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Sugar Mtn Honeybee
Waiting for a name!!
Posts: 114
(12/30/04 3:54 pm)
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Angry..
Got the denial on our appeal to the short-term disability company. They have not a prayer of winning if we take them to court, but they are persistent in being ridiculous. The new physician reviewer even had the nerve to make the comment that there were several lengthy & articulate letters in the file from me, providing "objective" evidence that I had no cognitive difficulties and that I still had the ability for fine motor skills that would enable me to work at my previous occupation. Never mind that I had told them repeatedly that most of my correspondence was typed by one of my daughters or even hubby -- or that I told them he handled most of the legwork & paperwork of the claim and the appeals. The short-term company is not bound by the social security decision. I did find out, though, that the long-term company is. Since they required me to apply for SSDI, they are bound by the decision of the ALJ, which was that I was disabled for my previous occupation (even though they found me not to be "totally disabled" for ALL occupations.
So, if the long-term company denies my appeal with them, there is a built-in grounds for civil suit under ERISA, considering that the long-term policy provides the first 24 months of long-term disability will be paid on the basis of being disabled from my own previous occupation. That would give us 2 years to fight the SSDI decision or refile a new claim.. We will be taking the short-term company to court on civil suit under ERISA law, for "capricious & willful denial". I'm anxious to hear from the Missouri Division of Insurance as to what their opinion is of my complaint.
Having read multiple court records & decisions last night, I'm not surprised that they've done this to me. It seems these companies are not a bit frightened by what happened to UNUM/Provident. They certainly haven't changed their policies or claims administration any. We put a call in to our attorney, and now are just waiting to hear back from him.
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Gaia Angel 
ezOP
Posts: 2315
(12/30/04 7:59 pm)
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Re: Angry..
awwwwwwww sweety  sending you luck darlin 
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Sugar Mtn Honeybee
Waiting for a name!!
Posts: 116
(1/8/05 11:56 am)
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Re: Angry..
This, too, has been placed in the capable (I hope) hands of our attorney. I took the whole darn huge envelope full of stuff to him yesterday. He said they have already filed the appeals council review request for SSDI. Now, he will look over this massive envelope full of stuff to start something on the Short-term disability company. They owe me over $5K. So, if he takes 25% of that also, well, that still leaves me $3750.
The long-term company sent me a letter notifying me they were taking another 45-day extension.  It was expected, but it's still annoying. I think they are just waiting to see whether we really intend to sue the short-term company (or not). The long-term company can't win in court, and I'm sure they realize that. WHY do they persist in trying to deny what they are responsible for paying, even though they know they will not win in the end?
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