For 1.5 years I have been going through the process of tring to find out what's wrong with me.

I have already received a diagnosis of Pernicious Anemia, and have the whole laundry list of symptoms, with maybe one or two exceptions.

I am anxious to have a life, and contribute to the health and happiness of my family, but I have received several denials of my LTD claim which falls under the ERISA laws. The "Lawyer" that was evaluating my claim, took 3 weeks to call me back to tell me that the paperwork he received 3 weeks prior was not compelling. The information did not contain even my Pernicious Anemia diagnosis, and this is what he supposedly received from the LTD Insurance Co. The problem is who is lying. If the insurance company fraudulently not submitting all my medical data to my lawyer, are my doctors??

Now I have roughly 3 weeks left within which to file an appeal, or I lose all rights to LTD, as I was terminated from my job while on disability.

My Neurologist has in hand Neuro-psychologist testing that shows numerous cognizant deficits, as well as "terrible" dexterity, yet my neurologist doesn't seem compelled to believe me. I suffer the worst fatigue, nerve pain, have Diarrhia 8-12 times a day, have Strabismus, where my left eye wanders drastically to the left so that I have very bad vision.

I feel like there is not one resource in this system that is a true advocate for the patient... ME.

I am in Northern California, and need to find an PA/MS Doctor that is not sleeping with the insurance, or sympathetic to their causes. Any help would be greatly appreciated.

I am not really a naive person, but I cannot believe the extent to which this government, and these idiotic laws (ERISA) shield the Insurance companies, and Doctors from responsibilities for their actions, or inactions.

Man, I am sooooo sorry this is happening to you. Surely you need to go ahead and file an appeal, as there seems to be nothing to lose by doing this. But how depressing and demoralizing and frustrating. Have you hired an attorney to help you? I know it is tempting to just throw in the towel because of the stress. Sending hugs your way.

I'd definitely go ahead and file for the appeal. That will get you the time you need to pursue it more medically. Perhaps your reg. doctor can get you the proof you need. I wish I knew more about this stuff but I'm retired. Hopefully someone will come along with more info than I have.

Billye

Please appeal ASAP and get copies of ALL your medical records. Unfortunately, you cannot necessarily take the LTD company at its word. They could be picking and choosing what they sent your lawyer, or your docs may have told you one thing and put another in your records; the only way to know is to look at them yourself.

Also, does your contract have an exclusion or limitation for mental illness? Some LTD companies deliberately "misinterpret" neuropsyche test results if anything in there points to depression or you seem "preoccupied" with your physical health. My LTD company has cut off my benefits, claiming I have somatoform disorder (which is absolutely untrue) so they can enforce their 24 month limitation for mental illness.

Does that lawyer specialize in ERISA cases? Very few do. I don't know for sure if that would make a difference, but it could.

And you are absolutely right about needing to find a neurologist who will take you seriously and who will properly document your ailments. Without the support of appropriate treating specialists, the LTD company can basically call you a liar and claim you can work. Do you have a reliable primary care doc who can refer you to a specialist in your area?

I am fighting a similar battle to yours. I had excellent doctors where I used to live, but due to the massive financial loss that accompanies disability, I had to move to another state, and none of the specialists in my new location are at all knowledgeable about what ails me. So I am basically having to start over and will be going to the Mayo Clinic to be re-tested because I know my LTD company won't have a valid argument against them.

It is inexcusable that insurance companies and doctors have such power over us. All it takes is one boo boo or disagreement over a diagnosis and our financial stability goes right out the window. I know it is aggravating and exhausting, but don't let this go without a fight.

fanfaire

appeal,and no matter how hard you deserve to have a good life for you
and your family. Please i know you have lawyer but try and hunt down everything you have any records on,my son did this for me and we had
to straighten all the mess up ourselves,it was hard but it can be done.
you should not have to go through it.

Was he provided by your employer? Go out to the courthouse and ask the clerks [after you've combed the phone books and the library's Martindale-Hubbel directory] pick 3-5 names and ask which one is the most agressive...YOU DO NEED AGRESSIVE here. Fanfaire is right in that you want one that specializes in ERISA cases..And that they are going to look for any and every excuse to deny you...not fair, but that's the way it is.

IF the lawyer was 'recommended' by your employer well, you know who he's really working for.

Also there might be an area magazine [we have one in the DC area] that does 'Top Docs, Top Lawyers' features every year or so...you can find the toughies there...they do not come cheap but you get big bang for your bucks.

Martindale Hubbel is a directory of lawyers and they can only be listed with the 'nomination' of other lawyers...they are rated...Soo if an attorney is listed there - and rated highly they are truly not run of the mill.

Move on it as quickly as you can...My hopes are with you! - j

I'm really sorry to hear you are going thru this - its a nightmare and you are dealing usually with companies who will do anything to NOT pay a claim... first, I'd be sure that you get your medical records asap and get them to the attorney yourself... the LTD company, as mentioned above, cannot be trusted... its not in their best interest... also, have you filed for Social Security Disability - if you are awarded that - they will have a much tougher time fighting you.... as Fanfaire said - many LTD companies will only pay for a psych disablity for 2 years and will try to get your docs to say this is whats wrong wth you - so get a copy of your plan asap and go thru it! Hate to say - but your attorney doesnt sound like they are much in your corner - again, you need an ERISA attorney and need to move fast with the deadline so close.... I found an ERISA attorney in So Cal - if you want their number just PM me - maybe they can give you advice or refer you... (my LTD company puts me thru a nightmare review every year and make it as stressful as possible)

ALso, have the docs written letters to the LTD company - or has the LTD given you their own testing?... at two years they put me thru extensive psychiatric testing - which further proved it was NOT in my head - but I couldnt even get copies of the exams cause they (the LTD) paid for them - unforutnately docs tend to buckle under pressure from these companies and the sick are left the victims - which is the last thing we need to compound the picture.....

(also, you said you were terminated while on disability - do you mean Calif State Disability? or was the LTD company paying and then stopped?)

Fight - but move fast! Hang in there and sending good thoughts!

Yeah i fully agree, fight them as hard as you can, they are hoping you won't.
Insurance companies over here are the same, they don't like paying out at all, there only interested in making big bucks in profit.
good luck
Brian

I appreciate all the input, support, and kind words in response to my post.

I am in the process of preparing the supposed "complete file" from the LTD insurance company, and getting it ready to send to the next lawyer, who is hopefully not a minion of the insurance machine, that has grown far too powerful and pervasive in our everyday lives.

The things I have discovered while researching this process both about doctors, and insurance, are well.... as Don Henley said, "This is the end of the innocence".

I will continue to fight the good fight, and thanks for the many thoughts that put a little wind in my sails as they were luffing.

My eyes are wide open to the vast corruption of not only the aforementioned entities, but our law makers who have created this legislation (ERISA) which is solely beneficial to the huge insurance companies. Imagine my shock when I discovered that no matter how long the insurance company denies, and delays payment of what I am rightfully entitled to, they will in the end only pay the same amount as if they paid on the first day they received my claim. No penalty, no damages, so why should they pay??

The pettiness of their assertions as to why I should still be able to work (because I can sit.... nevermind that I can't think but maybe 3 days in 10) are so parochial that they make one feel ridiculous in addressing them, and playing the game.

In the midst of the most difficult time of my life, I am forced to undertake something I would find immensely challenging under normal circumstances.

There is only one way that we as patients can truly serve ourselves regarding such travesties and that is to fight for changes to this corrupt crony designed system of government, that serves only corporations, and not "We the People".

I have seen injustices in my life, but they all pale compared to this system, where no doctor is willing to write the evaluation that certifies a patient as disabled, because they have become so cow-cowed to the insurance and drug companies.

I actually asked this most recent Neurologist if he had a significant number of MS or PA patients, to which he responded that he does/did. I continued, by asking, "Just curious, but out of those vast numbers, how many did you mis-diagnose with somatized disorder, and prescribe Anti-depressants?" He reponded that he had never mis-diagnosed a single MS, or PA case. I remarked that he must be really good, because based on everything I have seen, heard, and read, that seems a statistical improbability if not impossibility.

In fact once you have been told that you definitely, not probably, have Pernicious Anemia, as he had me, it means that your intrinsic factor has been negated by ones autoimmune system. There is no cure for this, and taking B12 (tablets... hmph) cannot change the fact that your body does not allow the intrinsic factor to work as it should, and the villi damage in the small intestines remain permanently damaged, so it doesn't go away in 6 months or 10 years, even if B12 levels should rise to acceptable levels.

Equally, the profound damage done to nerves, and resultant brain damage, motor functions, mobility, or general abilities to function daily, to say nothing of the pain which often goes untreated because few doctors believe a person with so many symptoms to be anything other than a somatized person, therefore only requiring one pill. An anti-depressant. DONE! What time do I tee off?

As I look here and across the web, and see vast numbers of patients praising anecdotally, not scientifically, the use of B12 shots for their MS, and yet no one is asking the questions in a scientific setting, why are these two seperate diseases? The commonalities far exceed the disparities between the two diseases/syndromes/disorders/maladies, hell no one can even agree on what to call them.

I am astounded by the obvious that goes undisturbed, and unearthed for the sake of real discovery. What if PA, MS, and IBS (Iritable Bowel Syndrome) were all inter-related <Ooooooooooo> how could I an untrained, non-medical professional make such claims??

It seems to me that the Father and Mother who came up with Lorenzo's Oil fought the system, did their own research, and even fought with the support groups who argued that they should not break ranks and challenge the medical establishment with unproven protocols such as their oil, in spite of the profound progress their son experienced. How we do often resemble sheep, or lemmings more appropriately, as we accept this screwed up system, out of sheer exhaustion, not usually apathy.

Where are all the real inventors, and real humanitarians. Is every Doctor, Lawyer, and scientist only in their field for the money?? That's rhetorical of course, the answer is a reliably foregone assumption based on the omnipresence of evidence supporting the obvious conclusion.

Does no one in this country do anything anymore for genuine altruistic reasons? It appears not. Not without superman or Michael J. Fox spearheading your cause for more research money. Even then, it only lasts as long as the poor soul who makes their last days/months/years on this earth count for the many someones who follow in their footsteps, after their struggle culminates in the ultimate tragedy.

Forgive my verbose nature. Forgive my deep seated anger. I am a man who just wants to be able to lay down and feel terrible, when that's all I am capable of, and not have to worry if there is some paper to be filled out, or a call to be made, or an extention to file, or a doctor to beg to send in a report that's months overdue, and to beg your doctors to act on your behalf regarding matters of disability insurance.

I've worked in a highly paid profession for 30 years, and am not used to begging, but I'm getting better at it. Not by choice though.

Imagine a world where you purchase financial security vehicles such as LTD, or life insurance, and they actually are held to a reasonable standard of conduct. Why is there a CSI (Customer Satisfaction Index) for my car repair shop but not for people who keep us alive and well? Well who are supposed to.

Wake up... this is America!!!


PS. Never believe a doctor that says things like ... "They can't fire you while you're on disability". That's something I have personal knowledge is not only not true, but any doctor who has known one disabled patient, should know otherwise, and their motivations for making such patently untrue statements are highly suspect.

Wow, I don't know if there is anything I can say to truly help you except to agree with several things you said. Yes, you can definitely be fired when you are disabled. It happened to me two years ago.

I am in a mess nearly identical to yours. My LTD company officially dumped me at the end of October. Their rationale? "Somatoform disorder" and "self reported symtoms".

It's a real quandry. Here I have a neuropsyche exam that pinpoints slowed mental processing and cerebral dysfunction, yet all the LTD company can see is that the "personality" portion of the exam indicated that I was pre-occupied with my health, which they have interpreted as somatoform disorder. They even paid a sham shrink to "confirm" the "diagnosis".

Um, sometimes you HAVE to be pre-occupied with your health in order to get appropriate medical care. Especially when you have a systemic ailment that is frequently mis-diagnosed. Either your neuro is extraordinarily lucky or he was lying, because most people I know with MS or any number of autoimmune diseases was mis-diagnosed early on, including me.

It's truly humiliating, being treated like a criminal or a liar at the very least just trying to obtain the benefits that you paid into in the event of such a crisis. I spent three weeks coming up with a rebuttal for my 16 page denial letter, and it was pretty much impossible to not feel hopeless and discouraged. I am having nightmares about losing my home, about becoming seriously ill due to not being able to afford medical care, and about trying to go back to work and getting fired on my first day because I just can't keep up.

I keep telling my husband I would do just about anything to be able to go out and get a job. I don't care what job, just anything that would get me away from the bullying tactics of the LTD company, the endless paperwork, the doctors who run the other way when they find out you're disabled. I had no idea when I slgned up for LTD coverage that I was signing away my dignity.

I am terrified to go to a doctor now, because if I am honest and admit to the myriad of symptoms I experience, I know the mental health questions will be next. Which would be fine if that's where my problems were. Except that then it seems everyone forgets that this whole nightmare started with an autoimmune disease.

The neuropathy has been a particularly tough one to get taken seriously. Because those lightning-bolt pains, those weird buzzing sensations, those numb fingers never happen while I'm being examined. I can't help that I don't fit into a textbook definition of a common curable disease, but I honestly have a lot better things to do than to make this stuff up.

It's almost impossible to know what approach to take in a doctor's office. I've actually been kicked out on a few occasions for being a know-it-all when I tried to reference some articles from the NIH website. I've also been treated like a complete moron, with a doctor practically patting me on the head and saying, "there, there, don't worry about a thing, you're just suffering from stress."

Oh, and I've been told by two rheumatologist's offices that they "don't support disability". I got mad the second time and asked them what exactly I was supposed to do to become "un-disabled". The reply was that if I would just do cardiovascular exercise, I would be cured.

So this is what happens when doctors get fed up with going round and round with the LTD companies. They simply deny that their patient could even be disabled, even when it's obvious. Most of the time, all the patient is doing is trying their best to have a life.

Despite all this, I haven't given up, and I hope you haven't either. Even if you can no longer leave the house and your only form of communication is a computer, do what you can to make the world aware of your situation. There are times I feel the world would be much more comfortable if I were invisible, but I use what's left of my cognitive function and energy to fight for what I have earned.

Hang in there. Like I've said before, being sick is a full time job.

fanfaire