Need help with disability Claim

What is the name of your state? Wisconsin

Here is my situation:

My disability insurance became effective on 07/01/2006, and I went on STD 10/26/2006 and was approved. I am still on STD for mental issues like Bi Polar Disorder, Anxiety, Depression and so forth. It's my understanding that the STD lasts like 6 months, and beyond that date it becomes a LTD claim.

I received a letter stating that they need to determine that my condition is not pre-existing, that I have not seen a doctor or taken medications for my condition for at least 90 days before I became eligible for Disability. Basically covering 04/02/2006 through 06/30/2006 Prior to April 2nd I did see a Psychiatrist in January 2006 to be exact. She did retire and wrote prescriptions to cover me for 6 months until I found another doctor. I knew I was leaving my employer and did fill some prescriptions before I left in case I needed them, but did not take them.

In fact I did not start taking medicines until 10/09/2006, basically 9 months. The prescriptions I filled basically went in the garbage because I felt I was cured of my then diagnosis of depression. In October 2006, I was diagnosed with Bi-Polar Disorder, Chronic Anxiety, Sleep disorders, and High Blood Pressure. The insurance company is wanting to know my health care providers from 07/01/2006, to present, as well as any prescriptions I took, but did not actually take.

Furthermore it is The Standard Insurance Company, and if they want to know of prescriptions I took from 04/02/2006 to 06/30/2006 I can say had I went on disability between 04/02/2006 to 05/26/2006 I would have went through the Standard, as my previous employer went through the same company.

I really need advice here, as I will need this income while my claim with Social Security is being processed. It looks like The Standard is doing a Double Standard. The Kmart pharmacist I go to claims they have never had an insurance company ask for pharmacy records before, and felt that scare tactics were being used.

Your helpful information to my situation would be greatly appreciated.

Sincerely,

DB

So, lets see if I understand your situation.
1) You had sufficient reason to see a Psychiatrist in January 2006.
2) The psychiatrist felt you needed drug therapy and prescribed 'some' (more than one... unknown number) medications to treat you for 'depression'.
3) At some point in here (presumably about June 2006), you changed employers (supposedly while under psychiatric care).
4) You have now found a VERY sympathetic doctor who comes up with a large number of 'illnesses' that you are trying to turn into a disability scam against your new employers insurance company to try to pay you on a pre-existing mental problem.
5) The employers insurance company has now asked you about your PRE-EXISTING condition... and you are afraid to tell them since you know they will deny your claim.
6) And you now are asking this LEGAL forum for advice on how to avoid their proper request.

Pretty much covers it, huh??
Sorry, but the only REAL answer here is for you to be totally honest and comply with their reasonable request. If you do, you have a chance of possible coverage. If you don't, you will leave them with no choice BUT to deny your claim.

You will have an extremely hard time trying to convince them that you had the prescriptions filled (your post is a little confusing there... since you deny it in one place, yet refer to K-mart as where they were filled??) and you didn't take them.

JETX said:

So, lets see if I understand your situation.
1) You had sufficient reason to see a Psychiatrist in January 2006.
2) The psychiatrist felt you needed drug therapy and prescribed 'some' (more than one... unknown number) medications to treat you for 'depression'.
3) At some point in here (presumably about June 2006), you changed employers (supposedly while under psychiatric care).
4) You have now found a VERY sympathetic doctor who comes up with a large number of 'illnesses' that you are trying to turn into a disability scam against your new employers insurance company to try to pay you on a pre-existing mental problem.
5) The employers insurance company has now asked you about your PRE-EXISTING condition... and you are afraid to tell them since you know they will deny your claim.
6) And you now are asking this LEGAL forum for advice on how to avoid their proper request.

Pretty much covers it, huh??
Sorry, but the only REAL answer here is for you to be totally honest and comply with their reasonable request. If you do, you have a chance of possible coverage. If you don't, you will leave them with no choice BUT to deny your claim.

You will have an extremely hard time trying to convince them that you had the prescriptions filled (your post is a little confusing there... since you deny it in one place, yet refer to K-mart as where they were filled??) and you didn't take them.

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I am not trying to scam the insurance company. I left a very stressful job for one that was even more stressful. I did in fact go 9 months without seeing a psychiatrist or taking my medications. I did have prescriptions filled at Kmart in case I would need them because I was leaving my employer for a new one, but did not take them. In fact the new psychiatrist personally discarded 3 out of the 4 prescriptions I was taking.

She said Topamax was dopamax, Neurontin had been proven to not help any psychiatric disorders, and Adderall contributes to high blood pressure. Zoloft was the only medication kept. My additional thought is through TCF I had Standard Insurance, and when I left for Countrywide I had Standard Insurance. If they are asking for medical records for 90 days in their letter, and a years worth of records on their form this doesn't see right. And providing them the 90 days of information would have had me covered under TCF's policy.

As I said I am not trying to scam anyone even if that is how it would appear. I am seeking advice please.

Dsmcseller said:

If they are asking for medical records for 90 days in their letter, and a years worth of records on their form this doesn't see right.

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Why not?? They have the RIGHT (really the OBLIGATION) to properly investigate your claim. Let them do that... unless you have something to hide.

And providing them the 90 days of information would have had me covered under TCF's policy.

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Not relevant.

As I said I am not trying to scam anyone even if that is how it would appear.

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It 'appears' that way because you are refusing to comply with their request since it could lead to a denial of your claim. Quack psychiatry is only one of the most common 'disability scams' out there and the insurance company's are right in investigating them to protect the funds for those who have 'real' claims.
Either yours is real (provide the proof) or it is a scam. Your choice. Oh, and if you think getting disability from insurance is tough... wait until you try to get SSI.

I am seeking advice please.

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And you got it.

Adderall is an inappropriate medication for bi-polar disorder. Did the prescribing doctor have a diagnosis of bi-polar disorder for you? The stimulant greatly enhances the mania aspect and contributes to a worsening of bi-polar symptoms.

You were not under a doctor's care for the ninety day period as the doctor who had prescribed the psychotropic medication had retired. This doctor should have transfered you to another doctor when she retired. As the doctor has retired, it is unlikely your medical records were retained past six months.

This essentially becomes a moral decision for you and none of us can help you with that decision.

The choice to work in a stressful environment is yours. If the SSDI vocational rehab expert who will testify at a disabilty hearing (in two or more years) determines you can work, but just not in a high demand field, your claim will be denied. What is your occupation?

JETX said:

Why not?? They have the RIGHT (really the OBLIGATION) to properly investigate your claim. Let them do that... unless you have something to hide.


Not relevant.


It 'appears' that way because you are refusing to comply with their request since it could lead to a denial of your claim. Quack psychiatry is only one of the most common 'disability scams' out there and the insurance company's are right in investigating them to protect the funds for those who have 'real' claims.
Either yours is real (provide the proof) or it is a scam. Your choice. Oh, and if you think getting disability from insurance is tough... wait until you try to get SSI.


And you got it.

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I fully plan to comply with their request for information and will not be hiding a thing. Kmarts pharmacy records will indicate many months without a prescription being filled. Because I was not taking any medications. I will be fully honest. So If they deny the claim should I just accept it then?

Dsmcseller said:

I fully plan to comply with their request for information and will not be hiding a thing. Kmarts pharmacy records will indicate many months without a prescription being filled. Because I was not taking any medications. I will be fully honest. So If they deny the claim should I just accept it then?

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I assume you are a lawyer, is this something a lawyer could assist with here in WI?

I sought an attorney for my workplace disability claim but couldn't find any takers--they all wanted to head straight for SSDI. There is not much money to be earned by an attorney for a workplace insurance disability claim.

Ozark_Sophist said:

I sought an attorney for my workplace disability claim but couldn't find any takers--they all wanted to head straight for SSDI. There is not much money to be earned by an attorney for a workplace insurance disability claim.

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Adderall was taken for ADD. During this time I was diagnosed with Depression, and ADD only. I was working as a Mortgage Loan Officer and went to Countrywide as a Processor. I do go for my SSI Mental Health Exam next month. I am now diagnosed with Bi-Polar disorder, ADD, schizophrenia, and sleep disorders. Countrywide provided very little training and dumped over 50 loans on me in one month and this greatly aggravated my condition. I did not ask to be placed on disability but was going through psychotic episodes with mania and that why I am on disability now. I do not feel I am trying to defraud anyone. I bought the coverage and had the same company for coverage with my previous employer.

Dsmcseller said:

Adderall was taken for ADD. During this time I was diagnosed with Depression, and ADD only. I was working as a Mortgage Loan Officer and went to Countrywide as a Processor. I do go for my SSI Mental Health Exam next month. I am now diagnosed with Bi-Polar disorder, ADD, schizophrenia, and sleep disorders. Countrywide provided very little training and dumped over 50 loans on me in one month and this greatly aggravated my condition. I did not ask to be placed on disability but was going through psychotic episodes with mania and that why I am on disability now. I do not feel I am trying to defraud anyone. I bought the coverage and had the same company for coverage with my previous employer.

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I believe you. I wrote about adderall because I was concerned. When I hear about a depression and ADD diagnosis, I think bi-polar. Untreated bi-polar with mania often induces schizophrenic symptoms of hallucinations and paranoia. Add stimulants to the mix and lifelong damage to the nervous system could result (meaning the paranoia and hallucinations never go away -- which is why treatment for bi-polar is necessary and the earlier, the better).

Ozark_Sophist said:

I believe you. I wrote about adderall because I was concerned. When I hear about a depression and ADD diagnosis, I think bi-polar. Untreated bi-polar with mania often induces schizophrenic symptoms of hallucinations and paranoia. Add stimulants to the mix and lifelong damage to the nervous system could result (meaning the paranoia and hallucinations never go away -- which is why treatment for bi-polar is necessary and the earlier, the better).

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Thanks Ozark. I now take Straterra which is suposedly stimulant free. I really do feel like a mess. I don't feel capable of doing anything right now other that working for Pizza Hut as a delivery driver, and would make far less than SSI disability of $1500 per month. So whats your take on this situation with Standard Insurance. I do need this income to survive and dates all seem to be the problem. Meaning I should not have had those presriptions filled and I would probably be okay. Your advice is appreciated.

It is a moral decision. You have already stated you intend to fully disclose--a good thing. Since the time period in question is 90 days, during which time you were not under a doctor's care (the doctor retired and did not transfer you to another doctor) and not taking medicine (despite having it -- how many people in this forum have pill bottles in their medicine cabinet from an illness last year or earlier), I think you are good for the STD (my personal opinion--not a legal one). LTD is tougher. Utilize the STD period to get as much medical assistance as you can. Has your illness resulted in any hospitalizations?

Ozark_Sophist said:

It is a moral decision. You have already stated you intend to fully disclose--a good thing. Since the time period in question is 90 days, during which time you were not under a doctor's care (the doctor retired and did not transfer you to another doctor) and not taking medicine (despite having it -- how many people in this forum have pill bottles in their medicine cabinet from an illness last year or earlier), I think you are good for the STD (my personal opinion--not a legal one). LTD is tougher. Utilize the STD period to get as much medical assistance as you can. Has your illness resulted in any hospitalizations?

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Oh I am approved for STD, this runs out in May, but since the prognosis has not improved it has been turned over to LTD dept. I have my SSI Mental Health Exam on 04/04/07. I was ordered to go to mental ward under previous doctor, and she had police dept called for attempted suicide but I lived over the state line and she didn't realize that. A few days and I was feeling better, was probably a manic episode. I wish I could send you the complete letter but that would span several pages. If they are wanting 90 days of medical providers and medications prior to July 1, 2006, then why are they asking for medical records on another page covering July 1, 2005 to the present. I dont mind being honest, but there is a difference between taking medications and having them dispensed. Would it be wrong to state from January 06 to October 06 I did not take any meds until I saw a new psychiatrist? There is an area I sign that says if I defraud the insurance company with intent all this trouble I can get in. Would the above be intent to defraud

JETX said:

Why not?? They have the RIGHT (really the OBLIGATION) to properly investigate your claim. Let them do that... unless you have something to hide.


Not relevant.


It 'appears' that way because you are refusing to comply with their request since it could lead to a denial of your claim. Quack psychiatry is only one of the most common 'disability scams' out there and the insurance company's are right in investigating them to protect the funds for those who have 'real' claims.
Either yours is real (provide the proof) or it is a scam. Your choice. Oh, and if you think getting disability from insurance is tough... wait until you try to get SSI.


And you got it.

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I think it is relavent if I had disability through the same company. At both jobs it was the standard. If they are wanting 15 months of medical and prescription information I would have been covered through them at the time anyways so if it's judged pre-exsisting they should be on the hook. Maybe I am wrong.