Disability Happens ™

[This is one person's personal story who has been denied Long Term Disability] 

Hi. I used to work for this warehouse as a shipping truck loader, from 200 to May 2006; thats when I got hurt. I was hurt at work while pushing a heavy cart with a 2,500 pounds pallet on top of it,**(note that maximum weight on this cart is supposed to be 800 pounds** when I was trying to push it inside the truck to load the freight. I was put on STD [Short Term Disability] and eventually turned in LTD [Long Term Disability] in August 2006. They at LTD kept playing games and putting my benefits on hold almost every month or so for no good reason. They always claimed that they needed new objective evidence with restrictions and limitations from my physicians, every month almost. Well they kept playing that game until April 2007, when they sent me 3 months back pay that had put on hold right on April 2007.

Thats when they started to get very aggressive and annoying, calling me at home, sending letters and requesting doctors letters and statements and questionnaires from me and my doctors, calling and sending questionnaires and forms to my doctors to fill out constantly. My doctors always gave me notes stating what my conditions and diagnosis were and that because of them I could not go back to work until further evaluation and also my treatments and then he would write the next appointment date, and things like that, etc. But they at LTD kept saying that they needed more papers from me or my doctors and that they would keep my benefits on hold.

In mid April 2007 they set me up for a Functional Capacity Evaluation (FCE) and at the same time they set me up for an “Activities Check” as they call it; but also known by regular meaning as Spying on You with Video Surveillance to try to cut off your benefits in any dirty and unfair way possible. They taped me for 18 minutes only out of a 3 days surveillance. The only thing I’m seen doing in the video is sitting on a chair in the porch, walking and standing for just a couple of minutes at the time during the first 2 days of surveillance and most of the time I was inside the house resting in bed. They at LTD claimed that I was not disabled and that I was able to do my job because in the video surveillance (in about only 8 to 10 minutes on the video) I was seen walking and standing and climbing the 3 steps of the stairs on the front of my house on the porch without using the cane to walk. The truth is that I was over medicating at my own risk in desperation to relieve the pain at least a little, and I had my foot wrapped very tight as the doctor suggested. I was so over medicated with Novasal and Ibuprofen that when they were doing the video surveillance on one of the days of the FCE, I could not pass or finish the evaluation and the doctor was the one that stopped the evaluation because of the great pain he saw I was in before and then even more pain shortly after starting the evaluation and because I ended up vomiting blood right in front of the doctor in a garbage can that he supplied. The FCE doctor stated and documented in writing all this in the evaluation report in writing. Thats why I was able to not use the cane for those very short minutes. Since then Ive been bleeding on my stomach and stool and I have developed liver damage and I have the objective evidence of the liver damage on two different test they did on me 1 month apart from each other done in the end of 2007.

I know some people have been caught on video doing fraud and have been taped going to the gym and lifting heavy weights for 2 hours, or working on the roof of their house on construction carrying 90 pounds rolls of roof material; and they were denied benefits and the decision was fair, but not everyone does this. This people didn’t have anything or any objective findings and raised a flag to the LTD CO and they got caught lying. But the big majority of people that files for LTD are really suffering from disabling condition and they have proof and objective evidence and they still get denied, and tricked by this cruel and unfair LTD companies that all they want is to make themselves richer by keeping the money you are entitled to and not paying it to you.

This is what happened to me. I had an MRI done by my orthopedist doctor and he diagnosed me with Chronic Tendinitis, Synovitis, and a sprain/strain fracture on my foot and ankle around May, 2006 when I got hurt. My foot and ankle was always swelled and I was always in pain and I couldn’t even walk and put my foot on the ground. So he ordered rest, no work and to use strong pain killers physical therapy and a cane. He also put me on Physical therapy.

After several months I started seeing other doctors and they all agreed I could not go back to work in this conditions and ordered me to be off work and rest, all 4 doctors agreed to the same conclusion. This wasn’t enough for the LTD co and they still refused to pay me my money, that I was entitled to, especially since I was and I am meeting their definition of disabled based on their policy, which states that if the individual could not perform the essential duties of his own occupation solely and directly because of sickness, injury or pregnancy the individual is considered disabled.

Off course I could not do this job in my condition. I had to use a cane 95% of the time, I was on heavy medication that made me drowsy and sleepy, I was in a lot of pain with constant and regular swelling of my foot and ankle and knee. My job was to load 7,200 pounds of hardware freight (things that their weight mostly ranges from 50 pounds to 150 pounds each item, constant bending, standing walking on concrete floor, reaching, pushing, pulling, and do it for mandatory 8 to 14 hours a day, with no light duty available as the employer stated on a letter sent to the LTD Co). I could not load a truck while using a cane and being on so much pain and with a swollen foot and ankle and with all my conditions. But they at LTD sent me to a second IME on June, 2007 paid by them and also set me up for another video surveillance. But this time the investigator reported on the record that I was always at home for those 3 days surveillance and that I only left the house to go to the IME using a cane and that my face showed that I was in extreme pain at all times and that I was limping and walking with a guarded movements and that it was obvious I had some kind of physical impairment. And that IME doctor said I did not have any of those conditions or any condition at all and that I was perfectly healthy and that I should go back to work immediately, full time with no restrictions or limitations, and that I was in perfect health. 2 weeks later I was diagnosed with CRPS by another of my doctors, a foot and ankle specialist podiatrist, and the later on by 2 more different doctors that certified the condition.

Then another of my doctors ordered a Bone scan and on July, 2007, I got the results of the bone scan and the results said that I have: Post Traumatic Arthrosis on my left foot and ankle, Degenerative Arthrosis on my left and right foot and ankles and both knees, and preciosities attributed to enthesopathy on both feet.

I called the LTD Co to let the know I was faxing this objective evidence from the Bone Scan results and also I was mailing them that very same day along with a letter of my doctor saying that I could not work because of the findings and my conditions that I was suffering and that he was keeping me off work for another month and a half, etc. The women from LTD was mad and very mean and she told me to not send any papers because based on the IME and the video surveillance I was not considered and believed to be disabled and that they believed that I could and should return to work immediately. I told her all the findings and conditions I was suffering and that it was in writing on the bone scan results like they said they needed me to send in order to pay me benefits and that on a letter they sent me it says that I had until August 24th, 2007, to submit any objective evidence to support my disability and that I was calling the on August 3rd and that I still had several days left. The woman from LTD said that she didn’t care and that it didn’t matter and that she was denying my claim right there on the spot while I was talking to her.

I haven’t appealed yet, but I have until February 2nd, 2008, to do so. I don’t have a lawyer because I don’t have any money to pay for one. I saw one a few months ago but he wanted $3,000 down and 25% if he wins the case. But I don’t have money since I’m disabled and can’t work.

After the bone scan I had several xrays and labs done and more diagnosis. I got so depressed that I wanted to literally kill the supervisors at work that denied that I got hurt at work and refused to make a report of the incident on that day on May, 2006, and lied after they sworn [him] to say the truth in court on the Workers Comp Hearing and also wanted to kill myself afterward that when I told this I was pink slipped and sent to a mental hospital for 3 weeks. I feel a better with all the bunch of medications I’m taking now for the depression on top of the pain medications, but the pain and physical limitations are still there.

I hope I can win the appeal. I’m sending everything, every medical exam results, every doctors notes, medical literature of my conditions, photos of my feet and ankles all swollen, copies of the medications I’m taking and their side effects and everything I can to prove they are wrong and that I can not perform my past job duties in this health conditions. Because that’s what [it] is all about. I only have to prove [to] them I can’t do my old job with my medical conditions until the first 24 months are up. And I obviously can’t load trucks with a cane and a swollen foot and ankle. After the 2 years period then that’s another story, since they will want me to prove that I cant do any type of work even sedentary. I wish I could, but I don’t believe I can. We’ll see. I’m still seeking a lot of professional help to try to get better, despite that the doctors have told me that my conditions are chronic and irreversible and that they will progress to worst with time.

I’m almost done writing the objection letter to the video surveillance report which exaggerates and twist everything they see on the video. Please be careful every time you are set up for an IME, you are probably been video taped for those few days before and after the IME. Just think that at any time, every time, you could be watched and video taped. Be careful.

Any advise is more than welcome, since I’m alone in the process of appealing. at jeidyann@att.nett

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.

Category : Bad Faith Stories

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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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