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Old 11-19-2005, 08:49 PM   #1
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Out of the blue my LTD was cut off! Help

Because of a severe neck, upper back and shoulder problem that required two (questionable) surgeries and a dozen "injections" and other "Theraputic" stuff I had been on disability for 27 months. The 1st surgery, a Anterior Cevical Discetomy with fusion was a rush to judgement and a miss diagnosis. It provoded no help and may have even caused more problems. I then had rotator cuff surgery only to discover a perfect cuff but some boney spur that were they but could not have been the cause of my pain. Since then I have been on a course of Steriod injections up and down my spine. Radio Frequency Lesionings at 6 location. Many many trigger point injections...the list goes on. Some of these have helped but the benefit has been very short term.

At this time I can do very little physical activity. More specifically, the mere act of taking a shower or bringing in ligh bags of groceries into the house sends my pain levels up to 7-8/10. I can go out of the house and "window shop" at Costco or Sears for about an hour, sometimes a bit more and then have to retreat to the house, lay down, take my meds and hit the ice.

I am taking rather large doses of medication (according to my Dr's). I take 240mg of Avinza(the strongest sustained release morphine availible), 30mg of Morphine (BT pain), 30 mg Baclofen (muscle relaxer), 3mg Klonopin (anti-anxiety med), 10 mg Lexapro (depression) and 30 mg Temazepam (Insomnia) per day.

The reason for the sudden denial is that the disability carrier has totally disregarded my pain levels and physical deficiencies. They claim that my cognitive abilities show that I am able to work. Keep in mind the my field of work is Mortgages and Finance. Everyday, while working, I deal with very complex senarios that take a sharp mind to work out. I recently look at a mortgage for a friend and I got lost. I could deal with the basics but when it got down to complex numbers I was lost. Figuring out interest rates, origination fees, broker rebate and then balancing all the rules and regulations associated with home loans.....forget it.

There claim that my congnitive abilities are sufficient is based on the notes in my Dr's charts that claim that I have no congnive deficiencies. This is soley based on my 20-30 munite conversations with these Dr's. What is not mentioned is that I prepared myself for 2 days prior to that short appointment just so I could remember everything I needed to report. I also do a lot of medical research online and read tons of info (over and over) so I have a clue about what my Dr's are telling me. This type of cognitive ability if totally different that Managing a Mortgage Company, working on loans, manageging and dealing with people and clients. Talking coherently for 20 minutes is pretty easy to do. In my opinion you have to do this to get your Dr to take you seriously.

Where I am confused is when did disability only come down to one's cognitive ability and disregards physical limitations? There is not one word in my denial about my physical deficiencies! I am wondering if the word "Chronic Pain" that poped up a few times in my reports has caused problems. I dont feel that I am dealing with the chronic pain where the situation cant be fix. I think that the current course of test and procedures that I have been going through is on the right path. Eventually they will find the right treatment but its only a matter of trial and error.

Anyone here with experience here? Any advice. I am going to seek out at Attorney to help with my appeal. I didnt need one before because they were so easy to deal with. This denial came so far out of the blue I was stunned for a week. Oh, because of the pain, meds and stress on my family, I have been seeing a Psychologist who has diagnosed me with a Major Depressive Disorder caused by a Medical Injury. Basically because of the pain and the meds, I have a hard time dealing with people. I have become reclusive. I dont like people to see when I am hurting really bad.

Lastly, considering the meds that I am on, if I was driving, couldnt I be busted for driving under the infuence?

I know this was long. Im hoping someone can shed some light on this. If I loose this income and still cannot work I do not know what to do. Its not just a situation where work would be "uncomfortable" and a "pain in the butt". It would be impossible. I would be so unreliable I surely would get fired quickly.

Thanks!
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2 Lumbar Lamies 93 (age 22); Cervical Fusion C4-C6 2004. Lumbar Fusion w/ hardware S1-L4 2007, DDD & stenosis entire spine. super low T. 30mg Methadone BID 10-20mg Norco 4 BT. 2mg Xanax PRN.

 
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Old 11-20-2005, 04:37 AM   #2
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Re: Out of the blue my LTD was cut off! Help

Hi Bilbo,

I had the same thing happen to me last January. After 24 months of LTD, I got a letter along with a partial check. It basically said they felt I was no longer disabled. I have appealed this twice and was turned down both times.
I have had 3 surgeries in all. A laminectomy/disectomy in 1983 at L4-5. I returned to work and had no further problems.

In 91 had an anterior fusion using my own bone. I had the surgery in Jan and was back to work in June. I started having problems again in 2000. Neuro said everything was okay. I continued to have neck pain, numbness in shoulder blade and baby finger, along with leg pain and sciatic problems. Due to insurance changing I had to switch neuros - he said I had a rupture at C3-4, Pseudoarthrosis at C6/7. Also a ruptured disc at L4/5 and DDD and L5-S1.

I had the surgery in Jan and came though it fine (have plates and screws). My range of motion is severely limited - can turn about 8 degrees right or left. Have nerve damage in right shoulder, get severe pain there if I use my hands too much. Have pain if I sit more than 15 minutes, stand or basically do anything. They want to do my low back now But I say as long as I can move about I am not having any more surgeries.

I am on Methadone for pain, with hydrocodone for BT pain. Also take, flexeril, lorazepam, paxil for depression caused by pain and inability to function and work. I also was just diagnosed with fibromyalgia.

Who is your insurance carrier? I got a copy of all the records the insurance company had. I am going to point out the descrepancies in their opinion and what my doctors have said. The surgeon wrote a letter that said I am unable to work due to lumbar and cervical radiculopathy. My pain management doctor has said I have irtractable pain. I was approved for Social Security Disability. My accupunturist, who is an MD also says I am disabled.

THe insurance companies "independent doctor" said that the side effects of my meds could not bother me because my doctor describes me as alert on my visits. Basically I think they don't want to pay.

After I file this appeal if they turn me down I am going to get a lawyer and fight. I just hate to have to pay to get someone to help me.

I have 180 days (six months) to provide them with further records.

Let me know what happens next.

Kay

 
Old 11-20-2005, 09:35 PM   #3
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Re: Out of the blue my LTD was cut off! Help

Wow Kay,

My LTD carrier is Cigna. I was reading your reply and felt chills because of how much it sounds like mine. I had lumbar laminectomies in 1992 and went back to work with no problems. My problem now is cercical, upper back and shoulder. I hade a cevical fusion with my own bone (hip) and plate and screws. Like you they paid me with no hassle for a little over two years. What was weird was that at the 19-20 month mark they stopped requesting info. They kept switching case managers on me (which they deny) and I had been calling in to tell them what was going on. Often I was leaving voicemails. So, when I got the termination letter I called them to inquire why and it was because THEY felt I could return to work despite every piece of evidence stating the contrary. All they are hinging their case on is that my Dr's say I am cognitive during my appts. Ah, if I wasnt cognitive, how could I have an appointment?? Do I have to be brain dead? I still dont get how a 20-30 minute "cognitive" appt with a Dr. translates into working 40+ hrs a week!!!

Im not waiting around to see if I can prove this. Seeing how absurd and rigid their stance is, I am going to lawyer up now and nip it in the bud. I dont care if I have to pay them. Right now my Wife's job isnt going all that well and we are afraid she may loose it. When I got hurt I trained her how to do my job. I used to be a outside rep for a wholesale lending company. I had a territory where 3 times a week I drove 150 miles a day. I would visit loan brokers and review files and try to get the to fund their customers loans with the company I worked for. Right now, with interest rates rising, its getting tough. Less loans are being done and our area is over saturated with reps.

What is really funny is that they listed 3 jobs that I am qualifies to do that wouldnt require the driving and would pay the same. Bank Manager, Insurance Office Manage..cant remeber the third. All three are completly different. Just because I look at mortgages all day long doesnt mean I could run a bank or an Insurance Office. I know nothing of banking and very little about insurance. Its like they think that I could just jump right into these jobs.

I will tell you one thing. I was already suffering from depression and angxiety from all of this and I was put on meds. This has sent me over the edge. I havent slept in two days despite taking PLENTY of medication.

Thanks for sharing your story and keep me informed about what is going on.



Quote:
Originally Posted by kay1946
Hi Bilbo,

I had the same thing happen to me last January. After 24 months of LTD, I got a letter along with a partial check. It basically said they felt I was no longer disabled. I have appealed this twice and was turned down both times.
I have had 3 surgeries in all. A laminectomy/disectomy in 1983 at L4-5. I returned to work and had no further problems.

In 91 had an anterior fusion using my own bone. I had the surgery in Jan and was back to work in June. I started having problems again in 2000. Neuro said everything was okay. I continued to have neck pain, numbness in shoulder blade and baby finger, along with leg pain and sciatic problems. Due to insurance changing I had to switch neuros - he said I had a rupture at C3-4, Pseudoarthrosis at C6/7. Also a ruptured disc at L4/5 and DDD and L5-S1.

I had the surgery in Jan and came though it fine (have plates and screws). My range of motion is severely limited - can turn about 8 degrees right or left. Have nerve damage in right shoulder, get severe pain there if I use my hands too much. Have pain if I sit more than 15 minutes, stand or basically do anything. They want to do my low back now But I say as long as I can move about I am not having any more surgeries.

I am on Methadone for pain, with hydrocodone for BT pain. Also take, flexeril, lorazepam, paxil for depression caused by pain and inability to function and work. I also was just diagnosed with fibromyalgia.

Who is your insurance carrier? I got a copy of all the records the insurance company had. I am going to point out the descrepancies in their opinion and what my doctors have said. The surgeon wrote a letter that said I am unable to work due to lumbar and cervical radiculopathy. My pain management doctor has said I have irtractable pain. I was approved for Social Security Disability. My accupunturist, who is an MD also says I am disabled.

THe insurance companies "independent doctor" said that the side effects of my meds could not bother me because my doctor describes me as alert on my visits. Basically I think they don't want to pay.

After I file this appeal if they turn me down I am going to get a lawyer and fight. I just hate to have to pay to get someone to help me.

I have 180 days (six months) to provide them with further records.

Let me know what happens next.

Kay
__________________
2 Lumbar Lamies 93 (age 22); Cervical Fusion C4-C6 2004. Lumbar Fusion w/ hardware S1-L4 2007, DDD & stenosis entire spine. super low T. 30mg Methadone BID 10-20mg Norco 4 BT. 2mg Xanax PRN.

 
Old 11-21-2005, 01:53 PM   #4
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Bilbo HB User
Re: Out of the blue my LTD was cut off! Help

Just got off the phone with Cigna Long Term Disability. What a joke. Despite the fact that I cant use my right shoulder in any capacity and that I am on very very strong pain meds they think that I could work in fields close to my old one. When I posed that fact that I was a target for DUI because of the meds I was taking they said that they dont care how I get to work. I could take public transportation. Ya, I could see myself rolling up to my Bank Managers job in a cab everyday. Plus, I used to be a wholesale mortage rep which is nothing close to a bank manager. According to Cigna's Vocational Rehab department they match up.

They are basing my ability to work off a surgery I had a year ago. A Dr's I was referred too missdiagnosed my problem as a Rotator Cuff problem. He did surgery and found nothing wrong. He said afterwards that he though it was a longshot but it gave him a chance to practice. Apparently he sent in a report that said I could return to work as long as I didnt use my right shoulder. Some how doing sedentary work like typing and writting doesnt require the use of your shoulder. How about getting up out of you chair? How about driving. Oh, I am so frustrated.

Looks like I am going to have to get a lawyer which just means someone else gets money that should easily be mine if Cigna just reviewed the facts correctly.
__________________
2 Lumbar Lamies 93 (age 22); Cervical Fusion C4-C6 2004. Lumbar Fusion w/ hardware S1-L4 2007, DDD & stenosis entire spine. super low T. 30mg Methadone BID 10-20mg Norco 4 BT. 2mg Xanax PRN.

 
Old 12-01-2005, 08:43 PM   #5
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Re: Out of the blue my LTD was cut off! Help

Can't believe we have the same carrier ... do we see a pattern here??

 
Old 12-01-2005, 09:39 PM   #6
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Bilbo HB User
Re: Out of the blue my LTD was cut off! Help

Haw! Ya, Cigna is know for being pretty tough once the 24 month mark hits. Dont know about you but I am getting a lawyer. I told my Cigna rep that I was going to get a lawyer and that I knew I would win and that all this ment was someone else was going to get money that I deserved. Unfortunetly there are no punative damages even if the case is handled in the most egreegious manner.

There are a ton of discrepencies between my Dr's notes and what they are basing the claim off. On my case they are using info that is nearly 2 years old even though there is a mountain of evidence that is more current. All of their info is speculative. Its all post opp directions. Meaning, once healed I "SHOULD" be able to return to duties. Well those surgeries failed. So Cigna is just playing the system. I bet a number of people just walk away. They paid me though April, 06. I will get a check in early January for Jan-April and based on my claim it will look like a lot of money all at once. I think they think people just accept it and move on like they have other options.

I spoke with my Dr's and we are getting 2 tests done. A Cognitive-Behavioral Test and a Physical Ability Test. Those are not the exact names of them but they will prove my lack of mobility and my lack of cognitive function cause by the pain, meds and depression. My Shrink has diagnosed me with Major Depression caused by a Major Medical Problem. Its well documented and happens to be a Physcologist that I saw 5 years ago for another matter.

Just got to get the ducks in a row. Right now I am just looking for a good Attorney. Hopefully that will happen in the next few weeks.

On the medical side I just had 9 Thoracic Facet and Rib head injections. What a pain. Took the Dr' so long to find them under Floroscope because they are so hard to see. Now I feel all banged up and bruised. Just had the yesterday.

Anyway, keep me updated on you struggles with Cigna. Who is your Case Manager? Might be helpfull to exchange notes.

Bill

Quote:
Originally Posted by kay1946
Can't believe we have the same carrier ... do we see a pattern here??
__________________
2 Lumbar Lamies 93 (age 22); Cervical Fusion C4-C6 2004. Lumbar Fusion w/ hardware S1-L4 2007, DDD & stenosis entire spine. super low T. 30mg Methadone BID 10-20mg Norco 4 BT. 2mg Xanax PRN.

 
Old 12-18-2005, 03:22 PM   #7
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Re: Out of the blue my LTD was cut off! Help

Perhaps you have an acquaintance who is an attorney--or you could access legal aid. A beginning to a series of letters needs to go to these companies explaining violations of the Americans with Disabilities Act. Discrimination under this act is a federal offense. The highest standard of all is held by Social Security Disability and certainly if they found you disabled it is not reasonable for your LTD company to find otherwise. I believe you need assistance in filling out these Appeals. Otherwise they can just shoot then back at you, automatically denied. It would be a good thing, for instance, for you, or an attorney to find out what is the % of individuals turned down by Cigna within 2 1/2 years of injury--as opposed to several other large LTD companies in your area! It seems as though they have no intention of offering "good faith" regardless of your circumstances--which also needs to be in the appeal: "1) They are violating the Americans with Disabilities Act; 2) The highest standard of all is held by Social Security Disability who found you disabled; 3) It appears that your Appeals are not being taken seriously, given the level of disability you have incurred, and manner in which such claims are normally handled by other reputable companies; 4) IF THEY SHOW GOOD FAITH AND WILLINGNESS you would certainly like to settle this matter without further legal action." See your whole Appeal shouldn't be defending you--it ought to be partially putting THEM on the defensive!

 
Old 12-18-2005, 11:46 PM   #8
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Re: Out of the blue my LTD was cut off! Help

Thanks! I will be lawyer shopping next week. Frankly the last two weeks have been hell. During the last few months an ole back injury really started getting bad. I had 2 surgeries about 14 years ago. Although I wont push the issue but I can garantee that my current neck and shoulder problems led to the lower back getting worse...out of the blue. I constantly have to use my legs, back and abdomen to help me get up without using my arms at all. The increased strain was too much. Had a MRI and it shows major major problems. Also, seems I now have a hernia which I can also blame on this situation for the same reason. Having a CT scan Tuesday. One thing has led to another. Cant catch an break.

Hopefully I can find an aggressive atty who doesnt charge an arm and a leg.


Quote:
Originally Posted by dangovt
Perhaps you have an acquaintance who is an attorney--or you could access legal aid. A beginning to a series of letters needs to go to these companies explaining violations of the Americans with Disabilities Act. Discrimination under this act is a federal offense. The highest standard of all is held by Social Security Disability and certainly if they found you disabled it is not reasonable for your LTD company to find otherwise. I believe you need assistance in filling out these Appeals. Otherwise they can just shoot then back at you, automatically denied. It would be a good thing, for instance, for you, or an attorney to find out what is the % of individuals turned down by Cigna within 2 1/2 years of injury--as opposed to several other large LTD companies in your area! It seems as though they have no intention of offering "good faith" regardless of your circumstances--which also needs to be in the appeal: "1) They are violating the Americans with Disabilities Act; 2) The highest standard of all is held by Social Security Disability who found you disabled; 3) It appears that your Appeals are not being taken seriously, given the level of disability you have incurred, and manner in which such claims are normally handled by other reputable companies; 4) IF THEY SHOW GOOD FAITH AND WILLINGNESS you would certainly like to settle this matter without further legal action." See your whole Appeal shouldn't be defending you--it ought to be partially putting THEM on the defensive!
__________________
2 Lumbar Lamies 93 (age 22); Cervical Fusion C4-C6 2004. Lumbar Fusion w/ hardware S1-L4 2007, DDD & stenosis entire spine. super low T. 30mg Methadone BID 10-20mg Norco 4 BT. 2mg Xanax PRN.

Last edited by Bilbo; 12-18-2005 at 11:48 PM.

 
Old 01-01-2006, 02:32 PM   #9
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Re: Out of the blue my LTD was cut off! Help

Hi Bilbo - I just wanted to jump in here to say that my best friend had a situation almost identical to yours. She was an insurance agent who was responsible not only for writing policies but for driving a large territory to collect insurance premiums in a very rural part of North Carolina. She became disabled with severe depression and chronic pain from nerve damage that occured many years before, but took a long time to show up. Well, her long-term disability company gave her the hardest time about depression not being a real disability. She couldn't concentrate, she tried to go back to work but found herself making major monetary mistakes, losing her way when visiting her clients whom she had visited for years without any problems. The company accused her of not turning in all her collected premiums which turned out not to be true, but that just added to her depression and her stress. Finally, she had to stop working. She was denied by Social Security on the first 2 tries, but did get it on the 3rd go around with the help of a good lawyer. Her long term disability through her company continued for about a year, but eventually they ended her coverage and somehow they got away with it!! I think depression and chronic pain are probably two disabling conditions that are so hard to prove and continue to prove. I've been on SSDI and long-term disability coverage since 1997 and one of my problems is chronic pain. I agree with everything folks have said already - if you even so much as smile or act pleasant and carry on a conversation with the people who are in charge of making the decisions about your benefits, they automatically assume that you are just fine!! No problems with this person...she's able to walk in the office, sit in the chair, state her name and her address...hmmm...BENEFITS DENIED!!! I hope you keep fighting for what you think you deserve! All the best - KathyMac

 
Old 01-02-2006, 10:20 PM   #10
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Re: Out of the blue my LTD was cut off! Help

Quote:
Originally Posted by BilboCameron
Haw! Ya, Cigna is know for being pretty tough once the 24 month mark hits.
Bill
You might want to read the small print in your disability policy. Many companies allow themselves to change the way they determine disability... often at the 24-month mark.

Your claim was probably approved initially under the criteria that you were unable to work at your current occupation. But then at some point the policy "small print" allows the insurer to measure disability under the standards that while you may not be able to return to the occupation you held at the time you went out on disability, there are other jobs which your disability does not prevent you from doing. The disability standard changes from being unable to perform your job to being unable to perform any job, unto which an insurance company can have an absolute field day.

It could be that this is the reason why your LTD claim was suddenly terminated. These insurers throw out a few examples of jobs their vocational experts have researched and have concluded that you can do. It's awfully difficult, expensive and time consuming to prove otherwise.

Good luck in your pursuit of this claim.

--kaylbe

 
Old 01-03-2006, 01:24 AM   #11
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Re: Out of the blue my LTD was cut off! Help

I never got a copy of the policy. Seriously.

I plan to have my atty request one though.

Quote:
Originally Posted by Kaylbe
You might want to read the small print in your disability policy. Many companies allow themselves to change the way they determine disability... often at the 24-month mark.

Your claim was probably approved initially under the criteria that you were unable to work at your current occupation. But then at some point the policy "small print" allows the insurer to measure disability under the standards that while you may not be able to return to the occupation you held at the time you went out on disability, there are other jobs which your disability does not prevent you from doing. The disability standard changes from being unable to perform your job to being unable to perform any job, unto which an insurance company can have an absolute field day.

It could be that this is the reason why your LTD claim was suddenly terminated. These insurers throw out a few examples of jobs their vocational experts have researched and have concluded that you can do. It's awfully difficult, expensive and time consuming to prove otherwise.

Good luck in your pursuit of this claim.

--kaylbe

 
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