Posted 8/30/2013 2:15 PM (GMT -7)
So sorry about your daughter. She is in a very real plight....HAS to work so she has access to health care, but if she's working, (so thinks Unum or Social Security disability), why does she need to have disability payments?
I have Unum, had to stop working for medical reasons in Dec. I have been denied (it took them 6 mos. to decide this) for long term disability. I did not have short term.
I am just beginning the process with a lawyer to sue Unum. Some things I've learned:
-The lawyer will want to know if the claim is an "ERISA" claim or not. Her manual/policy will probably state that it IS (it's better for the ins. co. if it is, and Unum sends out a standard book to all employers with ERISA statements). Human Resources will know the answer. It's a state court or federal court issue. ERISA also limits what the plaintiff can get.
-The lawyer will want to know how your dtr. came to have this policy- did an individual come to her place of work and sign her up, or is it automatically given as a benefit to employees? And, does she pay the premiums herself by writing a check or payroll deduction, or does the employer provide this for her as one of her benefits?
-How long she has had the policy.
Although this sounds awful for a person who is hardworking like your daughter, it might be (my judgement, no one else's) GREAT for your dtr. to get fired for inability to perform essential job duties. And/or calling in sick when she is sick. It supports the idea of her being disabled. Then she can file for SSI which will help her obtain health care. I understand that this is a rough time for her. Walking away from a job where you have health care is awful. I don't know her age; maybe there is a low cost state health ins. that she could get to cover the time after she leaves work until she gets SSI. Unum will expect her to apply for Social Security disability (SSI is one, SSD is another) because usually Unum's payment to the employee is "offset" by the SS payment (Unum subtracts what your dtr. gets for SS every month from their payment to her, so she won't get more than what her policy from Unum says they'll replace. If Unum policy is to replace 40% of her earnings at work, and SS approves & replaces a number equaling 35%
of her earnings, Unum will only give her the 5% so she gets a total of 40%). Yes, I know it's crappy.
-Tell your dtr. to keep a "diary" of dr. visits, discussions with HR dept., discussions with her boss, anything she talks to anyone about her illness, disability insurance, write down in detail what was said by whom, and when, and whether over the phone or in person.
I did not know whether the pending long term disability claim is with Unum or Social Security. You probably know a lot of this stuff. Your daughter has probably been suppressing her awareness of her symptoms in an effort to keep working and save face. Having her sit down privately and listing ALL of her symptoms, even if she doesn't know who she will share this with, might be helpful. Even if she has experienced the symptom only once (for ex., getting lost when driving to a familiar place, or vision changes, or numbness) it may be very significant.
It was very hard for me to figure out that I needed to be very honest, excruciatingly honest, about every symptom that I have. I've been in denial about some of the cognitive changes and problems b/c it's embarrassing to admit them to anyone, particularly when you're trying to work. But she deserves what she deserves.
-Oh, the lawyer I talked with about Unum and their denial of my claim, said that Unum ALWAYS denies lyme disease claims. (Yes, they are awful). And that Social Security initially denies 90% of claims. They hope you won't realize that you can appeal this decision.
-If Unum communicates via their website with "correspondence" to your dtr., tell her to print all of their communications. I found that one of these items of "correspondence" suddenly disappeared from my file on their site after I complained about what was in the letter. Fortunately, I have that letter b/c I printed it out.
-Unum has been in a lot of trouble, for years, mostly regarding disability claims. They pay fines and settlements to customers b/c it is financially better for them to deny legitimate claims and risk being sued and pay big amounts to one person ,than it is to approve legitimate claims.
I can't think of anything else right now. But, first, before you go to a lawyer, find out from HR if this policy is ERISA or not. Then look for a lawyer with ERISA experience if it is. An attorney in another state can file an ERISA claim b/c it's in Federal court.
Good luck, I hope your daughter's health improves. I am so sorry she is apparently in a stressful situation which is harmful to her condition.
And I apologize if all I've given you is information that you've already gotten elsewhere.
Diagnosed/started trmt in 2009 for Lyme, bartonella, babesia. Continuing trmt into 2012 for mainly babesiosis symptoms.
2012 was: recurring relapse/remission of babesiosis symptoms.
2013:New dr.; positive blood test for mycoplasma. Will begin different course of treatment. Hopeful for the first time in a LONG time!