Feeling harrassed by my Long Term Disability Insurance company:

[jm1953]

Hey Members:

When I was hired by my last employer in 1987 I signed up for Long Term Disability.  I became officially disabled in late 1999 due to having AIDS.  And I was forced to retired.  Since then I have been getting social security checks with no problem.  But my LTD insurance company keeps sending me Attending Physician's Statement of Functional Capacity questionnaires about my health condition every three to six months since I started receiving benefits from them.  They require your primary doctor complete the same lengthy form within thirty days of the time I receive them. 

Basically in the form my last three HIV docs including the one I have now, have stated in countless forms the same answers that they see my illness as retrogressing, and that I will never, in their opinion, have the ability to return to work.  How many times does the Insurance Company have to hear the same thing?  Never means never.

It is a hassle to get these forms filled out and sent back to the insurance company in the time limit they give you, and I constantly have to bug the doctor and his staff to have it faxed or mailed in.  They state if they do not receive the statement from my doctor during the time they specify my benefits will be terminated.

The last statement I got had a cover letter personally directed to me stating they needed this statement back or else.  Kind of threatening.  It's almost they want you to mess up in getting the form in on time so they can terminate you.

I'm grateful I have the benefit, but it is not a lot of money each month, and really a hassle for both my doctor, his staff, and me going through the same motions every three to six months to tell them the same thing.   

Anyone else having this problem, or have comments.  What a hassle!!!

Thanks,

JM

[Miss Philicia]

JM, while I've not personally dealt with this I've certainly heard of such things from others, even to where the LTD company staked out the person's apartment to prove that they were doing their grocery shopping on their own.  Stuff like that.  This was quite some time ago so I don't recall how it was halted, but I think they had the legal department of GMHC deal with it.  Do you have something like that in Seattle that can advocate on your behalf?

[pozniceguy]

as a manager in a large company i saw several employees in this situation.... it is almost a standard term in these policies  which really are meant to be " some coverage until you return to work"  policies, in one case an employee was constantly deteriorating ( he had MS) and the insurance company tried the "preexisting condition"  game to stop his payments.... then  he hired a lawyer  and got a settlement to stop the "harassing" letters and agree that this person was not going to recover....  lost  tract of him after a few years  so don't know how long it lasted...

I think you already have had some good advice ...get a lawyer to  help get past the "routine" letters and get a settlement....


Nick

[CallMeSid]

Hi, JM.

I'm glad to hear that you had the foresight to sign up for LTD way back when and doubly glad to hear that you're getting paid some money (no matter how small the amount) each month.

Yes, you're correct that the insurance company is hoping that you'll screw up and then they can stop paying you.  This is how they make their money.  (I am amazed that their employees are able to sleep at night.)

I do have one suggestion that may help you and your doctor deal with this annoyance a bit easier:  Since the long form is exactly the same every 3-6 months, why don't you make a photocopy of the most recently completed form that your doctor has completed before mailing it in.  After discussing the following with him and getting his agreement, when the new blank form arrives in the mail, fill it out using  the photocopy of the old one as your guide.  Then bring both to your doctor's office, so he can confirm that you've completed it correctly (just as he would) and then he can sign and date it (and photocopy it and hand you the copy) before dropping it in the mail in the pre-stamped, addressed envelope you give him.  Yes, it places the burden of completing the form on you, but you're just copying what's been done before, and it eases the burden on your (likely overworked doctor) and gives the insurance company what they need.  (And to the extent that the form has changed and new questions are asked, obviously ask your doctor to add that new information when he reviews what you've done.)

I hope that helps!

[jm1953]

Great idea!!!!!!  I think I'll fill out the form copying the most recent I have from him and bring it in to my physician this week when I see him.  Hopefully he will just sign it, and I can be done with it.  

Anything to speed up the process!

And yes, I am very thankful I took out LTD at work.  It really helps in addition to my SSD check each month.  If offered, every employee should sign up for it no matter their age.

Thanks again for the tip:

Best to you,

JM

[jm1953]

JM, while I've not personally dealt with this I've certainly heard of such things from others, even to where the LTD company staked out the person's apartment to prove that they were doing their grocery shopping on their own.  Stuff like that.  This was quite some time ago so I don't recall how it was halted, but I think they had the legal department of GMHC deal with it.  Do you have something like that in Seattle that can advocate on your behalf?

Thanks for your support Miss P.  There is a legal help offered pro-bono through our ASO.  If necessary I will go to them.  Since I have posted this, I called the insurance company and the rep actually really got my dilemma, but stated it is my former employer's requirements not theirs.  She in turn gave me a 30 day extension.

I'm still going to look into it legally though. 

Always appreciate your ideas.  You are very knowledgeable in so many areas.

Thanks again,

Jeff

[jm1953]

as a manager in a large company i saw several employees in this situation.... it is almost a standard term in these policies  which really are meant to be " some coverage until you return to work"  policies, in one case an employee was constantly deteriorating ( he had MS) and the insurance company tried the "preexisting condition"  game to stop his payments.... then  he hired a lawyer  and got a settlement to stop the "harassing" letters and agree that this person was not going to recover....  lost  tract of him after a few years  so don't know how long it lasted...

I think you already have had some good advice ...get a lawyer to  help get past the "routine" letters and get a settlement....


Nick

Thanks Nick.  I am going to look into this with a lawyer.  However, as I said to Miss P, after calling the insurance company and kind of blowing up, the rep understood what I was saying and said the policy of sending out the letters on such a frequent basis is not theirs, but that of the huge corporation I used to work for. 

I got a 30 day extension anyway.

Thanks again Nick for your advice.

Best always,

Jeff

[tednlou2]

I was on short-term disability few years back after having back surgery.  The company did the same thing.  I would have to have those forms filled out by my doctor once a month.  I felt bad having to ask my doctor to fill out the same, long form.

That was with back surgery.  I can't imagine the added stress of this with HIV/AIDS.  My boss would also call me all the time to see when I was coming back to work.  Or, she would have co-workers call pretending to be just checking on me, but really searching for info.  I wish ya the best dealing with this.  What would happen if your doc refused to fill it out?  They would cancel your coverage?  I would bet many often have problems getting their docs to do it or do it before deadline.