Disability/Metlife

Discussion in 'Fibromyalgia and ME & Chronic Fatigue Syndrome' started by herbqueen, Mar 30, 2011.

  1. herbqueen

    herbqueen New Member

    My employer LTD is through Metlife. My history is fibro 13 years, last 5 years progressive neurologial MS type symptoms starting with optic neuritis. I fall into unknown neuro disease or chronic lyme category. I have letters from my GP, Neuro, and Naturopath (with neuro supporting the current naturopathic treatment for) that I am disabled and cannot work. Neuro says a no diagnosis is not unusual in field of neurology (they don't believe in chronic lyme)Insurance company says there are no clinical findings of disability and therefore rejecting my claim. I was a top performing employee at this major computer/sw company for 26 years. I'm trying to appeal their original rejection with these letter from my physicans but doesn't seem to make a difference.

    Any ideas?
  2. donnaba

    donnaba New Member

    I also had/have LTD from my job. I was approved not based on my diagnosis but on my symptoms and if they would allow me to do my job. It was determined by my physicians that I couldn't do my job, and I was approved.

    After 2 years, they require that you prove not only that you can't do your job, but any job to be approved. If your medical records give evidence that you can't do your job, then I would get an attorney if they are denying you.

    You have a right to be fairly compensated, that's what the insurance is for.

    donna

  3. herbqueen

    herbqueen New Member

    did you submit medical records from a rheum. or GP? So far mine have come from GP. I've not seen a Rheum-- only my GP, a lyme doc (i've opt'd to not go route that yet due tome my extreme sensitivities and treatments have history of triggering a neuro attack/progessing the illness)and i've seen many neuro's. But the neuro's all say I have normal neuro exam from an MS /neuro perspective.
  4. herbqueen

    herbqueen New Member

    did you submit medical records from a rheum. or GP? So far mine have come from GP. I've not seen a Rheum-- only my GP, a lyme doc (i've opt'd to not go route that yet due tome my extreme sensitivities and treatments have history of triggering a neuro attack/progessing the illness)and i've seen many neuro's. But the neuro's all say I have normal neuro exam from an MS /neuro perspective.
  5. caledonia

    caledonia Member

    "No objective medical findings" is a typical ploy by LTDs to deny your claim. They should tell you what findings would be objective medical findings.

    This should be a functional capacity evaluation to show how pain and fatigue affect your ability to work, and a neuropsych exam to show cognitive problems, depression, anxiety, etc.

    You should not handle the appeal of the denial yourself - you should hire an ERISA disability lawyer immediately to handle the appeal.

    The reason is that once you have run out of internal appeals (and you may only get one), then you'll have to sue them in Federal court. At that time you can't add any more evidence to your file.

    So you need a lawyer handling it right now to prepare your file for that eventuality.

    Call your local Bar Assocation for referrals. Talk to 3 lawyers and go with your gut feeling as to which one you like the best.

    You should also be applying for Social Security Disability at this time. You can use the same medical evidence for both claims.

    Good Luck.

    [This Message was Edited on 03/31/2011]
  6. herbqueen

    herbqueen New Member

    My cutoff for appeal is April 12- I wonder if I can ask for an extension. The neuro did have a a neuropsych exam done and it came back normal/no major deficits. I've not had the functional capacity exam done-I just found out about that. But it doesn't seem like it would help my case? I'm still mobile and can bend etc. I do yoga/stretching everyday to loosen up my muscles, I shake on most poses, but I can do it. It is very painful for me to reach for things , put my coat on etc. I have restriction in my arms. But I can touch my toes and because of my sheer will have kept my muscles (except my arms) in shape. I have a call into a law firm I found on the internet. I was too ill to get going on this before (was floor bound most of the time/in agony with neuro attack). And I did not know how to fight this. It is hard to focus on this when you are so ill--I feel pretty screwed all around- by my employer who so far has refused to extend my UNPAID LOA after being a top employee/professional for 26 years and the insurance companies who have armies of people and lawyers to defeat you and don't recognize chronic illness. And by the medical system who has no clue how to treat chronic illness disease.
  7. caledonia

    caledonia Member

    You may be able to get one. I would ask the insurance company, and see what they say. Don't tell them you're getting a lawyer, just tell them you need more time and how to file an extension. If not, maybe a lawyer can do it for you. You should ask any prospective lawyers about that too.

    BUT - whatever you do, don't miss your deadline - if it you miss it (either by not filing an extension or not filing a claim at all) your claim is over forever.

    Functional capacity evaluation - the question is not whether you can bend or whatever, it's whether you can do it for 8 hours a day, 5 days a week, consistently for years. Big difference....
    [This Message was Edited on 04/02/2011]
  8. anchor

    anchor Member


    why do you recommend an ERISA attorney?

    do they specialize in these illnesses?

    lisa.
  9. herbqueen

    herbqueen New Member

    Find the right LTD lawyer as soon as you have to leave work to work on your case. With Fibromyalgia, CFS, and autoiimune, chronic lyme your case will be dismissed. It will not be approved. With a good lawyer you have a chance. My case is still in litigation and has gone to the lawsuit step since no resolution was reached. My lawyer had me to a functional capacity test to prove my disability and all my medical records. My SS was approved which the lawyer also handled. I lost 8 months of time by not doing that. I was not knowledgeable. ERISA is the law that they use to file under. There is a good law firm in NYC listed on this site that has won cases. They would not take my case because I waited too long they said before contacting them. But referred me to another lawyer. That lawyer told me to ask the insurance company for an extension in which to file the appeal to their rejection. You have one chance to file an appeal. Go get a good lawyer if you feel you have a strong case.