Receiving disability payments is more difficult than one might think

To catch you up, I received short term disability payments through my employer over the summer. After an initial denial of my claim, I appealed the decision and eventually was approved based on a suspected diagnosis (and the pulling of strings of top executives in the company). With long term disability, I have not been so lucky. My initial claim was denied because they did not see sufficient evidence in my medical record to prove that I am, in fact, disabled.

Let me tell you, this is a very disheartening event–to have an insurance company extract quotes from medical records that “prove” I am qualified physically to work. Infuriating and insulting is more like it. They included one quote from my cardiologists note that stated on July 30, 2012 this doctor states “she is alert and oriented.” Ok, insurance company. Just because you can recall the date and know what type of building you are in does not mean that you can work 12 hour shifts as a nurse. They also decided to ignore the rest of the note which states that every time I stand up, my heart rate skyrockets to 170 and I have episodes of near syncope.

They extracted another statement from my neurologist that said that the small fiber biopsies were normal and negative for demyelination. But, what they failed to research is the fact that you don’t need small fiber biopsies to be positive to diagnose autonomic failure or dysfunction. They decided to ignore that fact as well.

I had my cardiologist fill out the physical capability form for the disability claim because he is closely following my case. He clearly stated that I cannot stand, lift, or walk. My physical capabilities are limited to activities of daily living only. Surprisingly, there was no mention of this document at all in the denial letter.

All this being said, I am currently in the process of appealing the decision. This could take up to 6 months. The worst part about all these minor details is that I am sick. I have no energy to sit up and research the policies, obtain all my medical records, call lawyers, etc. It seems almost impossible. But, I press on.

I will lose my employment officially next month–which means I will lose my health insurance. There is always COBRA, but without disability payments, that will deplete my savings quickly. Even with disability payments, I won’t be able to cover my rent, expenses, COBRA payments, or medical bills. It is also possible that I will be receiving treatment in the near future–an infusion that costs $10,000 a bottle. Five infusions in a treatment session, repeated every 6 weeks to 2 months until you are better.

At this point I’m simply frustrated. Unable to do much because of my current symptoms, I am stuck here just thinking about the claims and the impending financial difficulties.

It seems to me that there is something wrong with this healthcare system. So far, I have slipped through the cracks, been denied short and long term payments, and been passed around from specialist to specialist. You would think that I, an educated nurse, would be able to navigate the system–think again.

Everyday I would go to work as a nurse and treat my patients with dignity and respect. I would defend and protect my patients until the end. I worked hard to uphold the standards that my employer drilled into us. All I ask is to be treated by my employer and their insurance providers with the same dignity and respect  that I worked so hard to achieve for my patients.

Is that too much to ask?

Sarah Beth Cowherd is a nurse who blogs at SaraBethRN.com.

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  • J T

    Having gone through this myself, it’s very disheartening indeed. What people don’t realize, however, is this IS easier to get through – provided you know how to “play by the rules”, so to speak.

    What you’re missing is hiring a Social Security Disability lawyer. I hired one after being denied, just like you, and he worked w/ me to get me approved for SSDI. I doubt the process would be any easier for new SSDI applications once 2014 rolls around, but for now, getting a lawyer that works in SSD law is THE way to go.

    • JannyPi

      I had similar experience, and -while VERY knowledgeable, ultimately needed the disability attorney to get the papers in front of the judge on the right day. Fortunately, there is a CAP on how much a Social Security recipient can pay an attorney, in my case it was $5,300, I think. With Worker’s Comp or private insurance that fee can be 25% or more of settlement.

  • http://www.facebook.com/carol.levy.336 Carol Levy

    If you are talking about ss disability 65% of all first time applicants are denied, regardless of proof. SS attorneys and ss employees have told me it is because this helps to screen out the scammers; they usually do not want to be bothered with taking it further.
    I was thrown off ssd by Ronald Reagen when he threw off many on disability wothout rhyme or reason, just thght it would save the system money (some actually killed themselves because they were cut off without any assets available to them)
    The state docs and my docs all said I was disabled, social security decided to ignore all of it but one report from one doctor who wrote he questioned the severity of my pain, (a doctor who had a conflict of interest and they were informed of this). Luckily the judge who heard the appeal ignored this one report considering instead the approximately 7 other doctors and he reinstated my disability status and payments.
    You cannot take the initial denial personally as disheartening (I am sorry no pun intended) and frustrating as it is. Sadly, it is just the way the eyetem works, the scammers making it more difficult for those truly in need.
    Carol Levy
    author, A PAINED LIFE, a chronic pain journey

  • Patricia

    This has happened to me; three years later I am still suffering and my payments reduced to $30.00 per week because some doctor examined me for five minutes and decided my injury was not due to my claimed work injury (even though many doctors and physical therapists did not question this nor did the insurance company initially). On top of this I have had many people in my life comment on how they go about their days in (some kind of) pain. And even an accusation of ‘ripping off’ the insurance company (as if that were possible). It has caused a very irretrievably painful episode in my life as well as a lack of treatment for my injury.

  • http://www.facebook.com/brenda.dolha Brenda Dolha

    Sarah Beth, I feel your angst, as I too had great difficulty in obtaining LTD. 23 months, in fact. (Plus the 6 months since my last day of work.)
    It will be a burden off your shoulders when you finally get approved and obtain a settlement. Mine happened as the result of a mediation, with Insurer and my very competent disability lawyer(s), and my honest story of what life has become for me. Let yourself weep and rage when you need to.