cantgiveupyet
Frequent Contributor (1K+ posts)
Member # 8165
posted
std company just called evidence was not enough. they need objective evidence...mine was subjective.... i asked about chronic illness and she said there is always an underlining cause...something there to cause it.
so i doubt lyme will stick.
I was bit by a tick in April...while strolling at lunch... who would have thought a few months later a simple bite by such a small bug would cause so much undue stress. As i sit and ponder tonite, how can i continue this fight...i could sit here crying all nite.
My chest pressure has increased........im so sad.
-------------------- "Say it straight simple and with a smile."
"Thus the task is, not so much to see what no one has seen yet, But to think what nobody has thought yet, About what everybody sees."
-Schopenhauer
pos babs, bart, igenex WB igm/igg Posts: 3156 | From Lyme limbo | Registered: Oct 2005
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5dana8
Frequent Contributor (1K+ posts)
Member # 7935
posted
When I am sad and feeling hopeless I go to this webb site Hope it helps.
I don,t know much about insurance problems I am sorry I can,t help.But alot of people here do. I know they have fought and won for coverage .You may want to do a search under insurance Take care http://www.positivepause.com
-------------------- 5dana8 Posts: 4432 | From some where over the rainbow | Registered: Sep 2005
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Me again...I was rejected for the same reason. And, like you, I believed them and figured all was lost. But the "objective evidence" thing...It's an old trick of the insurance company to do that. It's wrong for them to do it and you can fight it. I got that straight from a lawyer.
See my post to you in the other forum for that link to ERISA lawyers.
Hang in there,
Alison
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The obscure we see eventually. The completely obvious, it seems, takes longer. --- Edward R. Murrow Posts: 923 | From California | Registered: Aug 2005
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cantgiveupyet
Frequent Contributor (1K+ posts)
Member # 8165
posted
hey you again!! I actually contacted 2 lawyers today....one thinks i just may have workers comp case.......slim chance but he wants to go with it...since i was bit at work. 2nd one will call me tomorrow...labor lawyer who handles these cases. so the objective evidence is a line.......hmmmmmm i mentioned FMLA to the std co women and she got real silent........like she knows thats the reason they wont extend the leave. I only hope these 2 lawyers can help me.
the first laywer thought they might throw it back that i havent seen my duck......and that they did.......he knows his stuff. Hes a quick mover too. thanks again alison for reminding me........i have to fight this.
-------------------- "Say it straight simple and with a smile."
"Thus the task is, not so much to see what no one has seen yet, But to think what nobody has thought yet, About what everybody sees."
-Schopenhauer
pos babs, bart, igenex WB igm/igg Posts: 3156 | From Lyme limbo | Registered: Oct 2005
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posted
I mentioned this before. Did you go to the website of the disability consultant I posted? I don't see any evidence that you went back to read the replies you got on your previous thread on this subject in general support forum.
In the Lyme Times write up I mentioned is an article by this consultant which includes the business about objective evidence. Read your contract, see what it says about objective evidence. You are kinda short on time. If you like, I will try to scan a few paragraphs on this subject. LET ME KNOW. But I am not going to go to the trouble if you aren't reading the replies here, kiddo. I know you are upset but you need to do clear thinking if you are going up against these bozos. Not a fair fight, I know, sick person against the company. Hope your lawyers know something about disability. If they do, maybe you can just be the sick person and skip being heroic! And wouldn't that be nice.
Posts: 8430 | From Not available | Registered: Oct 2000
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posted
I just talked to a couple ERISA lawyers today too. The guy said that it sounds like a tough but do-able case.
Just remember you don't *have* to pursue it if it is going to stress you out a lot....just no matter what happens don't let them get to you, ok? Just do this only if you want to and it feels right and all that good stuff.
I have to fax the lawyer a few things and he is going to check on some things so we'll see. My case is different because I found outit was lyme *after* they denied my claim.
Anyway, big hugs, hang in there,
Alison
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The obscure we see eventually. The completely obvious, it seems, takes longer. --- Edward R. Murrow Posts: 923 | From California | Registered: Aug 2005
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cantgiveupyet
Frequent Contributor (1K+ posts)
Member # 8165
posted
Hello lou~ I apologize for not responding to your post, i really meant to go back, but with everything going on plus getting sicker this weekend..ugh. Anyway, yes i did contact the consultant who gave me some good advice, especially now that my claim was denied. I also signed up for the Lyme times....and have to call someone regarding the article you mentioned...was going to do it today, but again had to fight for my job. Ive calmed down some now, I am thinking clearer stopped crying and im ready to fight. my pity party is over. I really appreciate your help with all of this the consultant was very helpful...and im going to reread her emails now...she felt that i do have a case and i have 180 days to appeal the claim once denied.
Alison- i guess its good that i got the lyme diagnosis before all this hit...only by a few weeks though. The fighting wont wear me out....its the proving that im sick that did...but im over it now....i do need a clear mind...and i do want to take this to the end all the way. thanks again for the support and help!!!
-------------------- "Say it straight simple and with a smile."
"Thus the task is, not so much to see what no one has seen yet, But to think what nobody has thought yet, About what everybody sees."
-Schopenhauer
pos babs, bart, igenex WB igm/igg Posts: 3156 | From Lyme limbo | Registered: Oct 2005
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posted
I too understand the frustrations around disability insurers. One thing you need to pose to them, is that if they have been paying you, what has changesd to make them stop paying you.
Especially if they have gone past the period of time of self-reporting, i.e. mental illness. The other thing to do is verify if in fact the plan is really an ERISA plan.
For the plan to be an ERISA plan the company offering the plan has to file certain papers to make it a plan. It is just not enough for a company to arange a plan with a disability insurer and call it an ERISA plan.
It is very possible to get a claim throun out of the ERISA arena if the proper paperwork was not filed. Having it out of ERISA changes everything.
It is also important to identify if the requirement of the plan that states working in any job, i.e. Social Security requirement, or the job you were performing at the time of disability. Then you need to get your doctor to say why you can not perform that job.
It is a long haul when it comes to these insurance companies, but you need to know your rights to get anywhere with them. Do not allow them to bully you. be assertive but not confrontational when talking to them, then get yourself a punching bag, so when you get off the phone you have something to destroy,
Good Luck
Posts: 533 | From Las Vegas, NV | Registered: Jun 2003
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posted
Relieved to hear you are reading posts and acting! Good girl. Proud of you.
I decided to scan just one page from the article in the Lyme Times, so others in this fix can find it in the archives, and maybe sign up for the Lyme Times at http://www.lymetimes.org/ They have great info in each issue, and online archives. This disability article was in the spring 2005 issue, was written by Linda Nee, and is 7 pages long. This excerpt is the third page of the article.
----------------------------------------
"a. Is the insured able to provide proof of impair�ment precluding work capacity from a physician with a specialty qualified to render an opinion on a specific diagnosis? The insurance company inter�prets this contractual provision to mean "objective medical evidence."
Objective evidence, as defined by your disability insurer, includes X-rays, lab tests, MRI results, surgical records (operative reports), diagnostic procedures, cardiac stress tests, EKGs, EEGs, lab work results, etc. "Objective medical evidence" is specific test results which prove positively, you have the impairment you and your physician claim you do.
First, many disability claims are denied on the basis there is no written, "objective medical evi�dence" to support the impair�ment you claim even though dis�ability policies do not require, or, specifically define "objective medical evidence." Read your policy carefully under headings such as "What Information Is Needed as Proof of Your Claim?" You may be sur�prised to find your policy does notin fact require "ob�jective medical evidence" as proof of disability.
Second, many impairments exist for which there is little or no "objective medical evidence." Examples include: fibromyalgia, chronic pain, Lyme disease, chronic fatigue syndrome, depression, headaches, ver�tigo, TMJ, and other self-reported impairments which may be limited to 24 months of paid benefits. For some of the above impairments, medical science has yet to develop specific diagnostic tests to prove "ob�jectively" certain impairments exist even though your doctor has indicated you have the disease. Your physi�cian will be able to certify your impairment by de�scribing your "restrictions and limitations," and, by reporting your progress in his/her office treatment notes.
You may hear your claim representative using the term "objective medical evidence" when requesting updated medical information, or, in written commu�nications informing you there is no "objective medical evidence" to support impairment.
You might want to write a letter expressing the following:
"... I have received your letter dated ___ asking for objective medical records in support of my impairment, and wish to cooperate fully with your requests for updated medical information as re�quired under the provisions of my policy. Since my policy requires me to provide you with proof of regular care by a qualified physician who certifies specific restrictions and limitations, I have provided you with my updated office treat�ment notes from my primary care physician(s). I will be happy to continue to provide you with updated medical information that meets the criteria described in my policy...." (Close your letter with a positive greeting.)
Other insurance terms you may hear include "restrictions and limitations." Most disability policies now require your physician to report "restrictions and limitations" which are "preventing you from returning to work." "Restric�tions" are those activities which your physician certifies "you may not do." Examples of medical restrictions include: "Patient is restricted from driving; patient may not lift or reach overhead."
Limitations are those activities you may be allowed to do somewhat, but only to the extent recommended by your physician. Examples of medical limitations include: "no lifting >10 Ibs.; no walking or sitting for more than 15 minutes; limited exposure to stressful situations." Ultimately, it is your responsibility to insure your primary care physician understands how to report your restrictions and limitations. Discuss your medical "restrictions and limitations" with your primary care provider, and help him/her understand the importance the insurance carrier..."
(continues)
Posts: 8430 | From Not available | Registered: Oct 2000
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cantgiveupyet
Frequent Contributor (1K+ posts)
Member # 8165
posted
hello lou, i just sent you a PM, not sure if it went thru though. Many thanks for posting this. i never thought of the medical community not having medical tests for what i have....i tried expressing that to the claims manager...but she kept saying there would have been objective evidence.....not so.
thanks again, i hope this all works out, and i can focus on healing again.
-------------------- "Say it straight simple and with a smile."
"Thus the task is, not so much to see what no one has seen yet, But to think what nobody has thought yet, About what everybody sees."
-Schopenhauer
pos babs, bart, igenex WB igm/igg Posts: 3156 | From Lyme limbo | Registered: Oct 2005
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Just do this only if you want to and it feels right and all that good stuff.
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