Private Disability Insurance

[nora]

I have been on disability for 4yrs because I have an autoimune disease (Polymyositis), and after 24 months of receiving long term disability the insurance company is trying to deny me benefits because my condition has improved but is not stable. I have sent them letters from my doctor stating that I have not reached full recovery, but their medical and vocational staff are disgarding my doctors advice and say that I should be able to return to work part-time. Can I sue the insurance company and what steps should I take? I am appealing, but what if they still deny me, what are my options? If I return to work PT and I have a relapse because of returning to work, can the insurance company be held liable? My doctor has already told them that the extra activity could exacerbate my condition.

Help! Thanks
Nora-Tampa, Florida
Insurance - Maine

 

[ALawyer]

This is a constant problem -- and it really is a question of evidence.

Just because your doctor says one thing does not mean the insurance company has to accept that. It knows that some doctors write anything their patients ask them to -- it's not like a note fom one's mom was at school, and others are not really experts in the field.

Sometimes it is what the doctor said, or if the doctor is not foceful enough in his diagnosis or conclusion, or lacks tests with objective evidence, or is not a sufficient specialist. The usual result is to see another doctor -- a real specialist -- whose opinion will be reinforcing and even stronger.

But perhaps you can work limited hours, part-time. Most policies have a partial reduction. Many people find they can do the work, and really value being productive again.

A lawyer who does disability work --perhaps someone who does Social Security appeals or insurance work can advise you -- it's worth the fees and less expensive than losing benefits and suing fee to get as strong a case as possible in to the company.

 

[nora]

Thanks

Thanks for replying and the helpfull information. I know that everyones so busy, so it's nice to know that some people still take the time to help. The information is very usefull and I have started looking for a lawyer to represent me and I have also begone the appeal process and filling a complaint with the department of insurance. Also, as my insurance company has requested I have begone looking for a part-time job this does not require too much activities (I don't think they exist. but I'll try and see)So far I have had only one interview from the multiple listing I have applied to, and the 30 days the insurance has given me have lapsed, so I don't know what I will be financialy be cause I spoke with the rep today and she said she cancelled my claim Fri. because she did't think I was looking and doesn't know that my looking even counts sence the time has past. I gave her the name o places I applied so we will see. It's been so difficult... not only do I have to battle with this desease but with the people who are supose to be helping too, and I have to do all the fighting myself and it's hard because my helth is crappy. So the moral of this story is that if you have good health value it and take as good of care as possible because you never know when it might happen to you (but what could I have done to prevent it-nothing). Sorry for blabbing, just frustrated. Thank again for taking the time to care and help. Greatfully, Nora