posted
i must hire an attorney to help me appeal my long term disability insurer, Cigna.
after 2 years of payment for "lyme disease and joint pain" they were desperate to deny my claim which pays me $5000/month.
so they hired a IME from a company who only rents out their docs to big insurance companies to weed out malinguring. i read their entire website before i went to the test.
his exam was bogus in so many ways i wont spend the time to tell all. but it said i had severe deficits that were all malingured (faked).
at the time of testing i had and still have mod. severe encephalopathy with a CD-57 of 20 so no reason to doubt my state of health.
this "doctor" wouldnt know that because he did not do an interview of any kind and read my medical records after the testing was finished. my new LLMD and her notes and tests including the CD57 were not yet in my medical record that he reviewed.
i must appeal with an attorney, it is an ERISA policy and i have read and read to educate myself. i have lots of good attorney referrals but what is worrying me most is:
does this lawyer need to have personal work experience with chronic neuro lyme to be dead on effective?
please, anyone with an opinion, please share. its ok to PM me if you like..
also, i would REALLY like to hear from anyone with experience with Cigna, good, bad, or ugly.
Posts: 68 | From washington/oregon | Registered: Apr 2001
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Keebler
Honored Contributor (25K+ posts)
Member # 12673
posted
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I see you are from WA/Oregon - well, I sure hope not Oregon. The official word from the Oregon Medical Board is that lyme does not exist. Washington state is perhaps a bit better.
Have you contacted the local support groups for suggestions? It's sad to say but you are in the wrong part of the country. I hope you will be dealing with someone from the east coast Cigna offices.
There is not one LLMD in Oregon. Not one.
[edited to add: other than a couple LL NDs] The medical community is very strongly against lyme in this state. VERY. That could hurt your case if you don't have an expert atty.
the Social Security folks in Oregon do not accept lyme as a dx (or at least as of a couple years ago, even with Igenex tests).
the severe encephalopathy should be of note. Do they need to know WHY - can't severe encephalopathy simply be enough of a dx on its own?
IMO, I would think the atty absolutely must be a near expert in not just lyme but other tick-borne infections - AND the cascade of impairments related.
The "standard" of (non) care outlined by IDSA will need to be countered.
You might ask the leader of your local AND regional lyme support groups. Find out if the Cigna folks are local - regional - or national as far as who is making the decisions along the way. Who are the medical experts they have on their payroll?
Best of luck. Hope this works out so that you receive fair treatment.
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[ 15. October 2008, 04:41 PM: Message edited by: Keebler ]
Posts: 48021 | From Tree House | Registered: Jul 2007
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bettyg
Unregistered
posted
suggest you go to top clicking on directory
go to 1st blank line and type in conniemc
hit send
will show connie's profile; send her a private message,
and include the LINK FOR YOUR POST HERE.
she is extremely knowledgeable!!! best wishes.
disinissues web site has ERISA lawyers as members who work with fibro/cfs patients ... not sure lyme, but they overlap.
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Keebler
Honored Contributor (25K+ posts)
Member # 12673
posted
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Too clarify for furture eyes reading this: I mentioned that there are no LLMDs in Oregon. There is one excellent LL ND who is an ILADS member. There are at least two other NDs who are fairly familiar with lyme.
However, for matter of law and insurance companies, the medical board and MDs carry the weight.
If the MDs in the state don't even acknowledge lyme, the insurance companies will usually go with that (although it's probably the insurance companies who are telling the doctors what to think in the first place).
Given the political circumstances, I hope you can find wonderful counsel. An excellent attorney would most certainly enjoy the professional and personal experience of helping you.
There may be similar cases from other states that would help as Cigna is a national insurance company.
TerryK
Frequent Contributor (5K+ posts)
Member # 8552
posted
After having been through this process myself, I must say that my insurance company (Standard Insurance Company) will do anything to get a person off long term disability no matter what the diagnosis. I think this attitude applies to most long term carriers.
Expect that you may even be followed by an investigator from the insurance company during this period. They may also park outside your house. Don't want to make you paranoid but these are real possibilities.
I personally think the most critical criteria in choosing a lawyer is that they specialize in ERISA law and that they do NOT work for any insurance companies.
I would not expect you to find a lawyer in Oregon who knows all about lyme and ERISA. Don't know about WA. Perhaps someone in CA?
I've been through the test that you went through. They sent a copy of the report to my doctor (not an LLMD). It was full of downright lies and snide remarks. My doctor got really mad about some of the misrepresentations in the report and wrote them back, rebutting some of what they said.
The insurance company pulled some really dirty tricks when I was going through this. Even tried REALLY hard to make my doctor angry with me!!! They sent her something that was supposed to cast doubt on my honesty about being disabled. She was afraid to tell me what they sent because she thought she might get into legal trouble. Luckily my doctor knows me really well because I have been a patient of hers for over 20 years.
I can see where they could really have messed up my relationship with my doctor had she beleived 1/2 of what they implied. Really awful of them to try to deprive a person of their doctor by undermining the relationship, all so they can save a buck!
My disability was not related to lyme because I didn't know that I had lyme at the time.
The criteria used by SS has more to do with your ability to work than it does with your diagnosis. Not sure what happens with the insurance company and their ability to deny payment when the diagnosis is unknown.
Some insurance companies started to exclude conditions like fibromyalgia or CFS which is often diagnosed for patients who actually have lyme. If your insurance company didn't exclude those conditions, maybe you can add other diagnosis to your records as a backup? Since so many of us are diagnosed with numerous other conditions you may already have other diagnosis.
Don't put anything past the insurance company. Be very careful when dealing with them. Get everything in writing, do not talk on the phone with them unless you record the conversation.
Join the disinissues group at yahoo to get valuable advice about all of this. They do not have any archives on the internet because insurance companies will use them. You get e-mails everyday with messages from the group rather than anything being stored on the internet. http://groups.yahoo.com/group/Disinissues/
Sorry you have to deal with this. Terry
Posts: 6286 | From Oregon | Registered: Jan 2006
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