Disability Denied

Hi everyone,

I haven't written in a few weeks but have been lurking the site regularly!  I was informed today that my disability claim  for FMS and CFS through my work's private insurance has been denied. I applied for short-term disability with the intention of applying for long-term disability once short-term ran out (17 weeks for short-term).

I've been off of work for the past 4 months, this is how long it took for them to get back to me to let me know their decision.  In the meantime, the insurance company sent me to an Occupational Therapist and a medical specialist.  Both of these professionals, along with my own doctor agreed that I could not work full-time but could manage part-time flexible work from home. (as if those jobs even exist!)  Anyway, the insurance company took all of that info and gave it to their in-house medical consultant and they decided that there was insufficient medical evidence to show that I could not work. In their opinion there is nothing preventing me working my regular job, full-time.    I can appeal this decision if I can present new medical evidence.

I spoke to a couple of lawyers and found out that the appeal process will take about 2 years (I am in Canada and it takes that long here).  During that time I would have no income at all and could not do contract or even volunteer work.  The lawyer said that the entire process is set up to make it so difficult and stressful for people to fight for the insurance money that most people just give up. Well, that is what I'm going to do too.  My husband and I decided not to pursue it. The barriers the insurance company has make it too long, stressful and financially impossible to continue with this.  There should be government regulations that prevent insurance company's from setting their own policies and policing themselves. It's shameful.

I am able to do some work from home. The type of work I do would allow me to get contracts and work when I feel well. That's what I'm going to do. I can't work full-time and can only manage to do contracts if I feel well enough. However, I am fortunate that my husband's income will take care of us. I feel sooooo terrible for people who do not have that option. This is a terrible system that is set up entirely for the benefit of the insurance company. 

But hey, I feel great about the $100 per month premiums I've been paying the insurance company all these years so I would be covered in case of illness.  Isn't it nice of me to donate this money to the lovely insurance company? They are so deserving.

I'm sorry this has happened to you. No it isn't fair at all but I'm glad you are in the good position that you are in.  You won't suffer hardships from this.  I do understand why you aren't pursuing this, too.  It probably would be like throwing money away.  We have people here in the US having much the same problem. 

 

I think our doctors' reports should have more weight.  Even here, they send us to their doctors...like our own doctors who have been taking care of us for years don't know what they are doing.  It would be laughable if it wasn't so sad.  I keep praying things will change. 

 

You do have a good attitude, I think.  I know you are reporting to us what has happened but I do think you have come to grips with this and will move on.  That's very good!  You probably were expecting something like this to happen, too.  But just move forward and get busy enjoying your life.  You can work when you feel well enough to and, boy, is that a blessing!  I would love something like that myself.  So you do have a lot going for you.  For this, I am glad.

 

Sherrine

Dealing with insurance in Canada is rough, I know. I have been fighting the fight for it feels like forever. I think Canadians just give up because the process is so long and draining. I think they enjoy beating us down so we throw out our hands and dbthe whatever. You are very lucky that you can do a job at home and your hubby supports you.

I know how difficult it is to get Canada pension plan disability. I have no other insurance as I certainly did not plan on getting sick. I have been denied and appealed and have done the tribunal now am stuck in the waiting game. Last I heard was I called they said I would know within 2 weeks then 2 weeks later I called and was told my file is in their legal dept and I should know within 4-6 weeks? What a bunch of cow dung, I am not able to work they have drs letters saying that but instead of helping take the pressure off they tell that to make me worry more. Is it any wonder my body is boycotting me.

Booklvr- sorry to hear about your case. I live in the USA and it was like pulling my teeth out to get disability. I am on long term disability with my old work place and social security. The long term takes a lot of paper work to keep it. They are always looking for a way not to pay you. I have to see Dr's frequently just for paper work. I am like you that you pay into it from each check, but when you need it you almost have to be in a coffin to receive it. No joke! I think long term is harder to get then social security.

Well, I hope your health was able to get one better. Glad you have some financial support. I have found out that our health is so more important then work or stuff. I am so much happier and healthier then I have been in many years. You might already see that you save lots of money not working. I use less gas, less out to eat and no new clothes for work. I hope you can enjoy being off and do some little work on the side lines.

Good luck in fighting them and I hope it works out well for you. I recently went down to see about it as I
have fibro, lupus, RA, spinal stenosis, scoliosis, sciatica, both knees operated on, hips going, upside down
heart, blah blah. They told me I make too much money to even apply. I'm trying to hold down a 40 hour
a week work schedule in a very physical job, now the lipomas are bugging the bejesus out of me and I need
to see a surgeon again. Went to one surgeon and he basically pushed me out of his office saying he wouldn't
do it as it would leave a scar...as if that matters. The guy at the disability place told me to apply when I
went out on disability for the surgery (have a big one in my stomach and a good sized one in my wrist) so
I'd be out for about 3 months or so. Gotta love the system, don'tcha think??

I notified my employer that although my disability claim through their insurance provider was denied, I will still be off of work for many weeks. I will now collect benefits via the government medical leave program (we pay into it like a regular insurance here). The payout is much, much less than half my salary and/or what I got from workplace insurance.

You'll all get a "laugh" out of this. I heard from my employer today. I am still expected to pay $100 per month for my private insurance premiums (the ones through work) even though my claim is denied. Ha!!!! Ridiculous. Apparently, these short and long-term benefits are mandatory through the employer and since I am still technically employed then I am supposed to pay them.

This makes no sense at all!! I don't have a job and now will be getting government medical benefits which are only a fraction of my previous earnings. I'm supposed to/ be forced to shell out $100 per month for private insurance that I can't even use??

Wow, this insurance thing is really quite a 'racket', isn't it? They're robbing me!