Disability Appeal Again?

[JCT]

I went on short term disability last July, for a still undiagnosed illness. When my STD was due to be converted to LTD, the doctor I was then seeing told me that he'd "handle the paperwork". He then gave the insurance co a return to work release--while specifically telling me (in front of my husband and his receptionist) not to try to drive or go back to work. The LTD was denied, because of the RTW release. The dr said that there was a mistake, that he was unfamiliar with disability forms, and that even though none of my test results were conclusive, he did not recommend that I go back to work. I appealed the denial, sending a letter stating all of my symptoms, the drs I'd seen (with their office notes and test results), and a (very lukewarm) letter from the original dr saying that I should be given the LTD, and a statement that I was being referred to another doctor. The appeal was denied, because none of the tests supported any medical findings to show disability, and the dr that released me to work did not provide an explanation of his error in doing so. I have since seen the new doctor, and she has indicated that she believes I have early stage MS, that does not show on the (limited) tests I have had, and for which there is no definitive test (the diagnosis is usually a clinical one, since there is no specific test for it). My question is, can I request another appeal, based on any new test results and/or the preliminary diagnosis from the new doctor? About a week after the denial letter, I received another letter from the insurance co, saying that if I wished to pursue this matter, I should consult the Summary Plan Description of the policy, which my former employer has refused to provide to me. The new dr has indicated that once I am diagnosed and can begin treatment, I will be able to resume my normal life, but in the meantime she recommends that I not try to work, drive, etc. I have been looking for work, (since I lost my job due to this in Nov) but I can't even get to the interviews, much less do the jobs, if I were to get hired. Any advice will be greatly appreciated.

 

[ALawyer]

This is a difficult case. The protestations of mistake by the doctor lack conviction, and the insurance company is rather doubtful and/or suspicious.

It looks like what was at best a close case was seriously harmed, and at this point it may make sense to see a lawyer who deals with disability (even Social Security Disability) and have the "medical case" better documented and then appealed according to the process the company laid out. As for the Summary Plan Description, write to the comapnay witha CC to the US Department of Labor asking for a copy, but I doubt that likely to help your case.