Long-Term disability denied - Q about paps

Lisa13Q said:

P.S.
By the way, even if you had been diagnosed with Ovarian cancer previously that doesn't mean you were disabled. There are numerous people with chronic conditions who live with them and are able to work. If they become unable to work, disability kicks in. They cannot deny you disability due to an exisiting condition that was not disabling. GET SOMEONE TO HELP YOU WITH THIS>

Thank you for all your responses!
I told my husband and my doctor that if the insurance company knows how to diagnose OVCA with a pap they should publish and let the medical community know about this miracle. They'd probably win the Nobel Prize in medicine!

Fortunately, my employer provided me with the disability coverage so it was not $$$ out of my pocket paying for the insurance. Since the company I work for is in the business of working with employers to put together benefit packages for their employees I have already let them know about this situation. I’m sure they will concerned, not only since they sponsor a UNUM disability plan in-house but also sell the product to clients.

I posted my original on the board about 5 minutes after I received the phone call about the denial - just after I went onto the American Cancer Society page to confirm the insurance company is absolutely and completely wrong! This is where I'm at so far after calming down and investigating my avenues for disputing their conclusion.

Yesterday was my last chemo (HOORAY!). I spoke with my Oncologist and he is outraged about the insurance company's determination of a pre-existing condition since their conclusion is not based on medical reality. The only time there is a possibility of a pap showing Ovarian cancer is if the cancer has metastasized and invaded the cervix. This is definitely not the case with me since I was fortunate that the cancer was discovered in stage 1C while still contained in the ovary. PLUS the labs all came back negative for everything except the ovary. The insurance company knows this; they have copies of all the medical records. This means my doctor will have to become involved in the dispute as will my current gynecologist and possibly the previous gyn who relocated to Florida last year, wasting both their valuable time as well as mine. I hope the letter my oncologist writes will be enough to overturn the insurance company's denial.

The problem with hiring an attorney is that it can end up being more expensive than the amount to be recovered, which is what insurance companies such as the one I'm dealing with count on. On the other hand, it would be exceptionally difficult to deal with such a dispute, especially while ill, without legal advise. I am very fortunate that my husband is an attorney and my son is in his final year of law school. Both will be very helpful to me. We will be filing a complaint with the insurance commission in our state immediately. My husband's firm actually has a litigation practice in defending insurance companies against claimants but UNUM, which is the company that provided my disability insurance, is not a client. My husband says UNUM is NOTORIOUS for denying legitimate claims. This is well known and documented in legal circles. Although my husband doesn't practice in the insurance area, he has access to people who do so I have a unique set of resources to review the claim before we file.
Fortunately, I have people who can help me navigate the legal aspects of the dispute but when I think of others who are ill and don’t have the resources I do I feel UNUM’s business practices are very unethical. I am recently remarried so although my lack of income for the past two months while the claim was being reviewed has been hard at least someone in the house is able to pay the bills. I shudder to think of the duress I would be under if this were not the case. As I progress with this, I will definitely post the steps we take to dispute the denial. Hopefully, the information I provide will help others in a similar situation that do not have access to legal help or knowledge of what to do to pursue a claim on their own.


I plan to pursue this vigorously! The comments about insurance industry are well taken. As soon as I get my documentation in order I will begin an intensive letter writing campaign to elected officials as well as anyone else who will listen. Hopefully, I can have at least some small impact and help others avoid the problem I have encountered with this insurance company.

I will continue to post as we progress with this. Hopefully, my information will be of help to others in a similar situation. When you're battling cancer you don't need the stress of battling for insurance benefits you're entitled to as well.

Thank you for all your comments and support. Please continue to add your thoughts and suggestions - they are all very helpful and I'm afraid I'm going to need all the help I can get to resolve this! I would be especially interesting in hearing from anyone who did have her OVCA diagnosed through a pap.

Lyn

Lisa 00 said:

disability
Hi,
You might want to pop over to www.disabilityinsuranceforums.com and ask some questions. They are very knowledgeable and helpful over there.

It sounds as if you might need a lawyer and, depending on your situation, I've seen that these things sometimes have a time limit to contest the decision. Good luck!

thanks for the link!
I will definitely be checking it out!

Lisa 00 said:

UNUM
Lyn,
I have been on claim for a few years now with an individual disability policy and found the website I mentioned earlier a few years ago. I've learned tons on that website about disability claims and your husband is absolutely correct that UNUM is about the worst in the industry about trying to deny ligitimate claims. Especially if the policy is of a group nature like yours is.
Individual policy claimants are protected by bad faith laws whereas holders of group policies are not therefore insurance companies can just deny you and see what happens without fear of loss beyond the claim itself.
So, yes, please appeal the decision. There is a great disability attorney who used to help out a lot on that site and I used him once for a meeting with my ins. co.'s rep. I remembered that he once posted an example of a notice of intent to appeal letter that he would send. Here is the link. I highly suggest you read it.

http://www.disabilityinsuranceforums.com/arcmessageview.cfm?catid=4&threadid=3392&highlight_key=y

Thank you, Lisa
I have added the site to my favorites and plan to check it out thoroughly. This is very helpful since disability claims are not my husband or son's area of expertise. I appreciate the information.

Lyn

Lisa 00 said:

the attorney
Lyn,
Your husband should call the disability attorney who wrote that letter and ask him a few questions as he is composing the actual appeal. Glenn Kantor is a great guy, very giving of his time to others, and very very smart (at least in my opinion). As I mentioned, Glenn was nice enough to chaperone a meeting between myself and a rep for my ins. co. a few years ago.

I'm very happy that my previous experience with disability claims can help someone else.
Good luck!

Thank you so much!
I will pass this information along to my husband. We're still waiting for the official letter - I was notified via telephone the day before chemo.

I appreciate your help with this, Lisa! When I finish the appeal I plan to write some sort of a "how to" for this discussion board. If you don't mind, Ill see if you have anything to add before I do (hopefully, soon!)

Lyn