posted
I am going through the LTD disability process with Cigna.
I have a question about how to medically verify symptoms for disability. I have read on this board that it is better to try for disability on a chronic fatigue symptom and/or fibromyalgia diagnosis rather than lyme. Correct me if I am wrong.
If so how does one medically prove chronic fatigue syndrome and/or fibromyalgia. It seems like it is either my word or the doctor's saying that I have either of these.
Is there medical proof of either of these?
Posts: 832 | From Somewhere | Registered: Nov 2010
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Dogsandcats
Frequent Contributor (1K+ posts)
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posted
I would think you would need to have doctor documentation of Fibro for it to stick.
Do you have any other documented co-issues with Lyme - Migraines, IC, depression, pain, etc.
My only experience is with disability - not insurance.
What is written in your doctors records about what is wrong with your body is what I would guess, along with your statement, they would base a decision.
Hope this makes sense - haven't had my coffee yet.
-------------------- God will prepare everything for our perfect happiness in heaven, and if it takes my dog being there, I believe he'll be there.
Billy Graham Posts: 1967 | From California | Registered: Oct 2010
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Dogsandcats
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posted
Thanks for the references. Lots of information.
I have a lot of documentation from my doctor regarding pain, cognitive, sporadic twitching and numbness, balance, etc. However most of it is just me telling him I these issues. My pain is in my nerves. I can ask him if can feel the inflammation in them next time I am in there.
I am particularly interested in the cognitive links because Cigna keeps bringing that up to me.
After my last conversation about my memory (which he casually asked about) I called him back and said that I have a lot of physical things, mainly that I am IV, keeping me out of work and the cognitive was far down on the list.
He said he was just asking because he figured that is where I would notice improvement first. I told him it was going to be a big deal to show that my cognitive function had returned to the level required to do my occupation. It wouldn't be something I would just notice while sitting around my house doing nothing.
I was so annoyed.
Posts: 832 | From Somewhere | Registered: Nov 2010
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posted
You need the documentation from the doctor on your function. Having specific name for what is wrong on the medical records is only part of what is needed.
You must prove that you can not function enough to do any kind of job. It is much harder to get disability through an insurance company vs social security.
Your insurance company will pay people to spy on you to make sure you can't do what you say you can't do. Horrible but that is what they do.
-------------------- Faithful
Just sharing my experience, I am not a doctor. Posts: 2682 | From Colorado | Registered: Oct 2009
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quote: You need the documentation from the doctor on your function. Having specific name for what is wrong on the medical records is only part of what is needed.
I go to the doctor next week and will ask him if there is a way for him to document function.
My big issue is that I will get terrible jaw-aches from inflamed nerves but physically function fairly well. I will become fatigued but try and stop before that happens, but that would be big reason that I could not work. I am not sure how I would measure that though.
I have no limitations on activities. Majority of the days there is no physical reason that I can't get in a car and drive to work and sit in front of a computer.
I will look more at the information in those threads. Maybe there is a solution in there besides requiring a psychiatrist to measure cognitive function when in pain and fatigued. However I really dont want to go down that route mostly because of the issue of finding a local doctor that can do this.
Posts: 832 | From Somewhere | Registered: Nov 2010
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posted
Looking at my past office notes, I think I need to provide my doctor more information than I have been giving him. I am telling him things are improving and I feel good but this is comparative to how I used to feel. I think I have a long way to go compared to the healthy person.
I am still on a lot of medication. It would seem that this should be markedly reduced to be considered "well". Maybe I am wrong on this.
I think I may be able to work with pain and fatigue that mostly occur in the afternoon, however they affect my cognitive function.
I have big cognitive issues even without pain.
Thanks for your help.
Posts: 832 | From Somewhere | Registered: Nov 2010
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posted
Yesterday we got an attorney. There is too much money at stake. We didn't have much of an issue with Cigna for STD. Mostly getting them the documentation within 10 days. Our experience with LTD has been totally different.
LLMD's office called yesterday to tell me Cigna called them asking for diagnosis codes and telling them they were very skeptical of the treatment I was on.
Posts: 832 | From Somewhere | Registered: Nov 2010
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posted
Same thing is happening to me with Aetna. Std benefits were paid. Ltd was denied. They don't agree with my diag and said treatment should be stopped.
Posts: 137 | From New england | Registered: Aug 2012
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Rivendell
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posted
It is hard when dealing with disability issues with insurance and SSDI and the doctor.
You want to tell the doctor when you are improving, yet as you say, improving is not the same thing as how you felt when you were well. Just that you have come up a few notches from the bottom of the pit.
But the disability people will use it against you when they see that in your doctor's notes.
So you have to be sure that the doctor clearly understands your limitations and mentions them in their office notes.
And when you have brain fog, trying to remember all of this when you see the doctor is a challenge.
Posts: 1358 | From Midwest | Registered: Apr 2009
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What you wrote is exactly my problem. My doctor needs to know that I am improving and this is (rightly and unfortunately) in the notes but I need to make more of an effort to tell him my deficiencies. Compared to where I started I am doing great but I still have a lot of issues. I am in no way capable of going to work.
Cigna wants a back to work plan from my doctor. I will get him to lay it all out there because I really doubt he wants me back to work. I will lose all the progress I have made.
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Judie
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posted
Maybe you can have a doc run the blood tests that Stanford runs at their Chronic Fatigue center.
You can do this with another doc and only bring the info up if it's helpful to you.
I had my doc do these tests and all kinds of stuff showed up (this was not for SSDI, but because I wanted to see if anything was being missed).
"I think I may be able to work with pain and fatigue that mostly occur in the afternoon..."
If you say anything like this it will be twisted and used against you. You are not dealing with people who have your best interest in mind. Remember that. You need to protect yourself.
I'd say something more along the lines of, "I'm slightly more functional in the afternoon, but I use that time to do "one thing" like bathe, brush my teeth, or go to the doctor, etc...because I don't have the energy for much else."
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Dogsandcats
Frequent Contributor (1K+ posts)
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posted
Judie- were you blood tests run thru Quest, Labcorp or the lab mentioned on the form?
Thanks
-------------------- God will prepare everything for our perfect happiness in heaven, and if it takes my dog being there, I believe he'll be there.
Billy Graham Posts: 1967 | From California | Registered: Oct 2010
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quote: "I think I may be able to work with pain and fatigue that mostly occur in the afternoon..."
If you say anything like this it will be twisted and used against you. You are not dealing with people who have your best interest in mind. Remember that. You need to protect yourself.
This was exactly the reason I got a lawyer. Right now I have a basic questionnaire to complete. My answers to questions 1 & 2 are where it go horribly wrong.
Posts: 832 | From Somewhere | Registered: Nov 2010
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map1131
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posted
terv, you are fighting the slime of the earth. All LTD companies are out for one thing and one thing only......deny, deny and deny.
Be very careful. They can and will be crooked in all dealings.
I lost my case vs Metlife. The judge chewed them up and spit them out for their work on my case. Judge still had to rule in their favor, due to technicality.
I made a big mistake in thinking I could handle my case early on. I didn't have a brain and didn't have anyone overseeing my mistakes. I hired a lawyer and he tried to correct my errors.
Pam
-------------------- "Never, never, never, never, never give up" Winston Churchill Posts: 6478 | From Louisville, Ky | Registered: Jan 2002
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posted
All your function paperwork should be filled out based on your worst days. LTD companies are relentless to catch you doing something you say you can not do.
Records have to back up what you say and I hope the doctor that is seeing you is in your corner.
-------------------- Faithful
Just sharing my experience, I am not a doctor. Posts: 2682 | From Colorado | Registered: Oct 2009
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Rivendell
Frequent Contributor (1K+ posts)
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posted
I used this form when applying for SSDI.
I know yours is insurance disability, but it still might help.
Read what the attorney has to say and then click on "Medical Source Statement" for CFS/fibromyalgia AT THE BOTTOM OF THE PAGE.
Judie
Frequent Contributor (1K+ posts)
Member # 38323
posted
"were you blood tests run thru Quest, Labcorp or the lab mentioned on the form?"
I did mine through Labcorp.
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Rivendell
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Well, at the time it was Urgent Care that tested for lyme, which came back negative.
I'm guessing Quest or Labcorp. I didn't know that the form mentioned a specific lab.
Maybe the form has changed since I used it.
At the time I applied, I was figuring out it was lyme instead of CFS (long story behind that), but since the lab test was negative, it fit in perfectly with the requirments to meet the definition of CFS for social security.
I don't know if you have to meet those requirement for the insurance company.
You could also look at the other forms on this website and then make your own that fits your own needs.
The idea is just to show specifically why you can't work, and have your doctor back you up on that with proof.
If you have to meet the SSDI requuirements for CFS diagnosis, then I guess you will need a negative test for lyme, or state that have been treated for lyme and are still sick, so it must be CFS.
Your doctor would have to make that conclusion. (If he/she could state that on the form somehow, that would be good).
Also, ask your attorney if the diagnosis (if needed) of Chronic Lyme would be acceptable to insurance company.
Posts: 1358 | From Midwest | Registered: Apr 2009
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posted
Thanks everyone for the information. It has been really helpful.
Went to the doctor. He is on board with supporting me. His office was drafting a response to Cigna's letter. Cigna had many issues but they boiled down to that no measurable diagnostic studies in my file that showed I had Lyme.
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