My Disability Is Denied

[sandrarojas]

What is the name of your state? ILLINOIS

I underwent for a Cochlear Implant on 08/27/02.
I got paid for short term disability from 08/27/02 thru 11/05/02.
My short term disability insurance is denying my benefits for disability pay for the month of November, December, 2002 and January 2003.
My claim had been denied on November 5, 2002.

In November 20, 2002, my doctor sent the disability insurance a letter indicating that I was under his care and that he did not release me to return to work on November 5,2002. He also wrote that the only date he release me is on January 21,2003.

I have been experiencing "Vertigo" since the surgery until January 21, 2003. Which there was no way to do my daily activity.

Disability insurance has indicated that my doctor's letter was not enough sufficient or not enough evidence. And that my claim is denied due to their own Doctor's opinion from the disability insurance stating that I should be back to work.

What should I do???
I have wrote numerous of letters, I sent them all my medical records, and still nothing. All I get is a letter stating, "CLAIM DENIED".

Should I hire a lawyer??
Please help!

 

[sandrarojas]

..

 

[Bigfoot]

Try first to get a free session with an area attorney specializing in disability matters and ADA. The easy part is getting to court. The hard part is paying the attorney if you don't win. Compare the amount of lost wages to the cost of an attorney and then decide. This may sound pessimistic, but you probably don't have deep enough pockets to pay an attorney to appeal if you don't win.

 

[ellencee]

sandrarojas
Send your complaint to the Insurance Commissioner of your state and send all of your documentation. State that you believe your denial is being made in bad faith by the insurer. Find the portion of your policy that states that their physician does not overrule your attending physician and include that or any other related provisions of your policy. Heck, send a copy of the whole policy.

ERISA mandates that you be given a reason, based on your policy provisions, for the denial. ERISA also mandates that you be given specific and clear appeal process information, including the time interval for making an appeal.

An RN that attends the same church as I do had a cochlear implant. She had to adjust to hearing all noises and not just conversation. The noise level almost drove her insane! I am curious to know if you suffered the same way, as in hearing all noises and had to adjust to filtering out unnecessary sounds. You don't have to answer; I'm just curious.

Thanks,
EC