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Denial of Short term disability

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BEKKAYOUMANS

Junior Member
What is the name of your state (only U.S. law)? TX I have focal dystonia or hemi facial spasms and the dr injected more botox than needed in my right eye causing it to close instead of staying open, this has caused problems with my sight, focus, balance, I cannot drive and we dont know the results until the botox wears off. I am not able to work and My DR stated this however I was denied short term disability. I have never been on this disability or abused the system but they are causing me serious problems finacially. What can i do about this?
 


OHRoadwarrior

Senior Member
Social Security Disability is intended for people having a qualifying condition expected to last over a year. Botox only lasts about 6 months. Try welfare to live on.
 

Proserpina

Senior Member
What is the name of your state (only U.S. law)? TX I have focal dystonia or hemi facial spasms and the dr injected more botox than needed in my right eye causing it to close instead of staying open, this has caused problems with my sight, focus, balance, I cannot drive and we dont know the results until the botox wears off. I am not able to work and My DR stated this however I was denied short term disability. I have never been on this disability or abused the system but they are causing me serious problems finacially. What can i do about this?


If you didn't qualify, you didn't qualify.

You can of course appeal - you should have been given information about how to do this.
 

BEKKAYOUMANS

Junior Member
tHIS IS ONLY SHORT TERM DISABILITY AND I CANNOT WORK AND I PAY FOR IT WHY SHOULD I GO

social security disability is intended for people having a qualifying condition expected to last over a year. Botox only lasts about 6 months. Try welfare to live on.
this is only short term disability that i pay for at work why should i have to go on welfare that i the reason we pay for this
 

commentator

Senior Member
We assume your employer must be the carrier of the coverage, since Texas certainly doesn't have any type of state program, and Social Security disability is not what we are talking about here as it is not short term disability.

Who administers this program for your work place? If it is self administered by the company, this is unusual, as most companies have some third party (like Afflac) handle the short term disability. So the first question is, who is refusing to deal with this claim? Is it your employer, who is refusing to send it in to their carrier, or is it the carrier who has received the information about the claim and is refusing to pay on it?

In any case, it is your responsibility to determine who to appeal this decision to, and how to put it through the system. Incidentally, premiums for employee disability insurance through a person's work may be taken from employee's paychecks, but it still goes into a general pool, it is not placed into a separate account for you specifically, in other words, "I paid this in for myself, so I should be able to get it out!" Unless it is a private disability insurance held by you for yourself, it's not specific to you.

But anyhow, the company you work for will be who you are dealing with, at least at first, and will probably be referring you to a carrier of some type where there will be an appeal or review of some type before they just say "NO!"
 

BEKKAYOUMANS

Junior Member
Yes my employer is the carrier and they are out of MD. Mutual of Omaha is what company we have and i have filed all the paperwork with 2 dr's my primary care and my neurologist who both say i cannot work temporarily this is not forever unless the medical botox has damaged my eye permanently which i hope is not the case. Mutual of Omaha denied my claim I have pictures of my face showing what I look like and it is obvious I would not be able to work. i didnt mean i should be able to get it out i meant i should be able to draw this while i am not able to work I am a working person and work up to 60 hours a week lots of weeks so i am not just someone trying to collect for the heck of it, They have already said NO @!
 

OHRoadwarrior

Senior Member
I would appeal. It seems they don't recognize a difference between you and other people with vision in only one eye and feel you are capable of doing your job. What kind of work do you do?
 

ecmst12

Senior Member
Unless driving is part of your job, being unable to drive is a transportation problem, not an inability to work.
 

scadv

Junior Member
They are required to give you a reason for denial.... what was their reason? This is key in appealing their decision.... nothing else really matters until you can answer this...


You need to get a copy of the policy.


What is the "Definition of Disability"?

Usually it is defined as not being able to do so many ADLs (activities of daily living) (usually 3 or so)
(this is very common with group policies)

Better policies define it as "not being able to perform the vital duties of your job; and this has to be affirmed by a physician"

Others define it as not being able to do any job.


All of this is key.


Also, was this a true necessary procedure?
The policy will list exclusions.

Some policies will exclude certain types of procedures they automatically deem "not necessary"; these are usually "newer" treatments that have proven alternatives that are deemed safer.



If the Company is in the clear, the doctor probably isnt.
His malpractice is causing you lost wages.
Go after is malpractice insurance, that is your best bet most likely.
 

cbg

I'm a Northern Girl
Disability benefits are a contract. The disability carrier will pay x when y happens. They will not pay when z happens. Simply being unable to drive is not a guarantee of benefits. Unless the poster is required to be able to drive as a part of his employment, it is unlikely that the disabilty policy covers transportation. It would be the responsibility of the employee to find alternate transportation to work, not the responsibilty of the disability carrier to pay the poster to stay home until he can drive again.

As for "malpractice", not all bad outcome or even error on the part of the doctor is going to generate a malpractice claim. Even if the employee could prove that the standard of care was breached, the cost of bringing the action would likely exceed what the poster could get back.
 

Zigner

Senior Member, Non-Attorney
If the Company is in the clear, the doctor probably isnt.
His malpractice is causing you lost wages.
Go after is malpractice insurance, that is your best bet most likely.
I'm sorry - but I missed anything from the OP saying the doctor actually did anything wrong. Is it worth looking in to? Sure...but that's a far cry from "best bet"
 

scadv

Junior Member
I'm sorry - but I missed anything from the OP saying the doctor actually did anything wrong. Is it worth looking in to? Sure...but that's a far cry from "best bet"
Its a better bet than the Insurance Company not knowing the terms of the contract that they wrote.


And she said he injected "too much"; not the medically correct amount. Because of that she now has lost wages.
 

Zigner

Senior Member, Non-Attorney
And she said he injected "too much"; not the medically correct amount. Because of that she now has lost wages.
There is nothing that has been presented to show ANY evidence that the doctor failed in her duty to provide appropriate care. It's entirely possible that the OP had a known negative reaction to the treatment.
 

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