Disability Happens ™

My husband has had Crohn’s disease for over 25 years. About 2 1/2 years he developed a rare disease called Pyoderma Gangrenosum. The best way of describing it is incurable ulcers that eat down to his tendon. It is systemic and chronic like Crohn’s. Mike has not responded to the medicines that are available. The condition is extremely painful, the fear is amputation if not controlled. Trauma makes it spread like ‘wild fire’.

We battled Cigna and PG for 2 years. Mike wanted to go back to work, so he would try. Cigna wanted to deny the claim, so they would try. It was an emotionally exhausting battle. Mike tried everything from Hyperbaric Oxygen Therapy to injecting chemo into his belly once a week. (as he does now as well as Cimzia). Ultimately 4 specialist came to the agreement that the only way Mike will keep his leg is to stay on permanent disability.

Through this battle to find relief Mike also developed Vascular disease, a “massive” dvt. Besides Osteoporosis.

December 2009 Mike moved onto Long Term Disability. They notified of a review in March. Then denied his claim in May 2010 without notice. Cigna has been told by 3 specialist since November of 2009, that Mikes conditions are chronic and dibilating and these diagnosis’ will not change. They have been told that any trauma to his leg WILL lead to amputation. These facts were made aware to them yet again in May. They still chose to deny his claim. They have been made aware of his limitations. They have a colonoscopy report from 7/2009 proving that is Crohn’s is active, yet in May 2010 that was not “current” enough. They have said to him they look for “weight loss” to prove that Crohn’s is active. They also want labs for PG. According to their own medical encyclopedia, there are no labs for PG.

This company has lost DR. notes. (the colonoscopy report had to be faxed 3 times). They have ignored diagnosis’ and prognosis’ repeatedly. They do not return phone calls from us or our Dr.s. They have said they have phoned Dr.s when they have not.

My husband did not ask to be sick. He is only 45 years old and he loved his job. Cigna is a horrible company. If we knew this is how he was going to be treated we would have been better off burning the money he spent on premiums in the back yard.

Category : Bad Faith Stories

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I am a 63 year old female, who was employed in the health care appeal industry for over 20 years. For years, I had paid for a portion of my disability insurance with after tax dollars. In 2007, I was diagnosed with severe osteoarthritis of both knees and had to undergo bilateral knee replacements. CIGNA covered me for the short term disability portion and long term disability portion of my disability period. In December 2007, CIGNA offered me a back-to-work incentive, so I returned to work for my company in a reduced capacity. CIGNA continued to provide the back-to work incentive so that I was making the equivalent of my former salary. In the fall of 2008, I began experiencing severe lower back and left groin pain. I could not sit for long periods of time or stand for more than 10 minutes without severe pain. I had to use a cane for ambulation. X-rays of my hips revealed no cartilage in my left hip at all and severe degenerative osteoarthritis of the right hip with joint space narrowing. CT and MRI of the back revealed severe degenerative osteoarthritis of the lumbar spine from L2 to S1. I had three areas where the central spinal canal was severely compressed and areas of severe neuroforaminal narrowing. My orthopedic surgeon advised hip replacements and my spine surgeon advised facet injections until after the hip replacements, and then possibly surgery. I was on narcotic pain killers. Facing three surgeries and over a year and a half of rehabilitation, I opted for early retirement and let CIGNA know I could no longer work. I applied for, and was approved by Social Security Disability within two months with no medical examination required. CIGNA continued to cover me until May 2009, my two year anniversary. They sent me for an IME to an occupational medicine doctor, who saw me for a total of about 15 minutes. He stated I could work a full time sedentary job. CIGNA then denied further benefits. I am in the process of appealing this decision with an attorney’s assistance. I have had one hip replaced and developed a postoperative wound infection. There is no way I can work in any capacity, yet this doctor, not even an orthopedist or spine surgeon, says I can work. I can barely walk with a cane. This was totally unfair and has caused extreme economic hardship for me.

Category : Bad Faith Stories

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I faced many denials/appeals for my initial application for LTD benefits through cigna.I prevailed and received four yrs back payments and four more yrs. I was sent to an IME after I disagreed with my worker compensation offset. cigna terminated my benefit using the ime and their internal machine. i obtained an attorney. we appealed but cigna failed to even respond to the appeal. so I sued in federal court. cigna objects to the new york jurisdiction. we won the right to discovery recently.

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by “One who wants to see laws change” 

The worst insurance policy to have is a long-term disability (LTD) policy because it usually falls under the guidelines of Employee Retirement Income Security Act (ERISA). If you make a claim on an ERISA covered LTD policy and have been denied benefits, you will be unlikely to find an attorney to pursue the matter. The major obstacles to finding an attorney to handle your lawsuit are that you must sue in Federal court, you are unable to collect attorney fees if you do prevail, punitive damages cannot be awarded, and it cannot stop the insurance company from just doing it again after time has passed.

You will not have much luck with your state’s Department of Insurance (DOI) either. Of all the state DOI’s, California is probably the most effective one, and even it is powerless when it comes to a LTD policy covered by ERISA. In fact, no state regulates ERISA insurance policies. The state DOI’s only regulate how the insurance company conducts business in the state-not the policy itself.

I purchased a long-term disability (LTD) policy with CNA insurance thinking I would probably never use it but if something should happen to me, this policy would take care of me as it so stated. I didn’t think about it again, just made my payments each month, until my life turned upside down and I wasn’t able to work.

I was brought up with a strong work ethic, and I loved my work. I would have done it without pay if I could have lived without an income. This only increased the emotional pain of not working. Regardless of how much I wanted to return to work, the physical pain and was too great to overcome. Eventually my injury required surgery which was supposed to make me as “good as new” but unfortunately took away one physical problem and created others.

For the first 3 months of my disability, I had short term disability insurance through my employer’s insurance. For the balance of the first year, CNA made LTD payments to me but subtracted from their payments the full amount of the State of California’s Disability Insurance (SDI) benefits. CNA’s contact rep assured me I was lucky and had a good policy and I would be taken care of. Actually that was the first rep I had, (She was the one who said don’t bother with workers comp because you have us and the policy clearly indicates you’re covered!) As the months went by, I was passed on to new reps. The kind and compassionate attitude diminished with each rep change. At the end of the year, when California’s State Disability Insurance was about to run out, I received a letter from my newest rep stating CNA was denying any future benefits because they felt I ’should’ be better. My LTD income immediately stopped. I later found out that this was typical…to stop paying when they would have to pay the first complete benefit payment. First make you feel safe, then kick you in the stomach when you are the most vunerable.

It didn’t matter to CNA that all 6 of my very reputable medical doctors said I was 100% disabled nor did CNA think I had a right to be examined by one of their physicians. I asked to see their doctor. I had nothing to hide. But I was refused. I was never examined by a doctor or representative of CNA insurance.  Our only communication was over the phone with an assigned rep. Yet, I had one of the “good” policies that said CNA would cover me if I could not go back to the kind of work I had been doing when I was injured, and that I would be covered as long as I was disabled. They cut me off, and I was told the only thing I could do was to file a petition for a grievance and wait 90 days before I had an answer. If I continued to be turned down, I would then have to appeal to Federal Court.  Since they wouldn’t even send me to a doctor, it was pretty clear what the answer would be. It was also clear that this would be dragged out.  I had to find an attorney.

I was not getting any better and, if anything, my situation was deteriorating under the stress of not knowing how I was going to be able to pay the rent and day-to-day bills and my COBRA $300 a month health insurance. I hadn’t filed for worker’s comp because the CNA Rep told me not to bother because they would take care of me. Also, I thought I would be going back to work soon.  Like so many others faced with medical expenses I was forced to use credit cards to live while waiting for resolution. Eventually, I was forced into bankruptcy. Which was humiliating after a lifetime of good credit.

Like so many disabled individuals who find it difficult to muster the energy to fight a deep pocket insurance company, I needed help in working through the insurance company’s labyrinth of mythical proportions. I wouldn’t have been able to do it without the help of a friend.

Phone call after phone call to attorneys who handle insurance claims were met with the same response after telling them of my denial by the LTD insurance company-laughter.With the help of my friend he found an attorney who would see to me.

We located a law firm familiar with ERISA, and one that wasn’t on the side of insurance companies. At first, after wading through the contracts, it seemed clear that my claim against CNA insurance clearly DID NOT fall under ERISA guidelines and that the case could and should be heard in a California state court. Unfortunately, over a period of time, and several meetings,  my attorneys were out maneuvered by CNA’s attorneys. CNA provided NEW material that made references to ERISA–(surprise…surprise). Though not the original contract which I possessed (which indicated that I, not the company, had purchased the LTD insurance from CNA and I not the company paid for it without any reference to ERISA) , the new material made references to ERISA.

This new material, and a similar case elevated to the 9th Circuit Court which had just been denied the right to litigate in State Court, meant to my attorneys, that this made my chances of recovery slim. My case now referred back to Federal Court and I was left SOL. However, I was told that if I tried to go after CNA through Federal court, CNA would charge me their attorney fees for what they had already spent on the case while I was trying to be heard in state court. They strongarmed me into signing a statement that said I wouldn’t pursue it further. They forced me to stop. What else could I do. I couldn’t risk losing in Federal Court and then oweing their attorney fees. I maintain they defrauded me. To date, about $500,000 worth. This is just the monthly benefits I didn’t get. Since I am still disabled and the policy was for my lifetime…the backpay keeps growing. 

Fortunately, after being turned down the first time (common practice) and obtaining a social security attorney, SSDI approved my claim for 100% disability. I was able to start receiving Social Security Disability income. I also found a great Workers Comp attorney. After filing for bankruptcy, and moving to a lower income area I was able to just barely live on social security disability income. It took another 5 years to finally settle my workers comp claim. If it had not been for social security, I would have been destitute.  As it was I was left with 7-10 years of bad credit and the humiliation of how it effects all aspects of ones life. 

Long term disability insurance policies are worthless. The stats I found said that only 5% of the insured fight back when they are denied their rightful benefits–5%. That means I am in the 5% who fought and look what happened to me. I had all the reputable doctors, all the documentation, a signed contract that stated that the policy was between me and the insurance company, but when it came down to using it, they ‘found’ bogus “company” documentation that I had never been privy to, dated after my contract, that placed me “under ERISA guidelines. They defrauded me and there was nothing I could do about it. Nothing. No laws to protect me.

My only way to fight this injustice was through State Court and for a while I believed I might actually achieve justice. But the laws are set up for the insurance companies not people who are disabled. The judges side with the insurance companies a majority of the time. I get angry when I hear misinformed people making comments about ‘those people’ who collect disability income and spend leisure time water skiing or laying around pretending to be injured…stealing the federal or state money…you’ve heard the comments. I mean, after all, who do YOU believe,  individuals who ask for disability income or insurance companies?

Most people who ask for help, are legitimate, the insurance companies lobby in Washington and State Capitols, sell commercials on tv and radio, insert lies as public service announcements to make us believe that “those people pretending to be disabled” are causing “your taxes or insurance payments to go up”. The truth is their greed is causing the insurance policies to go up. I have learned a lot in the last 8 years. I hope this will help others who might be going through this. Get Attorneys, and fight for your life. Maybe you’ll be the one. The one to win in court. The one to change the laws to protect yourself and others in need. Maybe you’re feeling great today…no one expects to be injured and unable to work. When we feel well we all think we’re invincible, but we’re not. Contact your representatives…ask about your rights. Protect your future and the future of your family.       

Category : Bad Faith Stories

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One aspect of disability claim management that flies under the radar revolves around Certified Rehabilitation Counselors (CRC) and the use of transferable skills analysis (TSA). Many of these TSA’s are unethically prepared to help the Insurer deny benefits. Since insurers are the largest pockets in the CRC referral game the industry has seen a race to the bottom to receive the money thus leaving the claimant in the cross-hairs of the hired gun preparing these TSA’s. Please see http://www.thetsascam.com/ for stories.

Category : Bad Faith Stories

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This new feature was inspired by the documentary film, “bad faith.” Take a moment and share your experience being denied a disability claim.

Click here to —> Share Your Bad Faith Story

Category : Bad Faith Stories

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