how to appeal disability denial

[glsslady]

What is the name of your state (only U.S. law)? california
I have a ten-year history of fibromyalgia and chronic fatigue. However, in Sept. 07 I was also diagnosed with Multiple Sclerosis and Connective Tissue Disease. I stopped working as a teacher and in April 08 was approved for disability (short -term) through my elected provider. However, the insurance company continued to ask for additional medical forms and my Rheumatologist refused to fill them out. My disability ended June 30 and now i have sent a request to appeal that decision. I have had NO income since then and now am looking at being homeless, hungry, not able to get meds, etc. Please help! I would be greatful for any suggestions.

[Mrs3]

You have filed your appeal of the denial, which I assume is the LTD (long-term disability) and not the STD (short-term) and that is exactly what you need to do. There really isn't any other recourse at the moment. Getting an attorney at this point would be premature.

I've gone through the process in California so I can tell you information from a person of experience, not professional expertise.

LTD often times does not come easy. Just because one receives STD it does not mean that LTD will follow right away and even if you win your appeal it could still be a long process so I suggest strongly you find some way of being able to manage your situation, financially, by either borrowing from family/friends or moving to a cheaper situation...

I know that sucks and it is highly unfair! But I can tell you that there is no automatic way to make the LTD company approve your claim.

Now, for the doctor. I've heard attorney's suggest you sit down with your doctor, explain the situation (nicely and calmly), tell him/her that you understand this is a burden and that their time is valuable - offer to pay for their time to fill out forms (I know, I know...how am I going to pay them!!??) - just telling you the advice I've seen. Hopefully the doctor will understand and will agree to fill out the paperwork.

I'm guessing the paperwork has to do with assessing how your illness makes you disabled. Just having an illness does not in the eyes of LTD insurance companies, or Social Security Disability, immediately mean you are disabled. They have to know how your illness makes you disabled and that is probably the forms they are sending out.

LTD companies can be unreasonable but arm yourself but going over your policy paperwork so you know exactly how it reads, what you are entitled to etc.

When I was turned down for LTD I applied for State disability. You may be able to do that which will give you some relief while you wait for your insurance company to answer your claim. And just an FYI, your policy will confirm this but, if you do receive State disability and you are approved LTD the LTD company may reduce your backpay by the ammount you received from the State. You come out even in the long run but they will recoup those costs (depending on your policy) up front.

But really, if you cannot work you need to find a way to survive without the LTD money because it may be months of waiting.

Best of luck.

[glsslady]

Thank You so much! I am not going for LTD, just the remainder of my STD (2 years) so I could possibly find another way to make a living. I do not want to quit working, I just have to find something a little more flexible (I know, what's more flexible than teaching?). For now, I am disabled to do my job as described in my policy's definition of disabled. Even my primary care doctor stated that I cannot work period and my conditions are multiple, progressive and regressing! Wow! What does it take? Well, thanks again for the info.

[ecmst12]

If they're denying because your doctor hasn't submitted the required paperwork, then you need to call your doctor and find out why. Some doctors charge a fee for filling out these forms, since it is very time consuming, and this is legal.