Hi Candi,
I wish you the best of luck with your LTD hearing. You have a right to
all the paperwork out of your file at the insurance co. and should order it
if you do not already have it. The insurance companies have no conscience at
all. Their job is to get people off the disability roles, and I understand
that they need to get the ones off that aren't really disabled, but not the
ones that are.
My LTD provider (Prudential) did the same as yours regarding sending a
letter to my doctor requesting that he complete a form about my condition and
what my capabilities were. They also stated on the letter to him that I had
been working on a part-time basis and requested the stand, sit, walk, etc.
questions. Now, my policy states that I am entitled to benefits if I am able
to work on a full-time basis based on my training or what I can be trained to
do, something like that, and on and on. I haven't worked at all since Dec.
2000, and they know it or they would not have been paying me.
This was sent to my Neuro, and all previous correspondence was sent to
PCP. The Neuro hadn't even asked me to come into his office for a visit
before sending back the form to the insurance company stating that since I had
been working part-time that I could work full-time now, after listing
capabilities that don't match me at all.
In the meantime, I had gone to a Physiatrist that the insurance co. set
up for a review of my condition. This doc stated that I was not able to
work. Then, since the insurance co. got the form back from my Neuro stating I
could work full-time, they contacted their doc and asked him to reverse his
decision and state that I could work, telling him that my doc must know my
condition better than he does, and he did it. I was denied my coverage at
that
point.
It took a couple of visits to the Neuro to get everything squared away
with his paperwork and re-submitted. It also took me requesting copies of all
my paperwork from the insurance co. in order to have ammunition for my
appeal. There were about 3 reams of paper worth of copies they sent me, and
most
were triplicates of my early TM years, including hospital info. That was
very depressing looking back at that stuff. I had to submit 2 appeals. They
were tough, but I'm glad that I stuck with it and finally noticed what they
did
with the doc they hired. That was very underhanded and let them know it was
wrong and not proper business practice. When I later told my husband he was
really angry and felt we could have sued them for what they did, but I don't
know. Especially since I may not have caught what they did, and could have
possibly lost again and had the expense of a lawyer. If it went to a lawyer
and I would win, they pay the lawyer. If I lose, I pay the lawyer.
This was about 3 years ago, and I just got another letter with a form
for a doctor's statement. I now have a new PCP and Neuro, so I hope all goes
well. I have a HMO and the process is that I drop off the forms to the
medical secretaries and they go back and forth to docs to be filled out,
transcribed, approved, distributed and filed. I sent emails to them letting
them know
I am available for questions and the trouble that I had last time. I hope
this works out without any snags. If we don't fight for our rights, who will
do
it for us??
Hugs to all, Barbara A
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