UPDATE: Insurance company sending me for functional assessment.

So I just got a call from my work's insurance company where I pay into short and long-term disability insurance.  I've been off work for 4 weeks now and it's taken them til now to let me know that they don't believe there is any proof that I'm disabled because all of my test results have come back negative.

Well sure the results for all other diseases are negative. That's cuz I don't have other diseases, I have Fibro and there is no blood test for that.  Basically they got the report from my doctor of all the tests he's done so far to rule out other conditions and diseases. This is part of his process for diagnosing fibro. 

I said as much to the insurance rep and she said that they will not be approving my claim as is but will release benefits in the meantime until I go for the functional limitation test.  This test is done by either their doctor or by their physiotherapist.  So basically, I get paid some benefits until their doc assesses me and then they'll decide where to go from that.

Does anyone know what a functional limitaion test includes? 

At what point do I employ a lawyer? Should I wait until or if I get denied completely by the insurance company?

Advice please!

 

Post Edited (Booklvr) : 6/5/2012 11:00:38 AM (GMT-6)

Oh geez, that stinks. Can you tell me who the insurance company is? I am just now applying for LTD benefits, gathering all of the paperwork etc.

Do these ins. companies KNOW about Fibro? I mean of course like you said your bloodwork will come back negative. Does your Dr. have good records of your daily life etc. that they are supplying?

Please keep me posted. I'm nervous about this process too. To think that someone else can decide if I'm in need of disability other than my Dr. doesn't seem right.

Booklvr - I can tell you a lot of things about this. My first sickness I had a insurance company made me go through this test you are talking about. I was directed to go to a physical Therapy dept and someone perform about a 6-7 hr. test on me. It was all kinds of lifting, climbing and doing things with fingers and etc. At the time I had a 3 level cervical fusion in my neck and I really wasn''t supposed to lift a lot of weight. I realized they had me in a hard spot because my job requirement said I needed to be able to lift at least 50 lbs. So stupid me, lifted the weight because I knew if I didn't I would lose my job either way. I recommend you dont lift any extra weight you can't do because I was in severe pain and I could of bent my metal in neck. It was no time in the mail that I got a letter from them saying that we stop your short term pay because you past the test. I was discusted because if you didn't then they would say your a threat to getting hurt on the job. I guess you get the point. I went back to work for a few years and changed companies and got sick again. I filed for short term and long term disability. This time my diagnoses was different. I had severe depression and pain and seizures to name a few of them. I got short term very easily and then I decided I had enough and couldn't do it anymore. The pain was too much for me. The more pain I got the more depressed I got. After large amt. of paper work and a lot of homework I got the long term disability. I had no doubt that I could no longer work at this time. While I was getting long term disability I applied for social security. After 9 months I got social security and continue to receive long term from my old work place. I shared this with you because If you have a weight limit for lifting at work they have you in a corner. I think you are better off if you have depression as a diagnoses then just fibro. I have suffered depression for almost 20 years and the pain from the fibro is what made it life unmanageable. I hope I could help you some.

Thanks for the replies, everyone. This is a good discussion.  I'm still waiting to get the info from the insurance company on when my test is to take place.  I will keep you all posted on what happens so that we all have access to the info.

I sure hope this will not be a 6 or more hour test! Wow. That will be awful and send me into a flare for sure.  Someone here asked me for the name of the insurance company. I'll send you a private message as I'm not sure if we're allowed to name companies on the public forum.

 Thanks again for the input, everyone. The support from this forum is very encouraging!

 

UPDATE:

I finally got the information from my insurance company.  There are a couple of interesting developments.

1. they are releasing benefit funds "without prejudice", meaning just for now and they are not liable to pay later.  They will allow me benefits until I complete a round of assessments with their appointed specialists. After that they cut off the benefits and do an evaluation to determine if I am fully disabled or able to go back to work even for part time.

2. My Functional Assessment Evaluation is 2 days back to back with each day consisting of 4 hours of testing for things like: sitting and standing tolerance; hand strength; back strength; climbing; reaching; stooping; memory; attention; perception and organization; hand strength; limb strength and lifting.  This is all done by an Occupational Therapist.

3. Insurance company has arranged a specialist appointment for me with a Physiatrist. This is very interesting because I had never heard of a Physiatrist before. This is an MD who specializes in spine pain and chronic pain. http://www.spine-health.com/treatment/spine-specialists/what-a-physiatrist  Apparently there are very few of these specialists in Canada.  I'm interesting in seeing this doctor and maybe getting some helpful information from her.  The appointment will be 1 day lasting for 3 hours.

So, lots of time involved in these appointments. I'm not sure how I'll manage as just doing minor tasks in my house causes me pain and flare ups.  Last week I planted flowers in my garden.  I worked for about 1 hour and was careful but it sent me into a massive flare up that lasted all weekend. 

Should be interesting!