LTD Denial, AGAIN....

Discussion in 'Fibromyalgia Main Forum' started by Dara, Oct 8, 2002.

  1. Dara

    Dara New Member

    I have been going back & forth with my LTD carrier since last November. Now they tell me that they are still denying my claim because my doctor didn't have limits & restrictions in his chart notes. He did fill out a disability form but that is not what they want. I asked her what is it that you need?? She said, "well, I can't tell you that, if he didn't put it in his chart notes then he can't go back and change them". I told her that there was no way I could make it to work even 2 days out of 5, and she said that I had no medical documentation to prove that. Does anyone out there have any ideas or words of wisdom that can help?? I'm not going to give up on this, I have paid for these premiums and have every right to the benefit.

    Dara
  2. Dara

    Dara New Member

    I have been going back & forth with my LTD carrier since last November. Now they tell me that they are still denying my claim because my doctor didn't have limits & restrictions in his chart notes. He did fill out a disability form but that is not what they want. I asked her what is it that you need?? She said, "well, I can't tell you that, if he didn't put it in his chart notes then he can't go back and change them". I told her that there was no way I could make it to work even 2 days out of 5, and she said that I had no medical documentation to prove that. Does anyone out there have any ideas or words of wisdom that can help?? I'm not going to give up on this, I have paid for these premiums and have every right to the benefit.

    Dara
  3. Allen2

    Allen2 New Member

    you have to get strangled by institutional red tape! Do you have an atty? My disability atty really came thru and the law limits his fee...I don't know if anything I am saying is helping. Sure hope you are reinstated! God bless, Al
  4. contessa

    contessa New Member

    I did pick up my patient notes today from the clinic. I am highlighting points in my favor that they chose to overlook. Doctor's don't seem to listen well and they cringe when I mention disability. But my notes seem favorable. I finally threaten discrimination suit because they allow a healthy woman, giving birth to a healty baby 16 weeks paid disb leave, no questions asked. All disb claims must be given the same system of judgement. Suddenly my case has been passed to a 'senior claims analyist'. I haven't found any attorneys willing to take on a private insurance company - lots of SSD though. So I'm stuck unless I can get them on labor/discrimination laws. I think they know this and use it against us. Hope you have good news soon. I got my foreclosure notice on my house today (all because disb hasn't paid). I don't plan on going down without taking a big bite out of someones you-know-what!!
  5. Dara

    Dara New Member

    and just made an appointment with him today. I'm to the point where I'd like to dump my mound of paperwork on his desk and just say sue the hell out of all of them. I know I really shouldn't have that attitude, but all this added extra stress from them isn't helping either. Thanks guys, for your input, I appreciate it.

    Dara
  6. moewee

    moewee New Member

    It looks like UNUM is in BIG TROUBLE 10/18/02 03:16 PM

    It could be your lucky day if you are a Unum, UnumProvident, Paul Revere, or Colonial Life disability policy holder.

    KEEP READING AND REMEMBER WHEN THIS HAPPENS WITH *ONE* COMPANY YOU CAN BET IT HAPPENS TO OTHERS WHO WILL TAKE THE TIME TO STAND UP AND GET IN LINE.

    GOOD LUCK ALL.

    UNUMPROVIDENT CLASS ACTION SUIT

    Jon Holder, Esq., a Maine attorney, has recently filed a class action
    lawsuit on behalf of persons who feel that UnumProvident has unfairly
    denied
    or terminated their long-term disability benefits. He is seeking
    witnesses
    who are willing to go public with their complaints against
    UnumProvident's
    claims review process.
    For more information, contact Jon Holder at telephone 207-774-2899,
    fax
    207-774-9562, or e-mail at jholder@maine.rr.com or
    mcaufield@maine.rr.com.




    Tactics UnumProvident Uses to Not Pay Claims

    UNUMProvident and its subsidiaries Paul Revere, Provident Life and Colonial Life have used a number of methods to look for ways to avoid paying claims. Here is a list of common excuses to not pay disability claims.

    • Using surveillance on claimants to look for evidence against the disability claim, which in rare cases involves questioning friends and neighbors, invading a claimant’s privacy.

    • Requesting repeated independent medical examinations.

    • Using medical consultants who are not expert in the medical condition in question and who are therefore not qualified to determine the extent of the claimed disability.

    • Denying claims without an independent medical examination.

    • Prolonging denial of a claim to produce protracted and expensive litigation for a claimant.

    • Trying to induce a claimant to surrender his or her medical license.

    • Refusing to recognize certain diseases as disabling, such as Fibromyalgia, Chronic Fatigue Syndrome, and various mental/nervous disorders.

    • Inadequate medical documentation by a claimant’s attending physician.

    • Paying for residual (partial) disability on a claim for total disability.

    • Denying benefits by alleging that a claimant was not under the regular care of an attending physician.

    • Excluding coverage because of a pre-existing condition prior to the policy.

    • Alleging that the claimant made a misstatement on the initial policy application that affected underwriting, thus voiding the policy.

    • Alleging that a premium payment was late, causing the policy to lapse.

    Dr. McSharry Gives Consolidated Deposition In UnumProvident Lawsuit
    posted September 9, 2002

    The former medical director at UnumProvident who sued the insurance firm alleging that medical personnel were encouraged to deny disability claims was quizzed by a group of attorneys for three days last week.

    Attorneys from across the country had wanted to interview Dr. Patrick Fergal McSharry after he brought the complaint asking compensatory and punitive damages in Hamilton County Circuit Court. The case was later transferred to Federal Court.

    Attorney Harry Burnette said he had received over 60 inquiries from lawyers around the country wanting to take the deposition of Dr. McSharry.

    Numerous attorneys put down subpoenas asking for the McSharry testimony.

    Both UnumProvident and Dr. McSharry objected to the mass depositions.

    Dr. McSharry said he had taken a new position and could not afford to be away from his new employment for a lengthy time.

    Magistrate Bill Carter said in a court memorandum, "Apparently, there are a number of individuals across the country who have been denied benefits under a disability insurance policy purchased from UnumProvident or one of its affiliates and/or administered by UnumProvident who now have lawsuits pending against UnumProvident and/or its affiliates arising from the denial of disability benefits."

    Magistrate Carter ruled that Dr. McSharry would not have to respond to all the requests for depositions. He said, "Requiring Dr. McSharry to be deposed multiple times on the same subject is unacceptable."

    He ruled that Dr. McSharry would be quizzed about six different cases in one consolidated deposition. It took place in Chattanooga last Wednesday-Friday. UnumProvident was to be represented by four attorneys.

    Magistrate Carter said judges in other jurisdictions could decide later whether or not to allow the deposition testimony.

    He would not allow the media at the depositions and said the depositions could not be broadcast over the Internet.

    He gave the plaintiffs a day and a half to interview Dr. McSharry, and gave UnumProvident the same time.

    Dr. McSharry in his suit said he was one of several medical advisors employed by UnumProvident "purportedly to enable it to make valid judgments regarding the disability status of the various claimants."

    The suit says, "Although defendant employed various medical doctors for the ostensible purpose of providing needed medical guidance in reaching benefit decisions, the medical personnel were not truly utilized for that purpose.

    "It was defendant's primary purpose and policy to deny disability claims. The medical advisors were only to be used to provide language and conclusions supporting denial of claims."

    He said medical doctors "were supposed to handle a number of files a day, precluding meaningful analysis."

    The suit says, "The medical doctors were encouraged to use language in their reports that could be used to support denials. If reports were unsatisfactory to that end, the doctors were asked to delete and reword phrases so as not to compromise a denial.

    "Medical doctors were not allowed to ask for further information or to suggest further tests; rather their reviews were supposed to 'stand on the record.' The medical doctors were not supposed to help a claimant 'perfect' a claim."

    The suit says, "It was further defendant's practice and policy to evaluate every medical condition of a claimant in isolation and to render a disability decision on the effects of each isolated condition rather than to consider the restrictions of each condition in conjunction with those of other medical conditions.

    "Defendant expected the medical advisor to render opinions on conditions outside his or her specialty rather than to refer the file to a specialist in the field. It also required the non-specialist to support his training in the particular specialty even where the support required falsification.

    "Although an appeal of a denial is supposed to be reviewed independently and de novo, it is defendant's practice to rely on the original evaluation of the case."

    The plaintiff said in his first five months at UnumProvident he "tried to work out his ethical dilemma with defendant's practices and his role in them by walking a careful line, trying to follow defendant's express rules while still rendering truthful reports.

    "There came a point in time, however, when plaintiff realized he could not maintain his own integrity or contribute integrity to the company as long as he attempted to follow certain rules.

    "At that point, plaintiff let his supervisors know that he would no longer be a part of unethical and illegal practices in the determination of disability benefits."

    The suit claims the firm's practices were "illegal" in several different ways.

    The plaintiff said, after he began writing reports "accurately" that he suffered retaliation. "He endured verbal and written write-ups and warnings. He was subjected to constant criticism and ostracism. His work was routed around him.

    "Plaintiff refused to yield to defendant's coercive tactics and also refused to remain silent about the illegalities of defendant's practices when talking with other medical personnel."

    The suit says he was fired in January for "disruptive behavior."

    Attorney Anita B. Hardeman, who is a partner with attorney Burnette, filed the suit.
  7. Dara

    Dara New Member

    and I believe everything you just posted. It kind of reminds me of that book by John Grisham, The Rainmaker.

    Dara
  8. moewee

    moewee New Member

    Get on this quickly and good luck!
    contact Jon Holder at telephone 207-774-2899

    Jon Holder, Esq., a Maine attorney, has recently filed a class action
    lawsuit on behalf of persons who feel that UnumProvident has unfairly
    denied
    or terminated their long-term disability benefits. He is seeking
    witnesses
    who are willing to go public with their complaints against
    UnumProvident's
    claims review process.
    For more information, contact Jon Holder at telephone 207-774-2899,
    fax
    207-774-9562, or e-mail at jholder@maine.rr.com or
    mcaufield@maine.rr.com.
  9. teach6

    teach6 New Member

    Then someone on this board suggested that I would need to have a definite return to work date and a list of restrictions. So I wrote up some suggested restrictions and took them with me to my next doc's appointment. He asked me to email them to him so he wouldn't even have to retype them! My kind of guy!!

    Finally they quit harassing us every month. My doc used to roll his eyes and look at me and say, "How am I supposed to know if you wil be able to return to work , and if so, when?" Now it's not a question of returning. We decided it is more than I can handle any time soon, probably never.

    My insurance is with Liberty Mutual and I got LTD with no problem!

    Barbara
  10. SaraD

    SaraD New Member

    Thanks for the info, I will email Jon Holder immediately. I worked for unum for 9 years and they denied me earlier this year, after paying me ltd for almost 18 months. Said, I can care for my kids, then I can work. They harrassed me so bad on the phone and had given me so many anxiety attacks in front of my children. I am furious with them and at a loss of how to go up against such a huge company. My current lawyer is not doing squat. Thank you so much for this info.
    Sarad