[SBGUY]

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.

[Dakota]

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.

[Silverlady]

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

[fanfaire]

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

[shiney sue]

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.

[dahlek]

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

[BEGLET]

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!

[Brian]

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