I just got my long term disability denial letter in the mail today. They state that it is a pre-existing condition and that two doctors treated me in the year before I took out the policy for numbness and weakness in the lower extremities. Actually, the first dr didn't have anything to do with lower extremities because I saw him for arm numbness (no treatment for that either though). I told the second I appeared to have foot drop in in the left (not both extremities), but not once did anyone treat me. The definition of treatment, as according to the policy is:
1) medical exams, tests, attendance, or observation; and
2) use of drugs, medicines, medical services, supplies, or equipment
When I go back to my jr high grammar lesson, I learned that the "and" means that both statements must apply in order for them to use that against me. Yes, I saw two drs that ordered tests. No, they did not give me any drugs, supplies, or equipment, and I was not sent for any kind of medical services. The LTD policy paperwork I printed from my employer states that you're still eligible with a pre-existing condition if you have seen a dr for the condition but haven't received treatment for that condition for 365 days before the policy started. I was never given any kind of treatment until I was diagnosed, and that is after my policy started, so it doesn't matter.
I'm definitely appealing this because I think they're using a play on words to deny me, and I believe that what the policy states means that I'm legally eligible (and fyi, the insurance company conveniently left out the part of the policy that states no treatment for the past year means you're eligible, but I've got it in my possession).
I have absolutely no experience handling stuff like this, but I am a very intelligent person and I can write a very good paper. I figure I can highlight the terms and definitions to support my case and send those along with a detailed paper stating why I should be approved. Honestly though, I really don't know what I'm up against (but my head tells me this should totally go my way). Should I try to do this on my own and see what happens, or would I be better off contacting an attorney now? I'd hate to pay someone a bunch of the money I get if I win, but I also want to make sure I do win, and I'm out nothing if I lose.
1) medical exams, tests, attendance, or observation; and
2) use of drugs, medicines, medical services, supplies, or equipment
When I go back to my jr high grammar lesson, I learned that the "and" means that both statements must apply in order for them to use that against me. Yes, I saw two drs that ordered tests. No, they did not give me any drugs, supplies, or equipment, and I was not sent for any kind of medical services. The LTD policy paperwork I printed from my employer states that you're still eligible with a pre-existing condition if you have seen a dr for the condition but haven't received treatment for that condition for 365 days before the policy started. I was never given any kind of treatment until I was diagnosed, and that is after my policy started, so it doesn't matter.
I'm definitely appealing this because I think they're using a play on words to deny me, and I believe that what the policy states means that I'm legally eligible (and fyi, the insurance company conveniently left out the part of the policy that states no treatment for the past year means you're eligible, but I've got it in my possession).
I have absolutely no experience handling stuff like this, but I am a very intelligent person and I can write a very good paper. I figure I can highlight the terms and definitions to support my case and send those along with a detailed paper stating why I should be approved. Honestly though, I really don't know what I'm up against (but my head tells me this should totally go my way). Should I try to do this on my own and see what happens, or would I be better off contacting an attorney now? I'd hate to pay someone a bunch of the money I get if I win, but I also want to make sure I do win, and I'm out nothing if I lose.
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