Topic: Resources when contending against insurance and disability denials -- links
minoucat
Frequent Contributor (1K+ posts)
Member # 5175
posted
I've tried to keep this somewhat organized, but look through the whole thing for what you need.
Other additions welcome.
General Info
Cheryl's Lyme Info has a wonderful list of insurance resources (includes info in this post and more).
And I was going to add something else but I forgot. LOL. Oh yeah -- the newest issue of Lyme Times (Summer 2005? Special Patient Issue http://www.calda.intranets.com/ ) is ALL ABOUT all aspects of INSURANCE. Excellent, excellent stuff.
How to Deal with private disability, HMOS, medical insurance, and SSI
http://www.healthinsuranceinfo.net/ The Georgetown University Health Policy Institute has written A CONSUMER GUIDE FOR GETTING AND KEEPING HEALTH INSURANCE for each state and the District of Columbia. These Consumer Guides summarize your protections.
Form Letters for Insurance Appeals http://www.calda.intranets.com/ You can enter this website as a guest. Under Public Documents there are form letters for insurance appeals. There may not be one specific to your situation, but you may pick up some pointers.
Insurance, Disability Claims, Health Costs, and HMO Issues and Lyme Disease See link "fighting a denial" (Includes "HMO HARDBALL") http://www.hmohardball.com/
Fight Bad Faith Insurance Companies at http://www.badfaithinsurance.org/ Ranks insurance companies, gives info about the insurance laws, lawsuits against companies, etc.
Disability/Insurance Claims
==>SSI informational board -- has attorneys etc. who are knowledgable. http://groups.yahoo.com/group/Disinissues/ Note: 1)Go to the files/links areas and print off those links so you can check them off as you read.
A template for your SSDI application (can also be obtained from disinissues site, files section, "useful advice for SSDI applications"): http://www.cfids-me.org/socsec.html NOTE: Print the ENTIRE post of the female doctor's statements detailing what she could NO longer do. Can be used as a template for your SSDI claim.
Site established by Linda Nee, a whistleblower who used to work as an insurance claims analyst. She can assist with disability claims, through the application, the investigation, and if necessary, the appeal, for either group or individual disability claims. Works with applicants and with their lawyers. http:// www.disabilityconsulting.net
FAIM, the Foundation for the Advancement of Innovative Medicine, doctors' and patients' rights, advocacy and education. http://www.faim.org/ (we should all be members)
2 requests: on what you showed for the disinissues, please add for them to go to the files/links areas and print off those links so they can check them off as they read.
Also, for them to print the ENTIRE post of the female drs. thorough, detailed statements detailing in detail what she could NO longer do to do sustainable work. They could use hers as a guideline and show the comments that apply to them on their SSD app.
Wished I'd known about disinissues site 4.6 yrs. ago vs. having learned of it after I was 4+ yrs. into being denied on 2 disaiblity apps.
Also, would you post copy/paste this info to TINCUP & TREEPATROL's newbie links so we can have all this wonderful info in one spot? Thanks a million minou! Betty G., Iowa
Posts: 1 | From US | Registered: Aug 2015
| IP: Logged |
riversinger
Frequent Contributor (1K+ posts)
Member # 4851
posted
Linda Nee, former chief claims analyst at Unum Provident, who became a whistle-blower, is now helping attorneys and individuals who are fighting a disability insurer.
She can assist with the many mysteries of disability claims, through the application, the investigation, and if necessary, the appeal, for either group or individual disability claims.
minoucat
Frequent Contributor (1K+ posts)
Member # 5175
posted
Thanks, River and Betty. I've incorporated your comments. I'll post a note to ask Tree and Tincup to add this to their links.
Posts: 2331 | From WA | Registered: Jan 2004
| IP: Logged |
quote:Originally posted by riversinger: Linda Nee, former chief claims analyst at Unum Provident, who became a whistle-blower, is now helping attorneys and individuals who are fighting a disability insurer.
She can assist with the many mysteries of disability claims, through the application, the investigation, and if necessary, the appeal, for either group or individual disability claims.
This info is AWESOME!!! My disability carrier is Unum and I've had problems with them all along (and they do reduce my monthly income b/c I receive SSDI - I assumed this was just the way it was!!). I'm going to contact this woman ASAP.
Thank you SO MUCH!!!!
Posts: 689 | From western MA (we say buttER and pizzA) | Registered: Nov 2004
| IP: Logged |
treepatrol
Honored Contributor (10K+ posts)
Member # 4117
posted
WELCOME To LYMENET
Here's more goodys! A typical response to newcomers.
Hi and WELCOME! Get a LLMD or at least Dr that is willing to learn about lyme. Borrelia Burgdorferi is a clinical diagnosis, based on symptoms and on your response to treatment. Good Luck, bumpy road ahead.
( No you don't always see a bite and if there's no bullseye the only way your going to be able to tell is (symptoms) and (((Maybe))) WB or lyme dot blot 3 day urine banged with abx's to free your antigens up for the test. ) See this ( . )thats the size of the larva stage tick... Next nymph size... ( * ) Next is adult ( o ) to ( 0 ) Pretty small????? HUH
posted
2) Print the ENTIRE post of the female doctor's statements detailing what she could NO longer do. Can be used as a template for your SSDI claim.
How is this post listed on the website - cannot figure out which post it is?
Posts: 46 | From Norman, OK, USA | Registered: Jun 2004
| IP: Logged |
thanks for posting the links I mentioned yesterday....
Print off the drs. example & then use what you can of her detailed statements of why you can't work.
Look over the other links there as well....will take months if you look at everything but concentrate on her example so you can provide something similar like this BEFORE you apply the 1st time so you can win.
I was denied by appeals council 12-23-04 after it was in Virginia 2.5 years. I'm into this 4 yrs. 4 months! disgusting.
Learn from us so you don't repeat our mistakes! Best wishes. Betty G., Iowa
Posts: 1 | From US | Registered: Aug 2015
| IP: Logged |
I think this would be EXCELLENT with your SSDI stuff since it deals with the testing and how psychologists determine the different.
NOTE: I have printed off the 1 link of cognitive stuff to give to ALJ,lawyer, and treating drs. so they are aware of this! Heard it was deciding factor for one person on why she was approved for SSD.
See DURAMETER's post on neuro psychiatric for kids & adults. Please add this IMPORTANT neuro info on testings, etc. which also could help during SSDI process.
Thanks; you are terrific! Betty G.
Posts: 1 | From US | Registered: Aug 2015
| IP: Logged |
"I've been through ten years of fighting bad faith insurance on a disability case for my husband. His claim is already on adjudicated settlement, but the company cuts off payment at least once a year, sometimes more, without notice.
posted
I can not emphasize this link enough! Follow all of the advise here below! You could win your SSDI app and receive benefits on your FIRST try if you follow the female drs. DETAILED info she provided to SSD for her 1st app! http://groups.yahoo.com/group/Disinissues/
Note: 1)Go to the files/links areas and print off those links so you can check them off as you read.
A template for your SSDI application (can also be obtained from disinissues site, files section, "useful advice for SSDI applications"): http://www.cfids-me.org/socsec.html
NOTE: Print the ENTIRE post of the female doctor's statements detailing what she could NO longer do. Can be used as a template for your SSDI claim.
Also on Minoucat's links of info is something about lawyer Scott Davis, Phoenix. I would NOT advise hiring Scott.
He was my lawyer of almost 4 yrs. this Nov. He quit me in Aug. 04 after my lyme diagnosis. He can NOT represent anyone in CIVIL/FEDERAL court after appeals council denies anyone! He never told me that.
He also screwed me by NOT sending a detailed brief to Virginia's appeals council 2.5 yrs. ago when he submitted the request to appeal.
Scott did send them a certifed letter asking that a copy of my ALjudge hearing tapes be sent to him; they never sent them.
AC never sent me my ALJ hearing tapes either even after I faxed a letter explaining all of this 12-3-04 BEFORE appeals council denied me 12-23-04 WITHOUT even looking at my file since lawyer Scott Davis HAD NOT SENT DETAILED BRIEF.
So if you hire a lawyer, make sure they can represent you in civil/federal court to appeals the appeals council denial! They only have to look at what the judge decided on rules; NOTHIGN ELSE!
Betty G., Iowa...
still in this 4.5+ yrs. later and waiting for my 2nd ALJ hearing sometime maybe in March 05!
Posts: 1 | From US | Registered: Aug 2015
| IP: Logged |
henson2
Frequent Contributor (1K+ posts)
Member # 463
posted
Up! This is incredibly helpful. Thank you!!!!! Posts: 1066 | From East Coast | Registered: Dec 2000
| IP: Logged |
lightfoot
Frequent Contributor (5K+ posts)
Member # 2536
posted
Thanks!!
I'm deep into this process.....
Healing thoughts......lightfoot
------------------ C O L O R A D O * S U P P O R T * S Y S T E M [email protected]
"A friend is someone who knows the song in your heart and can sing it back to you when you have forgotten the words". Unknown
quote:Originally posted by lightfoot: Thanks!! I'm deep into this process..... Healing thoughts......lightfoot
Lightfoot, may I ask what step you are in the 4 step process? Are you on your 1st or 2nd CLAIM application?
I heard from the CHIEF ALjudge last week. My 2nd claim is worked up & I can review any time. Send in any new medical reports to be considered for a FAVORABLE decision. If we can't make that, a hearing will be held ASAP. I plan on representing myself since my lawyer of 4 yrs. quit me 8-04 after my lyme dx.
Betty G., Iowa
Posts: 1 | From US | Registered: Aug 2015
| IP: Logged |
lightfoot
Frequent Contributor (5K+ posts)
Member # 2536
posted
Hi Betty,
Wow......I thought I was at this a while!!!! Sorry your attorney quit cha" and didn't really clue you in on what he/she could and couldn't!!! You are to be commended for going to the Virginia's appeals council stage. What are the reasons that an attorney can't go to the appeals council?
I am in the first hearing stage. CO is one of the states using the new prototype process. Once the case is denied the first time around the case goes directly to a hearing. This is supposed to speed up the process.
Yikes, My first denial was over two years ago and I've been waiting for the hearing ever since. I began the process in the fall of 01!!!! I'm beginning to think this was a stroke of luck as I am in the process of changing attorneys which I think will be to my benefit.
So......I am working on the reasons I can't work.....function, function, function!!! My medical documentation is not that strong in that area AT ALL! Never mind that I've lost ten years plus of work. I wish I'd had these tips on how to present my symtoms (related to ability to function) about twenty years ago!!!!!!!!!!!!!
I will be thinking of you as I work on my symptom stuff here!! Good luck!!
Healing thoughts......lightfoot
------------------ C O L O R A D O * S U P P O R T * S Y S T E M [email protected]
"A friend is someone who knows the song in your heart and can sing it back to you when you have forgotten the words". Unknown
posted
Lightfoot, sorry I missed your response until I happen to see this post again in Treepatrol's newbie links...
I'm finally scheduled for my 2nd ALJudge hearing & last on 6-16-05. It was to be in Des Moines, but I called asking them for a VIDEO conference in my local town; yes, they would accommodate me. They had set this up for 830 am! It would have been 60-90 min. trip to DM with all the freeway construction. Glad I don't have to get up 6 am!
Minou, here is some new info I just last weekend. Can you add to your list of info...think it would be helpful for those w/fibro & CFS applying for SS disability. An online friend of mine from disinissues web site posted this info today, so I have copied it over here.
Subject: fibro/CFS disability info [Disinissues] what does an Functional Capacity Exam entail?
Lyme, fibro, & CFS support group members who are/will be filing for SS Disability insurance benefits, please go to the web page shown below.
There were 9 pages of info I printed below area where you can order from fibro network a 70 page packet. I too plan on including this info when I send my FINAL packet of info to chief alj before my June 16, 05 hearing...my last chance! =======================================
Please read the site mentioned on: WHY DISABILITY TESTING FOR FMS IS OFTEN MISLEADING ADVICE FOR FM/CFS PATIENTS AND THEIR DISABILITY TEAM.....
Also after this article are the following articles:
WHAT COULD BE CAUSING DELAYED-PHASE FLARES?
BENNETT'S METHOD FOR ASSESSING FUNCTION IN FMS..
TECTONIC CHANGES IN DISABILITY LAW by lawyer Joshua Potter, CALIF.
MEDICALLY DETERMINABLE IMPAIRMENT REQUIREMENTS FOR CFS & FMS
DOCUMENTIONATION...VIEW IT AS AN INSURANCE POLICY
I printed this out in larger print for my eyes....9 pages! Will read it thoroughly and mark up 2nd copy to go to ALJudge for my 2nd hearing as medical evidence also....
bettyg, Iowa
Posts: 1 | From US | Registered: Aug 2015
| IP: Logged |
minoucat
Frequent Contributor (1K+ posts)
Member # 5175
posted
^
Posts: 2331 | From WA | Registered: Jan 2004
| IP: Logged |
posted
Minou, thanks again for ALL your wonderful work on putting all these disability web sites together!
Lightfoot thinking of you on your 2nd claim.
Betty's 2nd ALJ hearing 6-16-05 at HS ICN/video room....wonderful class room!
Maintenance man told me when I came in they were having problems with ICN; student speakers weren't working so I'd have to use instructor's; otherwise, it would have to be canceled & rescheduled! NO WAY. I'd make do. I couldn't sit on the high, wooden seat, so found me a LOW padded steno chair w/arms in the room & put up by the microphone.
It went well today and surprised me by being 30 minutes only with me, and 10 minutes with voc rehab woman! We hauled up my 2 big boxes of files & none were needed!
At beginning, judge advised he that I had legal rights to have a lawyer/rep; did I wish to proceed? Yes.
We went thru the basic questions. How long can I sit, stand, walk, bend, lift, climb, squat? What is my typical day like? Do I cook, do laundry, grocery shop, live in 1-2 story house, climbing steps often, etc.
I asked about ALL the medical evidence submitted from 7-1-04 to now since my "last day insured". It WILL be taken into consideration when the judge makes his ruling. At beginning, he stated it would take 30-60 days or LONGER. At the end he emphasized it could take longer than 2 months.
I asked if that were the case later, if his staff could email me a note stating that. NO! "Do NOT call my office to check up on it."
I took along my tape recorder & taped my session. My end was good; his was fairly good, the voc rehab woman I can barely hear, but she stated that "she can NOT do any type of work" based on all the restrictions of sitting, standing, walking, hands/figure movement, etc. So I asked the question clarifying if I heard Marian correctly, that she feels I can NOT do any type of work.
Judge said, IF I CHOSE to use that scenario, YES he would approve, and asked her to clarify...yes, she can not work at all. =======================================
Judge stated, he is going to go thru my ENTIRE file again before deciding based on medical evidence submitted and my verbal sworn testimony.
Couldn't believe it was only 40 minutes. He said they would NOT LOSE my file, have patience, and eventually, I would receive his ruling of approved or denied.
Patience is not my strong point; and he stated not to sit by the mail box for his decision as it wouldn't be coming SOON!
I am calm inside and wasn't worried after the 7 weeks of work I had done prior to submitting him my 20 pages of impairment codes, drs. & broken down by sections of the body effected.
Thanks everyone again for your thoughts & prayers for me today. I'll be filing my 2 boxes full of stuff away today to put this behind me and go on.
------------------ bettyg, Iowa .. I'm a former secretary who typed many legal agreements but not the type you folks are thinking of. Also been trying to get SSDI, disability insurance, benefits for 5 yrs. 8-05!
Posts: 1 | From US | Registered: Aug 2015
| IP: Logged |
Could you add these comments to your helpful list of info from a former SS disabilities examiner to me?
Here are some anonymous comments to me from a former disabilities examiner about the questions I raised on my top post:
"ALJs have to squish you into meeting or equaling some listed impairment or other, and use affective disorder routinely as a catch-all for unlisted impairments, particularly those that involve pain.
They can't approve your claim without referring to the Social Security regulations, so even if they use your actual illness, they may still have to add another impairment to get your symptoms to equal a listing.
I think that getting the basis for your approval changed is better done at review time than at the time of approval of your claim, especially since it's taken you so long to get approved.
Your actual condition might be a listed impairment by time your claim is reviewed!
If your claim was approved by an ALJ, did your letter state that the Appeals Council may choose to review your case? ===============================
Yes, that is a standard phrase, used even in cases that were never at the AC before.
Your ALJ did not write that paragraph. That part of the letter is a bunch of standard paragraphs, selected out of a stock of paragraphs that appear in all letters.
The only part your own ALJ actually wrote is the Decision with its findings of fact. If your OHA is like mine, the page numbers begin again with p.1 for the part the ALJ wrote."
I think I'll copy the above comments in this post to Minoucat's SSDI info links so they can hopefully help someone else out understand their approval letter.
Bettyg, Iowa
Posts: 1 | From US | Registered: Aug 2015
| IP: Logged |
The Lyme Disease Network is a non-profit organization funded by individual donations. If you would like to support the Network and the LymeNet system of Web services, please send your donations to:
The
Lyme Disease Network of New Jersey 907 Pebble Creek Court,
Pennington,
NJ08534USA http://www.lymenet.org/
UBBFriend: Email this page to someone!
Printer-friendly view of this topic