Cigna Denied!

Discussion in 'Fibromyalgia Main Forum' started by silky17, Mar 7, 2005.

  1. silky17

    silky17 New Member

    Well our good ole insurance company have ALL the power. Take our money for years and still deny short term disability. I am so frustrated and scared to go back. I really do not think I can deal with it again. I have had a headache for about 15 hrs straight nothing touching it.

    Every bit of noise seems to be magnified. Sometimes I just want to give it up! I am tired of the fight. What should I do? Has anyone came across this before? I am sure someone has. I still have 2 months on my docs note but now "no" money coming in. Is it possible to drwa unemployment while you are sick? Thanks,

  2. jasmine7

    jasmine7 Member

    I would recommend filing a complaint with your state financial insurance bureau. I did and they are investigating the company. I also have a lawyer I found online that works where they only accept payment at settlement. I am not going back to work as I can't and was told if I did it would hurt my case. You will need your doctors progress notes etc for the complaint as well to send to your lawyer and the complete claim file from your insurance company. Silky I hope this helps. I'm getting a bit further now. My employer is due to fire me in a few weeks since I can't return due to my health. I would encourage all to file a complaint with their state financial insurance bureaus. Good luck and I will keep you posted!
  3. jasmine7

    jasmine7 Member

    I would recommend filing a complaint with your state financial insurance bureau. I did and they are investigating the company. I also have a lawyer I found online that works where they only accept payment at settlement. I am not going back to work as I can't and was told if I did it would hurt my case. You will need your doctors progress notes etc for the complaint as well to send to your lawyer and the complete claim file from your insurance company. Silky I hope this helps. I'm getting a bit further now. My employer is due to fire me in a few weeks since I can't return due to my health. I would encourage all to file a complaint with their state financial insurance bureaus. Good luck and I will keep you posted!
  4. deelite127

    deelite127 New Member

    i've been fighting to get my short term disability for 4 months now. unfortubnatly you can't get unemployment. i don't understand it either. they don't care that we're going to starve to death & wind up living out of cardboard boxes. At this time i'm on my 4th appeal.

    hugs & good luck
  5. pookeysmom

    pookeysmom New Member

    I am sorry to hear that you were also denied. Are you going to appeal their decision?

    I was out per my Doctor's orders for 5 weeks. She wanted 2 to 3 months, but at 5 weeks I found out my claim was denied. We are running out of money so I was forced to go back to work. The best part was when the nurse realized I was taking narcotics for pain she told me not to take them at work! Duh, I am not supposed to be at work (I am taking them anyway). My Doctor's note stated that I was returning for economic reasons and that it was against her advise.

    The diagnosis of Fibro and Ankylosing Sponylitis was bad enough. Now some of the people I work with don't believe there is anything wrong with me. They can't see the constant back pain and severe fatigue so it isn't real. So far I have not had a headache/migraine, but it has only been 3 days. I called in sick on friday.

    It is soo hard for me to be here at work, I can only sit for a few minutes before my back is killing me, but I am too tired to walk around. Now in my spare time I will file an appeal to get paid for the time I have missed. They need "objective evidence". Apparantly the discussion that my Doctor had with their Doctor was not enough. My Doctor said it had gone very well and she was sure that it would be approved. The next day I got the phone call saying it was denied. When I spoke to her she was very upset. Sorry to ramble - I am still so angry.

    <br>[<i>This Message was Edited on 03/07/2005</i>]
  6. silky17

    silky17 New Member

    I hear ya, I have no clue what to do now. I believe I will probably go back to work and then they will lay me off. I hate insurance companies and if I could I would never use another one. They are nothing but takers of honest people. Then if you lie and cheat thats when you are successful.

    I honestly am torn. They want to get rid of me then they wonb't have to pay a cent. Personanlly if a person loses thier job and they refuse pay, I think they should have to at least pay back the evtra 6 and 3/8% I pay. For the extra money if I needed to collect disability. They get you coming or going. Sick to death of this so called life.

    Thanks for your response.

  7. pookeysmom

    pookeysmom New Member


    That is exactly what I was thinking. We pay for this insurance and when we need it - too bad. My Doctor did say that their Doctor was talking alot about long term disabiliy. She told them that it was only short term. That made me think that maybe they are worried that since I have 2 chronic conditions, if they agree that I am disabled eventually they will have to pay for a long term claim.

    You should check into the unemployment for your state, I read something that said you could collect for illness here in Florida. (This is one of the worst states for workers rights.) I just wonder what kind of proof they need.

    At least we know that we are not alone and there are others who understand. Hope you feel better soon. In the mean time I am buying lottery tickets!

  8. dd2926

    dd2926 New Member

    Hi, I'm new to the Board, but have had CFS on and off for the last 10 years. I have a great Dr., she's listed on the board for good doctors. Anyway, in May, 2001, she said I had to STOP working. So, I did, filed with good ole CIGNA and no questions, easy, was on STD, then went to LTD. In January, 2002, I had to go back to work, as my Company was going to lay me off. Went back, was doing OK for a little while, but then in June, 2004 had a major flare up. Same Dr., same Insurance company, but this time they DENIED me. They said they treat every case as a new one and do not look at when you previously were on Disability. Soooo frustrating. Anyway, the other posts are 100% correct, if you are to appeal, do it within your time limit, I also messed up there. Just wanted to let you know I feel what you are going through. I am really miserable and everyday is a struggle to work, but the Insurance Companies think they know how you feel. They want "Objective Findings".

    Good Luck and take care,

  9. pookeysmom

    pookeysmom New Member

    I found out today that our "global" HR people are going to have a meeting about me tomorrow. I am not sure if they will be able to influence the disability company, I think maybe they can since they are the one's who have contracted with them. My manager said that the note my Doctor wrote may be used against me. It stated that I had to return to work due to economic conditions but that it was against her advise.

    I am beginning to think that I shouldn't have returned to work at all, even though I worke 2 days then called in for 1 day. So far this week I made it in both days although I am miserable. I guess I panicked when I got the denial phone call. 5 1/2 weeks without pay and we might not be able to make the mortgage payment.

    I did speak with the disability company again, trying to find out when I might recieve the denial letter. It has not been completed yet! It has been 8 days since she called me with the denial. I need the info from the denial letter so I can start the appeal!!

    Silky 17 - you should think long and hard before you go back to work. I feel like I may have incriminated myself. Please let me know how you are doing.

  10. pooped

    pooped New Member

    Have you worked at this job long enough to qualify for a FMLA leave?

    I am not sure if all companies are the same or not but where I work, you have to have worked for something like 1,400 hours in order to apply for FMLA.

    Ask someone at your company about it.

    Although you usually don't get paid for an FMLA, at least your absences are covered from work and they cannot let you go.
  11. silky17

    silky17 New Member

    Thanks for that info,all we can compare with is what keeps us from not giving up. Now all I need to figure out is how to bring in some money while trying to appeal.

    Why did they tell you that if you didn't come back to work they would lay you off? How long does LTD last?

    Good luck to you,
  12. silky17

    silky17 New Member

    I have decided not to return so far. I am going to appeal. Sounds like they are holding back on your letter so you will run out of time. I wonder if they can say that you have to start your time from the time you are told by phone and not by denial letter? I'm tellin ya, they have all kind of tricks. Hang in there I will keep you all posted.
  13. silky17

    silky17 New Member

    Thank goodness that my HR rep told me about it. I am totally surprised she did. But I did get one. But now they want me to fill out a new one. Which tells me to be off so I can put in my appeal. This stuff is really hard.I have had the upper head and neck pain now for 3 days. I beleive its from the stress. Nothing is touching it.

    I will keep you all informed
  14. tess0306

    tess0306 New Member

    I did get my short term disability with no problem. However, when it came to long term, I was denied. I got found a lawyer that is versed in ERSIA to file an appeal. It did cost me some money up front which I thought was alot, but as others have said here, it is a drop in the bucket if your appeal is won. I did win my appeal and and it is in the process of being paid the back pay I was denied initially. Don't know how long that will take, but I had to go through my savings and had to draw some on my 401K to make ends meet. At least I had that to keep me from going under as I am single and had no income coming in. I personally think that if you are denied, get a good lawyer right off the bat! You have a much better chance at winning your case.
  15. dd2926

    dd2926 New Member

    Hi Silky17,

    I had exhausted by vacation, sick leave and also Family Leave. LTD can go on for years, it depends our your policy. I am at a point I just do not know what to do and you know how when we feel the way we do, it just takes soooo much energy to pursue and fight with the Insurance Companies, however, what they are doing is WRONG, WRONG, and it makes it worth fighting for.

    take care,

  16. rigby

    rigby New Member

    On Nov 2002 I applied for STD got 2 week and refused to pay the next year I got SSD but on STD or LTD even when I was in the hospital I have a lawyer who is now handling this for me as Unum refuses to pay anything. I still can not work. Rigby
  17. Mikie

    Mikie Moderator

    <b>Exercising Discretion: A Check on Health Care Costs and Coverage</b>


    Tuesday, March 8, 2005; Page HE02 (The Washington Post)
    By Tom Graham

    Back when she was selling disability insurance, Roberta Glick was covered by one such policy sponsored by her employer. Glick said she knew a group policy was less consumer-friendly than individual coverage; still, her plan promised to replace half of her income for two years if she was unable to return to her profession and until age 65 if she was unable to work at all.

    Glick, a District resident who is 64, said she stopped working early in 2001 due to osteoporosis, spinal stenosis, fibromyalgia, chronic fatigue and other ailments.

    Four years later, "I find that I am unable to sit or stand for more than 20 or 25 minutes at a time," she said. "There certainly isn't any job that I can hold down." Social Security agreed, she said, promptly approving her claim for disability assistance.

    According to a suit Glick filed in federal court, her insurer began paying her benefits in September 2001 but stopped two years later. (Many disability policies allow payments to end after two years if the policyholder is deemed employable anywhere, even outside the person's prior profession.)

    Marni E. Byrum, the Arlington lawyer who filed suit on behalf of Glick, said she is repeatedly seeing clients who have been "denied coverage once they reach the end of that initial period." Glick and her insurer, Liberty Life Assurance, ended their dispute last week with a confidential agreement ("This matter has been settled to the satisfaction of all parties," said Adrianne Kaufmann, a Liberty spokeswoman.)

    "Group policies are almost not worth the paper they're written on," said Fairfax lawyer Ben W. Glass, because they usually give the carrier "discretion" in handling claims and because dissatisfied consumers can overturn a denial only by convincing a federal court the insurer's decision was "arbitrary and capricious."

    Discretion clauses "offer a complete shield" to insurers, said Mila Kofman, an assistant research professor at Georgetown University's Health Policy Institute. "Insurance companies can deny a claim really for any reason . . . and they know it's a free pass in court."

    In November, UnumProvident, the country's leading disability carrier, resolved a national investigation of its claims-handling practices by paying a $15 million fine and agreeing to reconsider up to 215,000 denials. While noting that the probe "did not make any findings of violations of law," the company estimated that the settlement would cost it $127 million before taxes.

    "The biggest mistake consumers make is to believe that simply filling out the [claim] form, and having the doctor fill out the form" is adequate to guarantee coverage, said Glass. Filing a claim without strong supporting evidence from a doctor "doesn't work because the insurance companies legitimately want, legitimately need, objective information."

    Source: The Washington Post
  18. jasmine7

    jasmine7 Member

    I've been off work since November 2011 which is about 5 months now. I keep getting denied by Cigna as well. I'm on my 2nd appeal and have severe fibromyalgia, chronic fatigue syndrome, IBS and am down about 40 pounds now and still counting. I have to take nausea medicine daily so I don't get sick all day. I've been to internal medicine, rheumatology, GI, and the back and spine pain clinic. I've tried physical therapy and massage therapy and an getting worse. If I'm not back to work by May I'm fired due to being off so long. My progress notes all show I'm getting worse and my doctors have stated I'm 100% disabled. My job requires me to work 60-70 hours a week and I'm not even up for 40 hours a week!!! I hate Cigna, they are rude, do not care and in my records it states I'm under tremendous financial stress and have anxiety due to the insurance not paying me out. I've even seen psychology and they can't control my stress or anxiety levels due to this. I'm out of money and stuck at this point. I may have no choice but to go back due to financial reasons against doctors reasons as well. There is no way I could make 1 day, yet a week! These crooks should be put out if business!!! I've had extensive tests done for blood, X-rays etc as well to rule out every potential disease or condition other than Fibro yet they continue to deny me. My doctors are supportive but how can one get better when they are under so much stress which causes the pain to worsen?
  19. Mikie

    Mikie Moderator

    It is possible to file for SSDI while trying to file for LTD. Of course, if one wins both, the LTD benefit deducts what is collected from SSDI. &lt;BR&gt;
    It isn't easy to get approved for either. Our illnesses are especially difficult to prove. I had a very good atty. who sent me to various docs who he knew would document my case. It helps if one sees a shrink and a pain mgmt. doc. Taking narcotic meds is also a plus in winning one's case. My docs came through beautifully for me in filling out my atty's questionnaires. It took three years for my case here in SW FL to come to a hearing but I won and was paid retroactively. My atty. got some of it but it was worth it. Without him, I wouldn't have stood a chance of winning.&lt;BR&gt;
    Love, Mikie
  20. kbak

    kbak Member

    So sorry to hear your having such trouble. Everyone that I personally know, who have tried to get their disability ins., has had to hire a lawyer to get what they were promised. Disability ins. is a huge racket!! You pay for yrs. and when you need it they do everything humanly possible to make sure you don't get it.&lt;BR&gt;
    You might want to contact legal aid and see if they can help. Wish I had something more helpful to suggest. So sorry your faced with this.&lt;BR&gt;
  21. mbofov

    mbofov Active Member

    It sounds like you really need a good lawyer. I believe they will work on a contingency basis, so you shouldn't have to give any money up front. Their fees might even be set by law. I know with SSDI disability claims, legal fees are set by law (the percentage they can collect)&lt;BR&gt;
    I'm really sorry you are being put through all this - it's not fair, the only consolation is they do it to everyone!&lt;BR&gt;
    You might want to do a separate post about good attorneys for disability claims - many people on this board have had to go through this and could probably give you a recommendation -&lt;BR&gt;
    good luck!&lt;BR&gt;