thinkinghurts
Junior Member
What is the name of your state (only U.S. law)? CALIFORNIA
I need some insight from perhaps someone who has lived this process.
My STD ended this week.
My LTD was denied a month before STD ended. (Same Insurance provider (CIGNA), same documentation for STD approval was used to deny LTD).
I appealed.
Added additional doctors' office notes, documents stating that I could not return to work by my doctor, new MRI results, and a diagnosis of Relapsing Progressive Multiple Sclerosis (a rare quickly debilitating form that does not go into remission), there is no cure, obviously, but also no approved treatment for RP MS, and thus Chemo is the only approach. Efficacy is not assured, but worth a shot.
I was denied again, this week, claiming still "not enough documentation," to "prove" my continued disability, but certainly enough to suggest enough ability to work. How? I'm not sure, but I'm sure it's classic. This despite the fact they have every examination note from every doctors' office visit for six months, and a diagnosis confirmed by not one, but two (2) specialists, one a neurologist and head of the dept, (and Harvard grad, if that matters), and the other an MS researcher.
In the denial, it said I had another 180 days to appeal, during which I had an opportunity to pad the record with more documents, and when I appealed, they had 45 days to render another decision.
So, Two questions really:
1) Why another administrative appeals process? How many times must I appeal this before I can just go to US court?
2) One lawyer told me, considering my age 45, my salary, (about 150K), they'll fight my case all day long, regardless it's legitimacy, so I had better settle in for a two year fight.
Is that realistic ? Perhaps it is? I just need to understand what I'm facing.
Any insight is helpful. thanks
I need some insight from perhaps someone who has lived this process.
My STD ended this week.
My LTD was denied a month before STD ended. (Same Insurance provider (CIGNA), same documentation for STD approval was used to deny LTD).
I appealed.
Added additional doctors' office notes, documents stating that I could not return to work by my doctor, new MRI results, and a diagnosis of Relapsing Progressive Multiple Sclerosis (a rare quickly debilitating form that does not go into remission), there is no cure, obviously, but also no approved treatment for RP MS, and thus Chemo is the only approach. Efficacy is not assured, but worth a shot.
I was denied again, this week, claiming still "not enough documentation," to "prove" my continued disability, but certainly enough to suggest enough ability to work. How? I'm not sure, but I'm sure it's classic. This despite the fact they have every examination note from every doctors' office visit for six months, and a diagnosis confirmed by not one, but two (2) specialists, one a neurologist and head of the dept, (and Harvard grad, if that matters), and the other an MS researcher.
In the denial, it said I had another 180 days to appeal, during which I had an opportunity to pad the record with more documents, and when I appealed, they had 45 days to render another decision.
So, Two questions really:
1) Why another administrative appeals process? How many times must I appeal this before I can just go to US court?
2) One lawyer told me, considering my age 45, my salary, (about 150K), they'll fight my case all day long, regardless it's legitimacy, so I had better settle in for a two year fight.
Is that realistic ? Perhaps it is? I just need to understand what I'm facing.
Any insight is helpful. thanks