HUGE COMPLAINT - Experiance & Hope Needed

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Lynnwood
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Date Joined May 2005
Total Posts : 7022
   Posted 4/23/2008 7:21 PM (GMT -7)   
Dear Friends;

At 4:32pm today I received a phone call from my private disability company that has been covering me since I had to quit working back in Spring of 2003.

They claim that:

1) I was only working 20 hrs/wk when disability started -- in truth, I slowly went down from 60 hrs/wk to 8 hrs/wk during the year preceding the date of claiming disability.

2) That the doctor who has seen me exactly 3 times claims I can work 20 hrs/wk -- this doctor has never read any of the prior drs (who is NOT AVAILABLE) notes, and has only seen me 3 times since the first of November.

3) That therefore my coverage is stopped immediately. This is a monthly check that I received between the 21st-25th of each month, and have been receiving for over 5 years. This is my only source of income. My bills are ALL due within the next 7 days.

Has anyone had anything similar happen? Is it actually legal to stop paying with NO notice? I know I have to get an attorney and wait for the actual letter to arrive and go through the appeals process and read all the details of the policy and all that rot...I'm just wondering if anyone else had had private disability insurance pull this kind of trick on them.

I know most people don't have a policy like this at all, but I'm hoping one of you will be able to share something positive from a related problem you've had.

PLEASE do not share more problems with me. I simply cannot bear that right now! Thanks.

Lynnwood, Co-Moderator: Lupus Forum
SLE(’00), Sjogren's Syndrome, Raynaud's Syndrome, SAD, Depression, Herpes Simplex 1
Piroxicam, Plaquenil, Prednisone(was 15mg, now 8mg), Cellcept, Xanax, Trazodone, Boniva(3mth shot), Wellbrutrin SR, Valtrex
Links: DIAGNOSING LUPUS (4 of 11), LUPUS INFORMATION, LUPUS RESOURCES, Donate to HealingWell, Drug Interactions


AlwaysRosie
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Date Joined Jan 2005
Total Posts : 8616
   Posted 4/23/2008 7:29 PM (GMT -7)   
OH NO!!! Just sending you my HUGE gasp and I sure hope someone here knows how to help. Lynnwood I do have a telephone number for a local gal who specializes in nailing medical insurance for things we don't normally realize they should cover . . . or for things they are refusing to cover that we know should be covered. I would be happy to email you with her info. I know we are in different states, but maybe she has a clue what you need to do.

Blessings!

In His Grip

AlwaysRosie           "We can't control the waves, but we can learn how to surf!!"

Psalms 139

Co-Moderator - Lupus Forum

UCTD, Inflammatory Arthritis, Crohns, Diverticulosis, Sjogrens

Clickable Links:  Lupus Resources    Lupous.Org   Lupus Criteria (4 of 11)   Lupus Chapter Locator


mom46
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Date Joined Dec 2004
Total Posts : 8198
   Posted 4/23/2008 7:35 PM (GMT -7)   
Lynn,
   I had this happen to me just a few months ago. This wasn't my only source of income but it was through a private insurance company with my last full-time employer before going on disability.
   I had been receiving benefits from them for 8 years and they pulled the plug all at once. I called them and had to send them all my pay stubs, W-2 forms and a pay history from my current employer.
   Once they reviewed my work and pay history they re-instated my benefits and paid back what they took. It took 3 months but I did get it started again.
   I wish you the best with this and hope it gets straightened out quickly.
                                                           Babs
 
Dx: Lupus,RLS,RA,Asthma,Fibro,Sjogren's,Raynaud's,Divertic, Stroke,Atherosclerosis,Seizures,Neuropathy,CAD
Meds:arava,prednisone,plavix,aspirin,protonix,,zanaflex,xanax,
mirapex,advair,foxamax,Vytorin,folicacid,lunesta,Tramadol
 
JOB 5:18 For he wounds, but he also binds up; he injures, but his hands also heal.


Lynnwood
Forum Moderator


Date Joined May 2005
Total Posts : 7022
   Posted 4/23/2008 7:44 PM (GMT -7)   
Thanks Rosie & Babs --

This is so crazy -- they have reams of information from when I first filed lo these many years ago -- mine is a little more complicated as I was a full-time PhD student and owned my company which I worked at full time. But none of my work has changed since then....I haven't been doing any!!!!

The only thing I know of that changed is some information this new doctor sent -- now I have to decide if I'm keeping my appointment with him in mid-May -- I'm certainly NOT happy with him.

Did you need an attorney Babs or were you able to get it straightened on your own? Did your last full time employer get involved since they bought the policy originally?

Today has been SO fun... (This wasn't the only catastrophe today, just the only one that pertains to HW topics!)

Lynnwood, Co-Moderator: Lupus Forum
SLE(’00), Sjogren's Syndrome, Raynaud's Syndrome, SAD, Depression, Herpes Simplex 1
Piroxicam, Plaquenil, Prednisone(was 15mg, now 8mg), Cellcept, Xanax, Trazodone, Boniva(3mth shot), Wellbrutrin SR, Valtrex
Links: DIAGNOSING LUPUS (4 of 11), LUPUS INFORMATION, LUPUS RESOURCES, Donate to HealingWell, Drug Interactions


mom46
Veteran Member


Date Joined Dec 2004
Total Posts : 8198
   Posted 4/23/2008 8:09 PM (GMT -7)   
Lynn,
   I was fortunate enough to get it straightened out on my own. Yours is more complicated than mine.
   I'm sorry you have had such an awful day! I hope you will be able to get some rest tonight and hopefully come up with something soon to turn things around.
   Take care and keep us updated. My heart goes out to you!  You will be in my thoughts and prayers.
                                                      Babs
 
Dx: Lupus,RLS,RA,Asthma,Fibro,Sjogren's,Raynaud's,Divertic, Stroke,Atherosclerosis,Seizures,Neuropathy,CAD
Meds:arava,prednisone,plavix,aspirin,protonix,,zanaflex,xanax,
mirapex,advair,foxamax,Vytorin,folicacid,lunesta,Tramadol
 
JOB 5:18 For he wounds, but he also binds up; he injures, but his hands also heal.


Barbara Lee
Veteran Member


Date Joined Sep 2003
Total Posts : 2889
   Posted 4/23/2008 8:23 PM (GMT -7)   
Hi Lynn:

I don't have any experience with private disability insurance, but it sounds like you need an attorney and fast. I just wanted to say I'm really sorry this has happened to you, it truly sucks. I know this is all very stressful for you. I just wanted you to know I'm here for you and I hope your can resolve this issue quickly.

Love,
Barb
dx fibro, SLE, glaucoma, cateracts, bells palsy, depression, migraine headaches, gastreopaersis, chronic anemia, RA,MDS (Blood Cancer). Tons of meds.


Barbara Lee
Veteran Member


Date Joined Sep 2003
Total Posts : 2889
   Posted 4/24/2008 4:20 AM (GMT -7)   
Hi Lynn:

I've just gotten up and you were the first thing I thought of. I just wanted to wish you good luck with dealing with all the people you'll be seeing this morning. Try to not let the stress get you to bad. I know this was a huge shock to you and you've every right to be upset. Just know I'm sending lots of good vibes your way and I'll hope to talk to you later.

Hugs,
Barb
dx fibro, SLE, glaucoma, cateracts, bells palsy, depression, migraine headaches, gastreopaersis, chronic anemia, RA,MDS (Blood Cancer). Tons of meds.


MJLD
Veteran Member


Date Joined Jul 2007
Total Posts : 1048
   Posted 4/24/2008 1:35 PM (GMT -7)   
Lynnwood,
I would try to speak with your doctor. I have a private disability insurance policy and my doc just has to recertify occassionally that I am still disabled. My personal opinion is that he is the culprit. You need to get this straight with him and not spend money unnecessarily on a lawyer. Hope it all works out soon. God Bless You, Judy

Lynnwood
Forum Moderator


Date Joined May 2005
Total Posts : 7022
   Posted 4/24/2008 2:02 PM (GMT -7)   
After more than 8 years I am quite aware of the quarterly update required from my doctors.

A doctor I have seen 3 times cannot do much. As I said, the doctor who actually dx & treated me since 2000 is not available -- consider him dead for all practical purposes.

I *WILL* be filing a claim/lawsuit/whatever is necessary -- canceling a claim approximately the same day a check is due is NO, None, ZERO notice.

That is certainly unethical, and possibly illegal. Just got a fax of the actual letter today -- their justifications stretch over the last 8 years and are often incorrect and often taken totally out of context.

This is not a great company -- see unumprovidentclassaction.net/2007/09/08/anatomy-of-a-class-action-persistence-pays-off/
not the people I bought the policy from in 1991, it's been transferred/bought since then.

If you've had to battle a canceled personal disability claim, esp. if attorney's were involved, please contact me! Thanks

Lynnwood, Co-Moderator: Lupus Forum
SLE(’00), Sjogren's Syndrome, Raynaud's Syndrome, SAD, Depression, Herpes Simplex 1
Piroxicam, Plaquenil, Prednisone(was 15mg, now 8mg), Cellcept, Xanax, Trazodone, Boniva(3mth shot), Wellbrutrin SR, Valtrex
Links: DIAGNOSING LUPUS (4 of 11), LUPUS INFORMATION, LUPUS RESOURCES, Donate to HealingWell, Drug Interactions


Lynnwood
Forum Moderator


Date Joined May 2005
Total Posts : 7022
   Posted 4/24/2008 2:13 PM (GMT -7)   
PS. My father, who has more than ample funds (owns half his town) said "I like orange marmalade with my peanut butter", and "Thanks for letting me know". That was it. He's a fine highly functioning emotive and supportive individual, huh?


Guess it's not a good idea to hope this puts me in a really nasty flare involving lots of hospitalizations and horrid test results, huh?

Lynnwood, Co-Moderator: Lupus Forum
SLE(’00), Sjogren's Syndrome, Raynaud's Syndrome, SAD, Depression, Herpes Simplex 1
Piroxicam, Plaquenil, Prednisone(was 15mg, now 8mg), Cellcept, Xanax, Trazodone, Boniva(3mth shot), Wellbrutrin SR, Valtrex
Links: DIAGNOSING LUPUS (4 of 11), LUPUS INFORMATION, LUPUS RESOURCES, Donate to HealingWell, Drug Interactions


tink 2
Regular Member


Date Joined Jan 2007
Total Posts : 371
   Posted 4/24/2008 2:40 PM (GMT -7)   
Dear Lynn,
           
I know exactly what you are going threw. I had short and long term disability insurance and they did the same thing to me. That is after I had gotten a letter saying I was covered until I was 65. They said  my employer had changed the criteria. It is not fare how we are tread. I was lucky enough to have a husband who worked. I have no advice but to try to take care of yourself. That is easier said than done.  I will keep praying for you have faith something will come along.

Lupus since 2005, Fiberomyalgia since 2006,  sjogren's syndrome since 2005,  diabetes since 2006, Depression since 2004. who would not be with all of this.
 
       I just try to make it threw every day as best I can.
        God please remember I am on the diet platter.
                  So many beads so little time.....
 
                   Have a great Lupie Day Denise 


MJLD
Veteran Member


Date Joined Jul 2007
Total Posts : 1048
   Posted 4/24/2008 3:28 PM (GMT -7)   
Lynnwood,
I wasn't trying to suggest that you weren't "aware" of the quarterly updates required for your disability. It is obvious that whoever done your last update did not adequately describe your situation. Judy

redrose77
Veteran Member


Date Joined Sep 2005
Total Posts : 2573
   Posted 4/24/2008 11:47 PM (GMT -7)   
I wish I could help you. File for SSDI/SSI and help from your state. Also, call local churches as they might be able to help with the bills coming due. I have no clue about this kind of insurance as I have never had it and neither has anyone I know of in my family. I really wish I had something like that when I got sick because it would have helped a lot.
Dx:fibromyalgia 2002, systematic lupus 2005- definate CNS involvement dxed late 2005, psoriasis 2006, rheumatoid arthritis 2006, PTSD 2007, multiple allergies 2005, migraine, compression fractures T11 & T12, Sjögren's, damaged periphrial nerves 2007, pregnant due May 2008
Tx: plaquenil, Enbrel, Darvocet, Singulair, Flexeril, Baby Asprin, Imuran, Procardia, Prilosec


Lynnwood
Forum Moderator


Date Joined May 2005
Total Posts : 7022
   Posted 4/25/2008 9:25 AM (GMT -7)   
Humph. Guess they gave me a heart attack (not literally) for no good reason by lying in the phone call.

Yes, they are canceling but a check arrived in today mail...so a small reprieve ....:)

Lynnwood, Co-Moderator: Lupus Forum
SLE(’00), Sjogren's Syndrome, Raynaud's Syndrome, SAD, Depression, Herpes Simplex 1
Piroxicam, Plaquenil, Prednisone(was 15mg, now 8mg), Cellcept, Xanax, Trazodone, Boniva(3mth shot), Wellbrutrin SR, Valtrex
Links: DIAGNOSING LUPUS (4 of 11), LUPUS INFORMATION, LUPUS RESOURCES, Donate to HealingWell, Drug Interactions


tink 2
Regular Member


Date Joined Jan 2007
Total Posts : 371
   Posted 4/25/2008 12:29 PM (GMT -7)   
Will you be able to get it back? Is there another Dr you can go to? Try for SSD. ope it all works out for you keep us informed....
Lupus since 2005, Fiberomyalgia since 2006,  sjogren's syndrome since 2005,  diabetes since 2006, Depression since 2004. who would not be with all of this.
 
       I just try to make it threw every day as best I can.
        God please remember I am on the diet platter.
                  So many beads so little time.....
 
                   Have a great Lupie Day Denise 


Lynnwood
Forum Moderator


Date Joined May 2005
Total Posts : 7022
   Posted 4/25/2008 6:29 PM (GMT -7)   
SSD is another *long* experiance -- I've already been waiting to get scheduled to talk to a judge for 26 months already -- they tell me it may be another 10-12 months till I *might* get a hearing...

getting the stale cheap white bread, the water, and the cheap peanut butter ready!

Lynnwood, Co-Moderator: Lupus Forum
SLE(’00), Sjogren's Syndrome, Raynaud's Syndrome, SAD, Depression, Herpes Simplex 1
Piroxicam, Plaquenil, Prednisone(was 15mg, now 8mg), Cellcept, Xanax, Trazodone, Boniva(3mth shot), Wellbrutrin SR, Valtrex
Links: DIAGNOSING LUPUS (4 of 11), LUPUS INFORMATION, LUPUS RESOURCES, Donate to HealingWell, Drug Interactions


jhmom
Veteran Member


Date Joined Oct 2004
Total Posts : 2244
   Posted 4/25/2008 7:06 PM (GMT -7)   
(((((( Lynn ))))) sending hugs your way!!!!
Stacie

Trust in the Lord with all thine heart, and lean not unto thine own understanding ~ Proverbs 3:5 ~

DX: Hashimoto's, Celiac Disease, Raynaud's, Lupus and Sjogrens
RX: Imuran, Plaquenil, Methotrexate, Flexeril, Piroxicam, Levoxyl, Folic Acid, Lortab (as needed) and magic mouthwash (for mouth sores)


MJLD
Veteran Member


Date Joined Jul 2007
Total Posts : 1048
   Posted 4/27/2008 7:54 PM (GMT -7)   
Lynnwood,
     I just wanted to say you were in my thoughts this weekend.  Anything I can help you with, i'll be glad to!  I don't have alot of money, but i'll gladly share what I do have.  Let me know if you need something.  God bless you, Judy

okie
Veteran Member


Date Joined Dec 2006
Total Posts : 2818
   Posted 4/27/2008 8:08 PM (GMT -7)   

Hi Lynnwood, well if I were to tell you I knew anything about it I would be talking out of my behind. I'm glad you at least got this month check. I hope you were able to find some help out there.

carol


God Bless
Lupus like symptoms, stage 4 COPD w/CHF,  Cancer survivor.  Osteoporosis,osteoarthritis
Prednisone,Plaquanil800mg,vicodin 4x5mg,Evista60mg, Effexor 150mg, HCTZ25/Triamterene37.5mg,Xanax 1.0 x3,Singular,nitro spray, aciphex, percocet 10mg.x4.,lasix,inderal,pot.chlor.,B12 
I will never leave you nor forsake you!
 
 
 


Lynnwood
Forum Moderator


Date Joined May 2005
Total Posts : 7022
   Posted 5/1/2008 1:56 PM (GMT -7)   
Well, I think this is starting to hit me on a different level. It usually takes me a while to have an emotional response to things -- my first response is always to take charge and hit the beast head on with all the brainpower (mine or hired), etc that I can come up with.

Today I just want to sleep. Make everything go away...when I wake up, like Rip Van Winkel after umteen years....everything will be fixed.

I can still dream, can't I? I don't think anyone is charging for that yet!

Lynnwood, Co-Moderator: Lupus Forum
SLE(’00), Sjogren's Syndrome, Raynaud's Syndrome, SAD, Depression, Herpes Simplex 1
Piroxicam, Plaquenil, Prednisone(was 15mg, now 8mg), Cellcept, Xanax, Trazodone, Boniva(3mth shot), Wellbrutrin SR, Valtrex
Links: DIAGNOSING LUPUS (4 of 11), LUPUS INFORMATION, LUPUS RESOURCES, Donate to HealingWell, Drug Interactions


mom46
Veteran Member


Date Joined Dec 2004
Total Posts : 8198
   Posted 5/1/2008 4:17 PM (GMT -7)   

Lynn,

   This is a major stress on you and I'm sure its taking its toll mentally, emotionally and physcially.

   Keep on with the positive dreams! You just never know what tomorrow will bring!  Sending thoughts and prayers your way. Hang in there.....((Hugs)).

                                                             Babs


 
Dx: Lupus,RLS,RA,Asthma,Fibro,Sjogren's,Raynaud's,Divertic, Stroke,Atherosclerosis,Seizures,Neuropathy,CAD
Meds:arava,prednisone,plavix,aspirin,protonix,,zanaflex,xanax,
mirapex,advair,foxamax,Vytorin,folicacid,lunesta,Tramadol
 
JOB 5:18 For he wounds, but he also binds up; he injures, but his hands also heal.


AlwaysRosie
Veteran Member


Date Joined Jan 2005
Total Posts : 8616
   Posted 5/1/2008 9:21 PM (GMT -7)   
YES! A good long sleep will cure most everything!!! Sleep well Lynnwood!!

Blessings!

In His Grip

AlwaysRosie           "We can't control the waves, but we can learn how to surf!!"

Psalms 139

Co-Moderator - Lupus Forum

UCTD, Inflammatory Arthritis, Diverticulosis, (recent dx - Sjogrens, Crohn’s 4/08)

Clickable Links:  Lupus Resources    Lupous.Org   Lupus Criteria (4 of 11)   Lupus Chapter Locator


mom46
Veteran Member


Date Joined Dec 2004
Total Posts : 8198
   Posted 5/3/2008 4:43 PM (GMT -7)   
Lynn,
   I hope you are able to rest and relax a bit this weekend. Just wanted to let you know I'm thinking about you.
                                                            Babs
 
Dx: Lupus,RLS,RA,Asthma,Fibro,Sjogren's,Raynaud's,Divertic, Stroke,Atherosclerosis,Seizures,Neuropathy,CAD
Meds:arava,prednisone,plavix,aspirin,protonix,,zanaflex,xanax,
mirapex,advair,foxamax,Vytorin,folicacid,lunesta,Tramadol
 
JOB 5:18 For he wounds, but he also binds up; he injures, but his hands also heal.


Lynnwood
Forum Moderator


Date Joined May 2005
Total Posts : 7022
   Posted 5/3/2008 7:53 PM (GMT -7)   
Thanks for keeping me in mind. I do feel more relaxed today -- attorney called this morning and gave me a list of "homework" --- paperwork & information I need to request from doctors, the disability insurance company, my SSD attorney, and the like.

I keep forgetting to ask how long this might take, how much $$ the attorney will need, and whether the insurance company will be forced to do back pay or not.

While my family (father & brother) is of no help whatsoever, neither emotionally or financially, I am very fortunate to have 3 friends who are ready with groceries, money, housing, or whatever it takes. One of them is even in the midst of a divorce with a woman that is seeking way more $$$ than is reasonable, but is still trying to insist I take money. I guess I should have known he's committed himself to be a not-blood-related-brother years ago when he named his daughter after me.

I'm grateful that this doesn't seem to be putting me into a flare, and that I have such willing friends. Some of us never get better, and many people never have friends like these. I also am especially grateful to you, my HW friends -- you understand my fears and concerns in a way that the others never quite will.

You may think your postings of support are just words and that they won't help -- but they give me a warm spot in my heart and a special hope that tells me everything will work out -- we just don't know quite what that will look like yet.

Thanks to you all,

Lynnwood, Co-Moderator: Lupus Forum
SLE(’00), Sjogren's Syndrome, Raynaud's Syndrome, SAD, Depression, Herpes Simplex 1
Piroxicam, Plaquenil, Prednisone(was 15mg, now 8mg), Cellcept, Xanax, Trazodone, Boniva(3mth shot), Wellbrutrin SR, Valtrex
Links: DIAGNOSING LUPUS (4 of 11), LUPUS INFORMATION, LUPUS RESOURCES, Donate to HealingWell, Drug Interactions


AlwaysRosie
Veteran Member


Date Joined Jan 2005
Total Posts : 8616
   Posted 5/3/2008 8:24 PM (GMT -7)   
Thanks for the update Lynnwood . . . I've been checking this topic for updates. I hope tracking down the paperwork isn't too taxing. Arggggghhhh!!

Its good to know that you've got your army lined up and ready to protect you. Warms my heart to know that you have some good support.

Glad you aren't flaring . . . wow! that's a blessing!!!

Blessings!

In His Grip

AlwaysRosie           "We can't control the waves, but we can learn how to surf!!"

Psalms 139

Co-Moderator - Lupus Forum

UCTD, Inflammatory Arthritis, Diverticulosis, (recent dx - Sjogrens, Crohn’s 4/08)

Clickable Links:  Lupus Resources    Lupous.Org   Lupus Criteria (4 of 11)   Lupus Chapter Locator

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