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Disability insurance

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Dedicated_Dad

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I am just floored. I got the letter today from my insurer - they cut me off May 15 - in other words, at just past 9 weeks.

Some of what the letter claimed were outright lies. He claimed he'd not rec'd any of my PT records, when my PT is in my Docs office, all records are electronic and all were sent. Further, he claims he contacted them (not noting that Doc and PT share a practice-name and phone number) to request records and received a note from them saying they had no such records. Lie, Lie, Lie.

Their main excuse was a cherry-picked quote from my May 15 visit, wherein Doc said I was "improving" and ROM was "about 120." This must have been a typo, as all my PT records from before and after put me under/around 100 under "agressive, passive ROM."

In either case, they totally ignored the rest of what he said on that date:
"...Pt. cannot be released to return to work, he is unable to perform any job duties and will remain fully disabled for at least six (6) more weeks..."

I don't know about anywhere else, but in most cases employers will not allow you to return to work after any disability without a "medical release" from your Doc. Even if I'd wished to go back at ~9.5 weeks (as if I were anything close to capable - NOT!) I'd have been refused.

I had serious muscle atrophy pre-surgery, and was not able to have a quad-sparing surgery. I was still on crutches past 12 weeks and couldn't do a leg-raise until sometime in July.

As it is, I am to see "SuperDoc" and a surgeon next week to determine when I'll be having surgery to correct the "clunk" and will be laid-up for AT LEAST another 3 months.

Worst of all, though there's an appeal process, it appears that Fed law (ERISA) gives these thieves the right to screw me over with impunity. The worst that can happen to them if I sue is they'll be forced to pay what they owe, not a penny more. No interest, no penalty, no Atty. Fees, NOTHING but exactly what they owe. No Atty. will take the case as it's not enough cash to be worth their effort.

So, here I am, on August 15, just finding out that I was financially screwed three full months ago, that I can "appeal" but they'll probably rubber-stamp it with a big red "no" because they can get away with it, and there's basically nothing I can do about it.

This, while I lay on bed-rest ordered by one of the top Ortho surgeons on the planet. I just finished reading his CV - literally 200 pages of articles, books and etc. - but this non-Dr. thief can override his judgement?

I paid premiums for this coverage for 5 years, and just now find out that since I got it through my employer there's nothing I can do. If I'd bought the same policy direct I could go after them in state-court and all sorts of punitive and compensatory damages would apply. As a result, they tiptoe around "private" policies and ride rough-shod over the rest who have employer/group policies... They have every incentive to literally rob cripples, and nothing whatsoever to fear from doing so.

This is insanity. I don't know how I am going to pay my mortgage (14 days overdue) much less my med. ins. premium which is also overdue.

Years of working 90+ hours a week, running myself into the ground, making all my payments on time (FICO score 800+) and paying premiums on disability coverage to ensure I wouldn't ruin it all... I took a paycut 5 years ago to work for this Co. in large part because of the disability policy, yet they're still able to screw me like this.

Best of all, Congress has known about this "loophole" for years, could easily fix it, but will not because of the power of the insurance lobby.

Please be warned: If your disability insurance coverage is through your employer, you could be in the same boat. The only ones that are remotely reliable are private, non-group plans.

This will take 60-120 days minimum just to get through an appeal - about as long as it will take to do the other surger(y/ies) I need and get me back to work. Of course, my home will be in foreclosure by then, and I won't have insurance to cover the needed surgeries, but .... And this is the BEST-case, assuming they don't deny my appeal and finally decide to pay me.

I just can't get over this. I swear, when this is over I will publish every detail on the 'net and do my best to ruin their business through any means necessary.

Un-freaking-real...

DD
 
Dad, that's AWFUL!! I am so sorry for you. I cannot even imagine the anguish you must be in. How COULD they do this to someone in your position? And there is no-one to whom you can turn for support?

I have heard so many stories like this and people losing homes and worse. I cannot conceive how the US government can allow such things to go on.

Oh wait - yes I can - those laws are overseen by people who are so rich they have no need of medical insurance anyway!

My prayers are with you, my friend. You don't deserve this.
 
I am speechless. The mega-rich get richer, who cares about the rest of this. Your employer either can't or won't apply pressure? The only thing I can think of, other than to file the appeal of course, is the local media.
 
What's really ironic here is that the real root cause of my problem is that I didn't take the necessary time to heal and do therapy after my 2002 accident. I left rehab/hospital on Friday and went to work on Monday, 5 weeks post-accident - far short of the 6-12 months minimum the Docs said. Surgeon refused to continue treating me because I went back AMA but I had no choice - I had no disability insurance and had bills to pay and kids to feed.

As a result, I had a contracture of 15-degrees for 6 years. This caused Doc to make my joint loose to restore range of motion. This also caused extension lag since my quads no longer know how to shorten enough to fully extend my knee. The combination of these two things is what allows the fat pad to get pinched/impinge in the joint.

The problem I have with my TKA is literally 100% due to me not taking time to get better after the accident. Further, the altered gait, etc. caused a lot of the destruction that forced the TKA.

I'd been with my employer for almost 5 years. When they hired me I limped but was able to say "I had an accident a year ago, I'm getting better every day." That was true, then.

I'd delayed TKA nearly two years at their repeated request - every time I brought it up it was "bear with us a little longer..." or "just a few more months..."

I had a review in late January, all-aces, as were all of them for 5 years. I was in the top 1% of employees in the new quarterly bonus plan, all carefully contrived to maximize effort/billing/revenue and customer satisfaction. I was #3 only because the other 2 had new certifications which company needed and had promised big bonus points, remove the certs and I was number 1 by a wide margin. Working 80-120 hours a week for the quarter left ME no time to study or test...

I won the "customer sat" award for the entire nationwide company for 2007.

I had run myself into the ground, working for them. I was literally crashing, family worried I'd have a stroke or get killed driving... (2) Docs threatened to declare me "disabled" just because of how totally worn out I was. I hadn't had a holiday in 2 years, averaged 70-80 hours a week but was paid for only 40... In the past year I ended up working on every (only 6) vacation day I tried to take...

I finally told them Feb. 14 surgery was coming, and Feb 18 that it was scheduled for mid-April. Feb 29th they "let me go." This was without any cause - they said I'd been great, but... budget... somebody has to go... yadda-yadda-yadda.

I was *THE* top tech in my group, one of the top 2 in a 10-state region. NOBODY had the sort of numbers I pulled - hours, billings, up-selling, customer sat... Nobody. Less than 2 weeks earlier I'd been told by 3 layers of management that there was noone else with the skills to handle (2) major projects with our entire company's (3) major partners -- this was "make or break" stuff and I was the ONLY one who could do it according to 2 VPs. But 11 days after announcing my surgery I was suddenly expendable...

The last week I was forced to work 56 hours mon-wed. I tried to take Thurs. off but was forced to work 9 hours. Friday morning at 9 I was informed I was the one "expendable" person.

I called my OS the day this happened (2/29) and he did my knee Tuesday AM 3/4. I had to have it done before 3/7 in order to get the disability insurance. He knew if I didn't do it RIGHT NOW I might not survive - there was no way I was going to be able to get a job in the condition I was in, and no way I'd survive another 12-18 months to activate new disability coverage, so it was "NOW!!" He made it happen - which is why you'll never get me to badmouth him even if it were proven he'd messed up my knee. As it is, it seems to just be an odd complication - rare but not unknown...

I have no job to go back to. No way I can get one when I cannot walk and have 1-2 more surgeries necessary to correct the problem. I'm actually worse off now -- walking -- than I was before. What could I say to a prospective employer?

No way they'll operate before end of sept. due to cortisone shot he gave me 7/18 - no surgery for 60+ days. Figure a month to recover and see if it fixed this, if not (30-40% chance) then I need a revision to install a thicker plastic bearing. This won't happen before thanksgiving, meaning if I am lucky I *MIGHT* be able to work by new-years. nearly 7 months after they cut me off at ~10 weeks post surgery.

I am still paying $611 per month out of pocket for medical coverage - no spare income even for that. I've borrowed money from my father to pay that for a few months so I can get the operation(s) I need...

I'm just amazed... Everything I read and have been told says they can get away with this and if I win a federal lawsuit the best I can hope for is what they owe me. I've spoken/e-mailed with 3 Atty's who do ERISA/disability suits, none would take the case because 1/3 of what they owe me for 6 months is only a fraction of what it would cost to sue them. They suggested I seek out a "crusader" who could/would take it "on principle." Like they're found under every bush...

It's a sick, sad mess.

At this point, I would deeply appreciate (2) things:
(1) Help with filing appeal from someone who knows the legalities - need to convince them to pay but don't want to give them more ammo that could hurt in court. Need to make them feel they'd lose - while it would cost me to sue, it would cost them to defend. I must make them fear me.
(2) Prayer. Personally, I am praying that G*d will keep this man from sleeping or feeling anything remotely good so long as he continues defrauding widows and cripples - you KNOW I am not the only one they do this to. Further, I need prayer that they'll fear cheating me and honor my claim on review. Obviously, I also need prayer for wisdom to handle all of this properly, and for those (like surgeons) to know what to say to make them pay me.

DD
 
DD,

I am so sad that this is happening to you. I wish I was there to help. For now prayers from socal.
Judy

How old are your kids??
 
My heart breaks for you. This is a total nightmare scenario. And the worst of it is, you're not the first person to have told me such a story. I know of a young couple, mid thirties, married about 6 years, both had in good responsible, reasonably well paid positions, the wife particularly. Everything looked hunky-dory for them.

Then the wife got sick, had to have the most major kind of gastric surgery going after which she got complications. Two years on, she's still being rushed into ER 2-3 times a week, being treated for the untreatable nausea and vomiting the surgery has left her with. Sometimes she is in hospital or even ITU for days and her husband spends as much time with her as he can so the ovetime (unpaid) he can give to his firm is obviously curtailed. Naturally, she no longer works.

His boss was very sympathetic about the situation and let him have all the time he needed but a few months ago, she moved on and the new manager has been dreadfully unsympathetic. He has put the screws on my friend horribly, moved him to a job that pays less and is many miles away so he has the added expense of mileage and the worry of an old car to get him there and back each day not to mention not being so close to his wife in case of emergency.

Then their medical insurers decided she has cost them enough and pulled the plug on them!! Just about the time the doctors have also discovered this poor lady has cancer of the thyroid! So now they have lost their home, lost pretty much every thing and had to go into receivership.

I just don't know how your politicians sleep at night knowing these kinds of things are happening to their innocent citizens.

Which is not, I hasten to add, that things like this don't ever happen in the UK but would never be as a result of illness and no matter how bad the situation, 98% of the people can always get some kind of regular payout from the state.

 
You are certainly in my prayers. I wish we could do more. Have you thought about applying for SS disability? It costs nothing to apply, and if your are accepted it would be some income. When you are better, you can certainly go back off. I don't know if it's a plausible idea for you, but I just thought I would throw it out there. It's about the only safety net we have in this country. I also wonder if your could file an Equal Employment Opportunity suit against your former employer. They obviously let you go because of your disability--and that's not legal. I feel so badly for you in your situation. A person who is a responsible, hard worker should not get this kind of raw deal.
 
I don't see how you can handle this yourself. Explore all avenues but put all your effort in finding a disability lawyer that will work with you. Speaking to 3 lawyers is just a start... there's someone out there that will take your case. Make a list of all disability and workman's comp attorneys in your city, then go down the list and systematically call and ask to speak to an attorney(s) from each firm. Be persistent. Also, make sure you have all correspondence and important papers in date order, clipped down in a folder. Make copies that go into a 2nd folder in case an attorney requests you to leave it with him (her), for further study. Never let the originals out of your sight! Good luck.
Sandy
 
Dedicated Dad

You seem to have hit the jackpot of bad luck. I was also like you working like crazy and giving the company everything and then don't return the favor. My employer is not nearly as bad as yours but I have cut back and won't go out of my way. In the past, I did what you did and go back to work too early. Not this time.

Here are my thoughts.

1. Follow up on the message about Social Security Disability

2. call the office of your state senator/representative as all of them usually
have people in the office to help constitutents with issue like you have. If
none of them are helpful go for your federal reps.

3. If you live in a decent state, contact the office that overseas insurance.
In California they have been nailing the companies for dropping people
in the middle of treatment.

4. Follow up as someone mentioned with the EEOC as your firing was
illegal.

5. Check you local and state to see if they have an office of consumer
protection and contact them.

6. If you can't find a lawyer, check with legal aid or your local law school.

7. See if your local newspaper or TV station has an investigation reporter
and speak to them.

8. Talk to your doctors office and see if they can help you file the appeals.
I know when I saw my OS on Thursday he was more than happy to
write a letter to appeal that they would not cover part of the rehab
stay. He hates the way they think everyone is the same.


I wish you the best and hope you get some help as all of this is not good for your health.

Simon
 
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