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Short Term Disability Denied / CRPS&RSD

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Posted 8/19/2012 5:04 PM (GMT 0)
I recently became a new member posting about CRPS and diagnosis and work difficulty. I took a leave from work, as suggested by my family and doctors. Now, after submitting details to CIGNA to approve this STD I am denied ad must return to work. Since it was denied, I am also out all of the earned time I had accrued and will not be paid for the remaining difference in time which is 7 weeks.
Has anyone been through a denial and appeal process? The next step is appeal, however I now have to manage this as well as treatments/appointment regimen while working 40 hours. With no earned time I am not actually allowed time off until I earn it back by working.

Very frustrated, disappointed and nervous. If anyone has been through this or has suggestions I could use the extra help.

Nnej
Posted 8/19/2012 5:24 PM (GMT 0)
Unfortunately, I can't offer you any help, only sympathy. I am just beginning my "should I work? What am I allowed?" trek. While reading your story, I def feel the hit and can empathize. Will your HR dept work with you and offer any ideas / help?

I will certainly watch this thread with major interest and please know that I am thinking of you and hoping that someone can offer you some help. Take care and best of luck! xx
Posted 8/19/2012 5:29 PM (GMT 0)
Thanks. Tough as I am not sure when and how to approach HR, for fear of revealing too much if that makes sense. I do not want them to hae more ammnuition to jeapordize my career. 20 year relationship, first time it feels threatened. This forum has been very helpful in validating my condition. I am still trying to answer that same question.....should I push working, why am I causing so much stress. Will keep reading. Talk later, thanks again.
Posted 8/19/2012 6:14 PM (GMT 0)
Can you please post your state, might be able to come up with something since you left the name of the IC, but a lot is state specific.
Posted 8/19/2012 6:24 PM (GMT 0)
Cigna is the insurance company, I work in Massachusetts for a privvately held company. The Cigna home office is in Pittsburgh.

Thanks much.

Nnej
Posted 8/19/2012 6:24 PM (GMT 0)
I forgot to ask if your condition is caused by a work injury, can you specify that as well?
Posted 8/19/2012 6:45 PM (GMT 0)
Hi Matt,

No, it is not caused by a work injury. Ulnar nerve was pinched, have had a couple of surgeries to fix kins as well as scar tissue. This surgery has resulted in aggravating the nerve. Pain increase after the second surgery, possible Initial cause for nerve issue could be Thoracic Outlet Syndrome (TOS). DX right ow is CRPS/RSD. This DX detail as well as pain service notes have been submitted to CIGNA. Been working with the pain service for 3 1/2 years, their data on me is quite extensive and consistant supportig the Dx.

Let me know if that helps.
Posted 8/19/2012 7:14 PM (GMT 0)
Well, best I can come up with is that it was possibly denied due to the time expectancy of the condition, those are not short term injuries. I havnt been able to find anything specific to STD, but did find some info that seemed to be a generic appeal process, which basically said to call your claims department to start the appeals process. When you do this, I would have your doctor write a supplemental letter stating why you will only be off work temporarily, and what treatments they're trying to do that require you to stay off work for a short time.

I think because those are long term conditions, your IC probably views them as ineligible for STD if basing your need for it on the condition alone, and they most likely want you to file for SSDI. So if you can get info to them explaining why this is only short term (even if it isn't), you would possibly have a decision in your favor.

The other option you can choose is a disability attorney, they work on an award basis, if they don't get you anything, they don't get paid, and they generally work on a percentage.

Sorry I couldn't be much help. I hope you can find somekind of resolution to this. Good luck.
Posted 8/19/2012 7:33 PM (GMT 0)
I appreciate the help and your comment about the time expectancy of the illness/condition makes sense. I feel good in that I hae asked my primary to provide a letter summarizing what is wrong, the current restrictions and my expectation to return to work. My initial out of work letter was from her and well written with language of the "expectation is to return to work" nature. I want to work, but I must get better to get to that point. If I can get better. If I cannnot after more dedicated treatment time I will have to of course address that. Unfortunately with my insurance company and corporate policy, if I do not receive an approval for short term, I am not able to move on into long term. Your feedback has been extremely helpful to me...
Side Note: I notice folks list their Dx at the bottom of their emails. Is this part of your signature? Is that expexted? No rush. Thanks again. Hopefully soon I will be on the other side proiding help too to newcomers.
Posted 8/19/2012 7:44 PM (GMT 0)
What was the reason given for the denial? Do you have a union, if so there should be someone there that can help you with this. I am really shocked that you were denied. Has any other employees had trouble with this company before that you know of? Some people have had to hire attys in order to collect benefits.

I am sorry you are having such a time with this.....Susie
Posted 8/19/2012 7:54 PM (GMT 0)
No, you do not have to list your dx's or even the meds you take, it is not required. I prefer not to list the info in signature line because if someone were to do a google search on a subject I posted here at the forum, my post here at HW may show up out there in the cyber world for everyone to see. Not many of the folks are aware of that here. Some do not list their meds because they live in a small town and they are afraid of being recognized. Strictly your choice.....Susie
Posted 8/19/2012 8:11 PM (GMT 0)
Thak you for the info Susie. No union, privately help company. My theory is simply that my Dx does not fit into the little box as they would like to see it. Sadly, the HR department offers no assistance navigating paperwork. They advise of my benefits, requirements of what I must continue to pay for to maintain my benefits and will answer questions of that nature. The disability insurance company offers no advice, just forms to complete and more forms for doctors to complete. My health Insurance groupwas also of no help...I asked for a counselor and advocate or a case manager. I did not qualify for a case manager, I do not have a terminal ilness or a condition such as diabetes. I do not fit the mold. Most pain conditions don't. I am fortunate to have found this group though. Folks are very helpful. Will keep fighting...
Posted 8/28/2012 4:53 PM (GMT 0)
hi,

I've had RSD/CRPS since Aug 2005. But i've been dealing with Social Sec Diability not insurance disability. It's been a battle. I've applied, well this is my 4th try. Lawyers aren't all their cracked up to be. i;ve learned that you have to be your own advocate. I do more work then my lawyers do to get me approved.

Being in pain isn't something that people think of as "disabiling". It's ridiculous and wrong!

I hope things improve for you!

Heather

Posted 8/28/2012 5:36 PM (GMT 0)

 Hello Heather!...I wanted to get a quick welcome to you! Maybe we could get you to post an introduction of yourself on a seperate thread? Our members would like the chance to welcome you, and we find that when you start your own thread, more members will see you, and can welcome you there.

    oddly!...your username seems to ring a bell with me, as we had a member with a similar name.

 SE wink

Posted 8/28/2012 10:14 PM (GMT 0)
Professional, when speaking with the std adjuster have you asked this person what they based their denial on, or have they ever put it in writing the reason for denial?

Susie
Posted 8/29/2012 11:28 PM (GMT 0)
You said you returned to work because you needed to, which demonstrates that you are capable of working. You probably supported their rationale for the denial.
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