am told you are compelled to submit ANY evidence relating to your claim. So, if you have any doubts at all that these tests will confirm your health conditions, you should probably be consulting with or engaging a lawyer. They would be able to help you determine how to bolster your case.

It is possible to have these tests covered by your health insurance. It will likely be treated as out of network. You will need a detailed receipt showing the CPT codes.
++++++++++++++++++++++++++++++++++++++++
Next, I will talk about what happens while waiting...

Need to have some of that cake @andyguitar offered me again.
 
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Very well done.
In ways not dissimilar to how to apply in Canada (which i did a writeup for for my website but an working on editing).
In the end its about playing their game and winning. And you need to know the unwritten rules to play your best game.
Thank you, @Alvin2 . Yes, your comment about unwritten rule reminded me of another thing. I will post it later...
 
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Adding to item (8) Affidavits:
I also included my job description. I printed out how my employer posted my job and then I added what I actually did on a daily basis. E.g. "conducted phone and online meetings 3 to 6 times a day ~4-6 hours/day; wrote code/scripts ~3-4 hrs/day; administered/maintained software suite ~1-2 hrs/day" and "typical work hours: 50-60 hrs/week".

Adding to item (9) SSDI:
c) Dependents
You can request a scheduled phone application for spouse and children, once you are approved for SSDI. In my application, for some reason, I was told could not apply until I got an approval.
EDIT: In my policy, they offset for dependents' benefitd, too. So, make sure to refer back to your policy.

Continuation of item (10) 2 Day CPET, Neuro-Psychological, QEEG:
b) 2 Day CPET
Ideally, you have a 2 Day CPET under the supervision or with approval of an ME/CFS specialist. If you are already moderate to severe, it may be harmful to trigger any further PEM crashes which is inevitable with a 2 day CPET. I insisted on 2 days because only 1 day will show deconditioning. The 2nd day could show evidence of PEM.

There is no way to fake out this test as there is a baseline measurement that ensures that you exert to a minimum amount. This supports the integrity of this test!

c) Neuro-Psych
Per HowToGetOn, you should get tested by a psychologist who specializes in cognitive testing and is familiar with ME/CFS. I considered this but my understanding is that the battery of tests take all day, and I didn't want to overexert in that way.

I did, however, get a computerized test at my ME/CFS specialists' office. This measured my cognitive functions and I received a report.

d) brain QEEG
I am not local to Dr. Mark Zinn but he introduced me to an in-state clinic so they could take my QEEG measurements locally. My local brain clinic, then sent my data to Dr. Zinn.
This was not a painful test at all. They place a shower-cap with electrodes on your head. It took 20 minutes for the electrode placement and less than 5 for the actual measurements and 5 more to remove the electrodes.
My results were striking as it showed (consistent with his ME/CFS research) dysregulation 3 standard deviations outside normal range, particularly in the right prefrontal lobe. There was also wide spread hyper-connectivity reported, demonstrating severe impairment to higher cognitive functions and social functions.

e) plan on resting aggressively after these tests or trips!
I planned on being bedridden for at least 2 months after the 2 day CPET. I was mild to moderate at the time. For me, even just a 30 minute ride tires me out. The brain clinic was 2 hours away. I rode flat the whole time while my husband drove, and I think it helped some. I also ended up with PEM.

(11) Social Media and Surveillance
I stopped posting on social media except for here. No one tries to be miserable on purpose; we try to make the best of our energy-less life. However, I don't want the insurers to think that because I am smiling in a picture that I posted, that I am no longer disabled. Because ME/CFS is such an invisible disease, it is so easy to misconstrue what is posted on social media.
I always expect surveillance, so I make sure to keep basic notes on how I felt each day. I might miss a few days but I make sure to indicate how I felt before and after a day out. This way, I can explain away what might be reported through surveillance.
 
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AFTER SUBMITTING YOUR DISABILTY APPLICATION:
(12) Follow-up, follow-up and follow-up again
Again, this is all outlined in HowToGetOn but it deserves emphasis. Don't rely on your lawyer or the insurer. A few people lost their cases because the ball was dropped by the legal firm.
Either you or your helper should check that
a) insurance company (LTD or SSA) has received your paperwork

b) find out name(s) and contact details of person(s) processing your account

c) your doctor(s) have received records and forms requests from the insurer and are working on them and share copies of them with you

d) find out best way to send and track additional documentation you might send later
For SSDI, we reused the same bar coded cover sheet to send my supporting evidence like affidavits. I also faxed the same to my Disability Determinations Services (DDS) analyst once I got her number. Unless you are a legal firm or medical provider, the web portal for doxument uploads is not available to you. We already tried but could not get a login.
For LTD insurers, you may have mail, email, fax and web portal access to send documentation. Take advantage of the technology.
We also had to reiterate our disability accommodation request that the LTD insurer send written communications. Their excuse was that individual representatives can only try to remember my request.

e)check online status of your application when possible
This was possible for SSDI, through "my Social Security" website account. Although the actual award letter will only arrive by snail mail, the portal allows you to print a benefits verification letter.

(13) Expect a denial but don't take it personally
As many have explained before, LTD insurers aren't compelled to do right by you. There onus is unfortunately on us already sick folk to prove our disability. An initial denial is to be expected, especially if you are still working on getting the objective medical evidence. The key is not to let it rattle you.
a) Read carefully the reason for denial and work out a plan with your helper to rebutt with better evidence.
b) make sure to appeal well within the time frame allowed
We sent a short letter that only stated I was appealing. We intended to send out new evidence and a cover letter later.
c) Avoid a functional capacity evaluation
We know that these really aren't unbiased and unless that examiner understands and believes ME/CFS to be a legitimate illness, their testimony are more likely to harm your case. In particular, they may ask you to undergo functional capacity exams (FCE), which we know conveniently ignores PEM as a hallmark symptom. When we have ME/CFS, if asked to demonstrate functional actions once, we are likely to pass with flying colors. However, that medical examiner will not be coming home with you to see the delayed effects of PEM! Additionally, see the nucely worded warning "An ME/CFS Claimant Should not Participate in a Standard Functional Capacity Evaluation Scheduled by the LTD Insurer" at https://www.frontiersin.org/articles/10.3389/fped.2019.00231/full

d) Exercise your right during appeal to obtain the insurers' claim records. This will enable you to see what evidence was rejected and which was used in their decision. This is highly critical in forming your appeal.
I saw in my record that, in spite of my records showing the progression of my symptoms and the 2 letters of support (one from PCP and one from pulmonologist NP), these did not demonstrate functional limitations. It also did not help that the results from routine tests were "normal-looking".

During my LTD appeal, I informed them that I was waitlisted for an ME/CFS specialist. Initially, my slot was not going to open up until well after the 180 day appeal period. We called and emailed every month to remind the specialist clinic that we would be willing to make the trek out there on very little notice, in case of cancellations. If a cancellation had not occurred soon enough, we were considering asking for an extension of the appeal period, given that there are still so few ME/CFS clinicians in the U.S.

(14) If you are required by LTD to submit an SSDI application. Make sure to do that before their deadline!
The same advice you see in this thread for LTD applies generally to SSDI. We simply resubmitted the same evidence that I already gathered.

APPEAL or LITIGATION WON OR APPLICATION APPROVED
I have no experience with litigation since my LTD was won via internal appeals process and SSDI was approved at the application/initial stage.

(15) What are the gotcha's once your benefits are approved?
a) Carefully read your award letters.

Make sure the calculations are accurate. Otherwise, that is much of your money lost.

Make sure you understand the tax implications of your benefit payments. For some people, the LTD and SSDI payments are 100% taxable. This depends on your income level and how you paid for the premiums.
I paid a little extra on premiums to get 60% of my pre-disability salary (50% is the norm at my employer's ; but, because my employer paid most of my premium, my benefit was 100% taxable.

My SSDI is also 100% taxable due to income level. So, ultimately, I am getting much less than 60% of previous pay.

b) Overpayments
LTD insurers offset payments from other plans you are eligible for. In my case, I was also eligible for SSDI. My policy obliges me to repay my LTD insurer for any SSDI payments that coincided with past LTD payments. Additionally, LTD insurer reduced my future LTD payments by the same SSDI amount. They did credit me the SSDI lawyer fees.
Here is another calculatiin for which you should be eagle-eyed.

(16) Requests for updated medical information
Periodically, LTD and SSA insurer will ask for updated forms and records. You must continue to return them in a timely manner. I often take this opportunity to inform them of changes in doctors.

EDIT: Added more in 13d and 15a.
 
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(16) Requests for updated medical information
Periodically, LTD and SSA insurer will ask for updated forms and records. You must continue to return them in a timely manner. I often take this opportunity to inform them of changes in doctors.
Forgive me if I have the formatting wrong but I wanted to add to this. I left my job at age 45 and began collecting LTD. My particular policy paid 60% of my salary that is not taxed. I am eligible for my benefits until age 65. That’s a LOT of money that insurance companies don’t want to pay out. It’s imperative that you have a copy of your company’s policy. I did a few dumb things…I drew out of my retirement and closed it. That was a big ouch! My contract states that offsets my disability payments. So I lost all of my retirement. The verbiage wasn’t crystal clear however in hindsight it was stated. Never miss a deadline on paperwork they are requesting. Again, depending on your policy they can cancel your coverage. I was collecting my disability for 2 years, meeting all deadlines on paperwork and I got a note in the mail stating I was no longer disabled and was dropped for LTD. I immediately called and was advised my doctor wrote in one of his notes that I was improving!! Be super careful about what you say to your doctor. I was so happy that I had a good month that I told my doctor. So naive in hindsight. I asked for more clarification regarding the cancellation. That’s all of the information they would provide to me other than the fact that i had a right to appeal the decision. I happened to notice at the bottom of the cancellation letter that it was my right to request all notes pertaining to my case. I did that! It took me about 6 months to pull together a very detailed appeal. I didn’t want to hire an attorney because I desperately needed all of that money. I read every single note they wrote, reviewed every single document, and found many holes and mis truths. I won my appeal. It was the most stressful scary thing I’ve ever been through. If I lost those benefits I would have lost everything!
I apologize if these tips have already been provided. As a new member I haven’t had the opportunity to read through a whole lot.
 

Woof!

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I was so happy that I had a good month that I told my doctor. So naive in hindsight.
There is so much that sucks about being this sick, but one of the biggest things, IMHO, is this. When I'm feeling good, I want to embrace it, celebrate it and share it. To not be able to do this because it may be used against us is just one of the cruelest parts of having MS/CFS. Oh, DebOw, I can relate...
 
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Forgive me if I have the formatting wrong but I wanted to add to this. I left my job at age 45 and began collecting LTD. My particular policy paid 60% of my salary that is not taxed. I am eligible for my benefits until age 65. That’s a LOT of money that insurance companies don’t want to pay out. It’s imperative that you have a copy of your company’s policy. I did a few dumb things…I drew out of my retirement and closed it. That was a big ouch! My contract states that offsets my disability payments. So I lost all of my retirement. The verbiage wasn’t crystal clear however in hindsight it was stated. Never miss a deadline on paperwork they are requesting. Again, depending on your policy they can cancel your coverage. I was collecting my disability for 2 years, meeting all deadlines on paperwork and I got a note in the mail stating I was no longer disabled and was dropped for LTD. I immediately called and was advised my doctor wrote in one of his notes that I was improving!! Be super careful about what you say to your doctor. I was so happy that I had a good month that I told my doctor. So naive in hindsight. I asked for more clarification regarding the cancellation. That’s all of the information they would provide to me other than the fact that i had a right to appeal the decision. I happened to notice at the bottom of the cancellation letter that it was my right to request all notes pertaining to my case. I did that! It took me about 6 months to pull together a very detailed appeal. I didn’t want to hire an attorney because I desperately needed all of that money. I read every single note they wrote, reviewed every single document, and found many holes and mis truths. I won my appeal. It was the most stressful scary thing I’ve ever been through. If I lost those benefits I would have lost everything!
I apologize if these tips have already been provided. As a new member I haven’t had the opportunity to read through a whole lot.
Yes, this is perfect. I keep forgetting a few items
I also requested a full copy of my insurance case records as part of my appeal rights.

I am glad you were able to fight for and win back your rightful benefits, too.

I was able to learn from my claim/case records that my PCP did not respond to further requests for clarification and that the first two letters of support were disregarded.

Yes, it is good to read and reread the policy plan details.
 
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Yes, this is perfect. I keep forgetting a few items
I also requested a full copy of my insurance case records as part of my appeal rights.

I am glad you were able to fight for and win back your rightful benefits, too.

I was able to learn from my claim/case records that my PCP did not respond to further requests for clarification and that the first two letters of support were disregarded.

Yes, it is good to read and reread the policy plan details.
Exactly!! My policy even states this…
your Elimination Period and during the next 60 month period, you are unable to earn more than 80% of your Predisability Earnings at your Own Occupation for any employer in your Local Economy; or

3. after the 60 month period, you are unable to earn more than 60% of your Predisability Earnings from any employer in your Local Economy at any gainful occupation for which you are reasonable qualified taking into account your training, education, experience and Predisability Earnings.

Companies will do anything to avoid a full payout. They will try to say you could do a different job. Knowledge is what will save you! I’m blown away at the incredible detail you have in these posts. After my successful appeal I couldn’t even say the word disability. I still get sick to my stomach when Metlife sends my annual disability forms to complete. I will never make a mistake again!! I trusted the system only to learn the insurance company isn’t on my side. I trust that your work will save more than a few people from going through the hell you faced!!