Long-term disability claim rejected

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Nina2
Regular Member


Date Joined Sep 2012
Total Posts : 24
   Posted 1/13/2013 12:25 AM (GMT -6)   
Hello Fellow Lupies!
 
I need to appeal to you all for some advice and/or any similar experiences you might be willing to share with me regarding private long-term disability insurance (not social security).
 
I experienced a severe, organ-threatening lupus/MCTD flare in 2012, and I have been on medical leave from work and recieving short-term disability coverage from the State of CA.
 
I am almost ready to return-to-work, on part-time status, but my doctor feels I need about two more weeks of leave, which would require me to transition from short-term disability to long-term disability (LTD). So, I applied to my company's third-party LTD insurer, Cigna.
 
Imagine my complete and utter SHOCK when Cigna DENIED my LTD claims this past Friday. The reasons Cigna cited for denial were laughable, such as the benign findings of a completly unrelated biopsy, and for having a normal heart beat, full range of motion in my limbs, and no rash. (Gee, like a rash was going to prevent me from doing my job. LOL!!!)
 
I've heard that it is difficult, if not impossible, for those with organ-involved lupus to secure LTD benefits. Cigna said I can appeal its determintation within 45 days.
 
Questions:
1) Should I bother appealing the determination?
2) Should I hire a disability lawyer to help me do so?
 
I'm so happy to be well enough to return to work at the end of this month, so you can imagine how DEVESTATED and FURIOUS I am that Cigna isn't willing to support my complete recovery and assist me in returning to work part time. :-(
 
Thanks for your help!
Nina
 
---------------------------------------------------------------
Diagnosed with SLE 2010; MCTD 2012
Medications: Plaquinel (300 mg); CellCept (1,000 mg); Celebrex (200 mg)

Lynnwood
Forum Moderator


Date Joined May 2005
Total Posts : 5413
   Posted 1/13/2013 12:36 AM (GMT -6)   
If you can really go back in 2 weeks...it may be more trouble that it's worth to pursue it. But if not, yes, I'd certainly pursue it!

I had some issues with my private (personal) long term disability insurance. It's hard to find an attorney who deals with LTD companies, I followed referrals from attorney to attorney until I found the right one. {This is *not* the lawyer who does SSD disability, it's a completely different kind of law practice that deals with insurance companies.}

The attorney works on a % basis, and the max % they can charge you is governed by law. I was able to get my benefits, including a couple of past years covered, and thought it was well worth what I paid for it. If you happen to be in Georgia, email me for a referral.
Lynnwood, Lupus & Sjogren's Moderator
DIAGNOSING LUPUS & LUPUS RESOURCES
"Life is far too important to be taken seriously" - Oscar Wilde

couchtater
Elite Member


Date Joined Jul 2009
Total Posts : 11623
   Posted 1/13/2013 1:00 AM (GMT -6)   
I had an easy time getting my LTD going. They keep calling me and pestering my doctors for updates but so far so good.

To appeal have your doctor send them a note stating you need to rest at least two more weeks and that you are recovering from organ trouble.
I hope they change there minds.
Joy
Lupus, Fibromyalgia, Glaucoma, Asthma, Hypothyriodism, Sleep Apnea, Degenerative Disk and Facet Disease, and Allergies

When life throws you lemons....
Pick them up and throw them right back at them! :))

Nina2
Regular Member


Date Joined Sep 2012
Total Posts : 24
   Posted 1/13/2013 11:24 PM (GMT -6)   
Thank you Lynnwood and Joy for taking the time to share your experiences with me. I *really* appreciate it!
 
I'm not that worried about this particular two-week stretch, but I am tremendously worried about what this means if I might need long-term disability in the future. So scary, especially as a single gal. :-(
 
Depending on my energy level this week, I may try to obtain a consultation with a lawyer about LTD in general.
 
UGH!
---------------------------------------------------------------
Diagnosed with SLE 2010; MCTD 2012
Medications: Plaquinel (300 mg); CellCept (1,000 mg); Celebrex (200 mg)
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