LTD benefit cancelled saying MRI's stable

[onlyairfare]

Long post - hopefully helpful

I used to be a health insurance executive, not disability insurance, but anyway, here goes.

I would try to pursue the appeal yourself first before hiring an attorney (usually on a contingency basis because you don't pay unless there is an award), simply because they will take 20 - 50% of the award for anything they win for you. If it was an error on the part of an incompletely informed nurse case manager, your appeal could simply involve writing a letter, filling out the appeals forms if there are any, and getting your doctors letters to back you up.

I'd consider writing the draft letter yourself including all the details that had been previously left out, and then giving it to your doctors to write on their own letterhead. And I agree about sending everything certified mail, return receipt requested.

I think it is important to know why you were on disability in the first place - if it was for epilepsy and you are not in fact an epileptic, that could have led to the case manager deciding you were no longer eligible. But given all the other ailments you describe (spinal disorder, electrolyte & kidney disorder, EEG and brain abnormalities, functional memory and attention disorders), there may have been other factors disabling you and they haven't changed a bit!

Most cities have some form of Legal Aid Society which provides legal assistance for those with low incomes. And as I mentioned, some attorneys would take your case on a contingency basis - you don't pay a penny ever, though the attorney takes a large portion of any award you receive. That is best if you are in a law suit involving tort offenses - not just receiving "back pay" but also damages for all the emotional suffering or other damages you incur because of their callousness and carelessness.

Another point - in health insurance, most states do not allow a benefit to be denied unless a licensed physician decides that the benefit should not be paid because it is not medically indicated. A nurse case manager deciding to cut off your benefit would not cut it in health insurance. I don't know about disability insurance, but since they are denying you months or years of living expenses, it seems to me that is much worse than saying they won't cover your one-time MRI.

If you are reinstated with your coverage due to an error on the part of your insurer, I would think they would be required to pay you all they owed you, including those denied months.

I have had a lot of legal wrangles over the years regarding my health care and insurance. One time I had a matter that required assistance from my senator's office. That did not cost me a penny, and I had a letter from the United States Secretary of Health and Human Services by return mail (no fax or fedex in those days) granting my wishes. another time, I had my attorney write a sternly worked letter on my behalf (I had given him my own draft) which he sent out on his letterhead. I got over $10,000 and he charged me only $300 for writing and mailing the letter.

I am not a lawyer, but doing a fair amount of my own leg work, using federal representatives (they are paid to serve us, their constituents), and lawyers only when needed, I have gotten a fair amount of things to work in my favor at minimal cost.

If you are a bit foggy - and of course you are very emotional about such a disaster and shock as this - maybe you have a wise friend who could help you out, re-read and proof read you letters.

I sure wish you the best of luck with all this! God bless you in dealing with these trials.

[onlyairfare]

Despite the previous long response, I forgot to mention that the insurance company can't do any old thing they want to, no they have to follow the law. And the person who knows the insurance laws in your state is the State Insurance Commissioner, who has an office full of people who job is to assist the residents of the state in getting what they have paid for and deserve from their insurance company.

The Insurance Commissioner also knows who the bad actors are in the state, and may be gathering cases to put the kibosh on insurance companies that misbehave. Consider that office a resource for you also.

[mjan]

I would try to pursue the appeal yourself first before hiring an attorney (usually on a contingency basis because you don't pay unless there is an award), simply because they will take 20 - 50% of the award for anything they win for you. If it was an error on the part of an incompletely informed nurse case manager, your appeal could simply involve writing a letter, filling out the appeals forms if there are any, and getting your doctors letters to back you up.

I agree and this was my plan all along, to write the appeal letter myself and get one from my PCP who knows me the best and my MS doc, who is leaving March 1st..yikes. But I will ask her NP who did the last exam for me.

And there IS no reward but re-instatement which is why I would not even think of hiring an Atty, not to mention the just cut out my income. I agree, they should pay me for months they denied me pmt.
And Yes I will send it certified mail. thanks.


I think it is important to know why you were on disability in the first place - if it was for epilepsy and you are not in fact an epileptic, that could have led to the case manager deciding you were no longer eligible. But given all the other ailments you describe (spinal disorder, electrolyte & kidney disorder, EEG and brain abnormalities, functional memory and attention disorders), there may have been other factors disabling you and they haven't changed a bit!

They suspected epilepsy and had started me on meds for it; plus I could not drive. I was not tracking time, (time distortion) and got lost in a very familiar place for a min or two, before I recognized where I was. I also was "spacing" out at work, missing info my patients were saying, or writing bizarre things. They thought I having possibly complex partial seizures. Had the 5 day video EEg which was abnormal but not for epilepsy. Think its more MS according to that Epileptologist.

Most cities have some form of Legal Aid Society which provides legal assistance for those with low incomes. And as I mentioned, some attorneys would take your case on a contingency basis - you don't pay a penny ever, though the attorney takes a large portion of any award you receive. That is best if you are in a law suit involving tort offenses - not just receiving "back pay" but also damages for all the emotional suffering or other damages you incur because of their callousness and carelessness.

Another point - in health insurance, most states do not allow a benefit to be denied unless a licensed physician decides that the benefit should not be paid because it is not medically indicated. A nurse case manager deciding to cut off your benefit would not cut it in health insurance. I don't know about disability insurance, but since they are denying you months or years of living expenses, it seems to me that is much worse than saying they won't cover your one-time MRI.

A disability claim mgr, a senior claim mgr and Nurse case mgr reviewed my file (minus the last MS neuro visit they choose not to wait for). They deemed me not meeting the "disability criteria " for completing my job at least 80%.

If you are reinstated with your coverage due to an error on the part of your insurer, I would think they would be required to pay you all they owed you, including those denied months.

The part they got "wrong" was this: MRI-number of lesions and pattern unchanged from March24 (last MRI). Plus: the epileptologist note, where they state "the office visit note indicated Dr ___ decided against treatment of MS. He documented that you were having memory/processing problems and was going to schedule a neuropsychiatric evaluation this summer. " Its actually a neuro psychological test not psychiatric AND this doctor never said she decided against treatment of me ( I did) as this doctor was NEVER treating me for MS. See how they interpreted that?

I have had a lot of legal wrangles over the years regarding my health care and insurance. One time I had a matter that required assistance from my senator's office. That did not cost me a penny, and I had a letter from the United States Secretary of Health and Human Services by return mail (no fax or fedex in those days) granting my wishes. another time, I had my attorney write a sternly worked letter on my behalf (I had given him my own draft) which he sent out on his letterhead. I got over $10,000 and he charged me only $300 for writing and mailing the letter.

WOW good for you!!

I am not a lawyer, but doing a fair amount of my own leg work, using federal representatives (they are paid to serve us, their constituents), and lawyers only when needed, I have gotten a fair amount of things to work in my favor at minimal cost.

Thanks good to know.

If you are a bit foggy - and of course you are very emotional about such a disaster and shock as this - maybe you have a wise friend who could help you out, re-read and proof read you letters.

I am more determined now than ever, less emotional (except for first day). I will have someone re read m letter as one of my cog issues it not writing, hearing or saying the right word=I hear things wrong, write wrong thing etc.

I sure wish you the best of luck with all this! God bless you in dealing with these trials.[/QUOTE]

I cannot thank you enough for taking all this time to write such a thorough and careful response..means so much to me. May God bless YOU in the most special way you may need now.

Hugs, Jan

[macarolina]

Jan, you said that ltd was a benefit, not insurance- while it was a benefit offered by your former employer, it IS insurance, and all the bad things you've heard @ insurance companies could and will likely apply here. It also doesnt matter if you are diabled, you will have to prove it to them on their terms.
all your communications to them must be in writing and return receipt anything you send them. Anything you send to them, have a detail oriented friend read it before you send to check for holes. also have that friend read any correspondence they send you in order to make sure you both understand all the deadlines and items the insurance co is asking for.
All that said, you are doing a dangerous thing not getting a lawyer. If the insurance company strings you along sufficiently, you might end up not meeting their real deadlines and their obligation to you may expire. Their contract is not open ended.

[Seasha]

Oh dear, sweet Jan....I tried to read all these posts and my eyes and brain can't take it all in. Sorry I don't have any suggestions, but I can send you huge ((HUGS)). Poor dear~~ you shouldn't have to go through all this~~ I pray it all works out for you!!

[mjan]

Jan, you said that ltd was a benefit, not insurance- while it was a benefit offered by your former employer, it IS insurance, and all the bad things you've heard @ insurance companies could and will likely apply here. It also doesnt matter if you are diabled, you will have to prove it to them on their terms.
all your communications to them must be in writing and return receipt anything you send them. Anything you send to them, have a detail oriented friend read it before you send to check for holes. also have that friend read any correspondence they send you in order to make sure you both understand all the deadlines and items the insurance co is asking for.
All that said, you are doing a dangerous thing not getting a lawyer. If the insurance company strings you along sufficiently, you might end up not meeting their real deadlines and their obligation to you may expire. Their contract is not open ended.

Thanks for your thoughtful response. I meant its NOT the health insurance but it is a benefit from your employer yes. I cannot afford an atty at this time at all. I have no $$ for rent. I will see how they respond to my and docs letters first.

Again you are so kind!
Jan