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» LymeNet Flash » Questions and Discussion » Medical Questions » Cigna declined me for Long Term Disability. NEED YOUR ADVICE! PLEASE!

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Author Topic: Cigna declined me for Long Term Disability. NEED YOUR ADVICE! PLEASE!
Jenny in MI
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Member # 17225

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Hi All, I have been getting Short Term Disabiity for 6 mths now from Cigna, since I am on a sick leave through my employer.

Well, today, they just informed me that my medical did not support. This has been a bitter battle all along. The disabiity started when I was deathly ill back in April, but I was diagnosed with CFS at that time. This August, I was dxd with Lyme and very Low Iron. Below is a letter I just sent to Becky, my LT rep at Cigna.

I need your advice. Do I have any rights to get my entire file from them? How do I appeal their decision? Should I ask my LLMD for another Western Blot, CD-57, and MRI? My tilt table tests were always abnormal, maybe I should have another one of those.

What kind of lawyer should I look for? Has anyone ever had the same thing happen to them? Here is my email to Cigna... please give me your feedback.


Hi Becky (Cigna rep)- how do I obtain a copy of my ENTIRE Cigna file?

Also, what is Cigna's guideline on people with Lyme Disease?

Do you have a manual which states the average time people are off work from diagnosis to full treatment?

I know you are just delivering the news, but it is unconscionable to me that Cigna can brush me
off as capable of going back to work when I have only been correctly diagnosed and treated since
Aug 6th.

I have had Lyme Disease for at least 2 years and have spent thousands of dollars to get the
proper diagnosis and now I am not even able to get disability so I can recover.

Even though I have great insurance, I have spend at least $30k on medical bills since I became sick.

This is a terrible disease and it has diminished my brain power, my spirit, and my body.

If appeal is unsuccesful, I will be in touch with my local and state lawmakers and possibly an attorney specializing in Lyme Disease.

Can you please tell me why my Serum Ferrasulfate (Iron) level of 6.8 is not supporting medical?

Did you receive my Hematologist files that I am on IV iron infusions? I am shocked that the low
iron along with Lyme is not supporting.

What if I go back to work tomorrow and get killed in a car accident or hurt someone else because I am too dizzy to drive? Who is responsible? What if I make a mistake with a customer's account that could cost me my job and the customer a financial loss because I cannot think? Who is responsible? Cigna?

Please advise on how I can obtain my entire file. If there is a form, please email to me.

Sincerely,
Jennifer B

[ 31. October 2008, 11:49 AM: Message edited by: Jenny in MI ]

Posts: 63 | From Clarkston, MI | Registered: Sep 2008  |  IP: Logged | Report this post to a Moderator
seekhelp
Frequent Contributor (5K+ posts)
Member # 15067

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I am very sorry this has happened. I know all the major LTD carriers and Cigna can be tough on claims.

That said, all LTD carriers will be ruthless about Lyme as it doesn't exist here. I'm in the ssme exact boat as you. I'll be getting that letter anytime I'm guessing.

I have sat in many rooms filled with disability carrier reps and their perspective on disability is different than ours. In fact, one had a paraplegic come in to say they were not disabled and "disability" is what you make of it.

The thing is Lyme hits your brain. They don't see that. I'm not undermining any issue in any way, but Lyme is not recognizable from an outsider. No one can comprehend you feel like you want to collapse one minute and can function somewhat another.

I would think positive MRIs, brain SPECT scans, etc. would be of some use. An expert would definitely need to be involved. It's a sad state of affairs. Of course, your definition of total or partial disability under the contract is key too. The wording is very open to interpretation I know. I learned a lot.

The ironic part is it's easier to push s mental health claim through and get a limited benefit. They have mercy on those sufferers (sometimes even enough to quality for SSI), BUT zero smptathy for Lyme patients. The good part is it's easy to go "mental" when you get your claim turned down. lol.

I highly doubt your doctor will sign off on LTD forms (i.e., Attending Physician Statement). I'm speculating. I find none have any caring to get involved in that piece, unless you're literally on a death bed.

It's an endless chain. You'll have your PCPs say they are not smart / educated enough to sign LTD forms when it's a TBD and refer you to your speciliat. Specialists in turn are too busy to care and will not sign. You will be pushed to a Physical Medicine doctor to assess work limitations specific to your job.

Then you'll get sent to an independent medical exam and see an "impartial" PCP / possibly specialist who'll side with the LTD carrier because they are paid to do so and care absoluely less about your physical / mental limitations. In fact, you'll receive no objective testing. it's a crooked system.

Posts: 7545 | From The 5th Dimension - The Twilight Zone | Registered: Mar 2008  |  IP: Logged | Report this post to a Moderator
TerryK
Frequent Contributor (5K+ posts)
Member # 8552

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I'm sorry you have to go through this but I think this is par for the course.

It happened to me. I got a lawyer involved right away. If your employer paid for the disability insurance then this is an ERISA claim and you need a lawyer who does not work for insurance companies who is an ERISA specialist.

The wording in the policy is key as was already mentioned. Go to the yahoo disability group disinissues. Look at Betty's disability links. Do searches on here for more info on disability.

I would not write to the insurance company or talk to them without representation. Their job is to deny long term coverage. They don't care what is wrong with you or what happens to you. They are in it for the money.

Be very careful what you say to them. It can come back to bite you.

The key is that you cannot work. Never even imply that you can. Also, be prepared for them to watch you or your house, talk to your neighbors etc.. They are ruthless.

I was not with Cigna so I don't know about them specifically. Look for info on the internet about other Cigna claimants to get a better idea about them.

I would not re-do tests that clearly show positive results like the tilt table test. They no doubt have that result. Consult with an attorney on what you need to prove your case.

Best wishes,
Terry

Posts: 6282 | From Oregon | Registered: Jan 2006  |  IP: Logged | Report this post to a Moderator
   

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