I was wondering if anyone here has been on long term disability from work and then after a long period of time had a full medical review and sent for an IME (independent medical evaluation) by the insurance company. I just went thru that process and the doctor has written up that he cannot determine why I am unable to work. Therefore he sided with the insurance company and they took me off disabilty with no warning. I can appeal the decision but I am not sure that I can go thru that process. It was difficult enough to have survived a brain aneurysm rupture 9 years ago and then have cognitive problems associated with the rupture. Don't get me wrong, I am so thankful to have survived and be alive. I have met so many new friends here and have come to accept my limitations. I know that I could never return to the workforce. Any information would be greatly appreciated.
well my husband had spinal fusion on his back and he was out of work and he had to get a letter allowing him to go back and the insurance runs out after so long and the pay gets cut also. I would go through the process for the fact of having all the issues we have, i’m having mine go to court. 2 neurologist told me they cant help me, but they like to say we can be retrained. Ok , i cant stand up long enough cant sit long enough dont sleep and so on, yea right.well thats my input.
Jennifer,
I am not on diability as my annies did not rupture.
BUT
I am a paralegal and I work in a lawfirm. I will tell you that IME's are usually done a the request of the insurance company (so how can they call them independent is always my question).
I will also tell you that you should find yourself an attorney who deals with long term disability issues to file the appeal on your behalf, especially if you have your doctor who will back you saying you are unable to work due to the rupture of your annie. Most appeals processes are denied in the inital stages. I truly believe insurance companies believe most people will not fight beyond that.
Also, file for Social Security DIsability Insurance too!! Chances are you will need a lawyer for that also as most SSDI claims are also denied on the first try. But I believe it is worth the fight when you truly cannot work anymore!!
Please don't just lie down and take that from the insurance company. Fight for what you are entilted to.
Either way you decide, my thoughts are with you.
Linda
This is a standard move by a insurance company. Is your Doctor a specialist or just a primary care Doctor? This makes a difference. Also, in your opinion what is your Disability - cognitive, pain, or physical? As Linda mentioned, don't back down from the Insurance company. It will be important for you to begin assembling your medical information, file for Social Security Disability (it is normally denied at first so don't get to upset as you can appeal). When to hire a Attorney is not the easiest decision. Much will depend on your answers to the above questions. I am not a lawyer but I do have some experience in this area and have gone through this experience. I will try to help you where I can.
Jennifer...
All this disability data gets so complex. Is your disability insurance provided through your employer, and then it selects the IME who is not your usual MD?
Did your HR / manager attempt to have you return part-time at any time, or immediately put you on disability?
Do you have the written policy, or HR to help you with it?
Have you had neuropsych tests? Reasons relate to State L&I, Social Security, and IRS laws.
My State L&I would cover only the fractured shoulder (related to my first emergency), where other med records note SAH and SDH. I attempted to question if the SDH was related to my hitting the cement where my shoulder was fractured; no MD answers. I did not then know SDH was in my records to my med insurance provider until I ws having billing problems and one of the MDs used the Diagnostic code and/or the CPT for SDH. L&I would not address any of this, nor wood the MAJOR hospital; even tho the orthopedic specialist recommmended to L&I to contact the neuros. There is no record that it was done; and then, the IME from the L&I on my shoulder. L&I may have some name other than IME.
Social Security Disability requires neuropsych testing;and, presume they must also use MDs for some disabilities?
My initial psych test at the hospital notes "senorimotor testing deferred" w/no documentation of why.
My f/up 09/2007 (not required; my selection to gauge advancements, declines and which therapies to continue; of interest, both my right and left issues are reflected in this test results.
Due to cognitive damage, I filed five years of income tax in mid-2010. (skipping detail)
2005 filing is of a refund, which a specific law denies when the filing is 3+ years late. Initial Appeals directive is specific that I must have an MD letter specifying my med condition at the time I failed to file (2006); the law is specific it must be an MD, not a psychologist. My current/local PCP and neurologist gave me run around; they were not my doctors at that time; and "Possibly...she did not have the capacity..." The IRS will not accept that; so, now I have to file at the Fed Court. I can do it on my own or by an attorney.
What is overwhelming, SS required psych/test; the IRS requires an MD, L&I and other disability insurance uses an IME. It all adds so much confusion to our recovery process.
So hope you will keep us informed of your successes and for any data that may help others in similar circumstances.
Prayers and best wishes for your success.
I had 3 cervical fusion surgeries, I also had short and long disability coverage through my employer at that time..... My Doctor disabled me in June 2005 which he back dated to the date of the car accident March 2005. 3 surgeries between Aug. 2005 and Aug. 2006. My Doctor did NOT respond to my disability insurance, so after 3 attempts by them (with out my knowledge, as everything was being sent to my atty. ) Hence they closed my claim and I got NOTHING !! Second spinal surgery was un-warranted ..... My surgeon used a new device (I being the first in our area) I was his "Human lab rat" used the device off label, on day 3 the plate and screws pushed out, had an MRI and my Surgeon had to call in the sales rep to read my scan, the Surgeon billed my insurance fraudulently, among other billing manipulating to insure he was paid "out of network" when I had to jump through all those hoops with my health ins. to get a referral to him as a preferred provider, when I filed for SSDI he also falsified my medical records as NOT to put liability on him.... He is the Pres. of the Neurosurgeons board in our state annddd he is also a Lawyer. What this man has done to my health, quality of life and the downward spiral I'm currently in.
The device was removed, 11 weeks after surgery 2, you would think all of the device was gone. However he's not talking, he left 6 Barium markers in the bone graft which is highly toxic, one thing being swelling of the Brain, Aug. surgery and by Nov. I began to have tremors, head pressure, and a 24/7 headache, other problems with vital organs, It wasn't until I thought I was having a stroke in 2009 that they found my Annie, coiled, complications as usual I seem to be that 1% constant visit's to the ER, an actual stroke June 2010, last Angio had 2 blockages, and most recently back to the ER ... had a Dehydrated Brain. I so miss work, have a hard time with limitations.... I just can not accept that "this" is my life to be....
after years of fighting with SSDI I finally get my day !!!! Oct. 17TH ... am hoping they will see what some of these idiot Dr's have done to me and approve my claim !
In addittion to a) getting a good lawyer who specializes is disability and b) appealing you might consider applying for SSI. I work for the government and know for a fact SSI denies the vast majority of claims right off the bat. They are counting on the fact most people just give up. If you really have issues don’t give up. And find a lawyer that won’t give up either.
I’m glad that you are arguing your case in court. It is too bad that we have to endure all of this on top of trying to get better. Good luck.
Thank you so much for your input. I am going to seek an attorney once I see my original neuro-psychologist whom I saw 4 years ago. My neurologist continues to say I am disabled and cannot return to work but I also know that the insurance company wanted me off their books. It was evident when the claims manager originally asked me if I could retire from my job. She didn’t realize that I kept good notes. I know that I cannot possibly attempt to file an appeal myself. I’ve heard such awful stories of what disabled people have to go thru to fight for their rights. It really erks me that this doctor would write up his report in the way that he did - not coming out and saying that I can or cannot return to work, just that he doesn’t know why I can’t. He also kept repeating the same sentence over and over again, basically saying that I did not put forth effort, on and on and on. Really makes me angy, but I also have to put it aside and not take it personally I guess. I think the bottom line is the insurance companies don’t want to pay and they will seek any means possible to get out of paying. They really dropped me like a hot potatoe, so to speak. Anyway, thanks again for your input Linda. I appreciate it so much.
Thank you also for your input. I need all the information I can get on this issue. I realize this is a standard move by the insurance companies and I have to say they pretty much left me alone for 8 years but once they found out I was able to retire then the IME came about. The contract between my former employer and the insurance company says that I can stay on disability until age 65 if needed. That did not happen once they found out I could retire if needed. I will seek a lawyer for opinion/appeals once I see my own neuro psych this week.
It is confusing and thanks so much for your input. It is also so very stressful.
I am so sorry you have to go thru all of this on top of your medical issues. Good luck with your case on the 17th. I’ll be praying that you have a good outcome this time.
Thanks for your reply. The easiest way is to just give up - alot less stressful, but my hubbie wants me to fight so that is what I will try to do.
It is very stressful what they put you through… but at this point my onset date is March of 2005 with 2 “back to work attempts” 1 full time and the other part time just 2 four hour day’s… found myself worse off than ever, I even hit a Police car, vision issues. However this was before they found my Annie, and all the other health issues were beginning to present themselves. Totally medicated while trying to work, not a good idea !! I do have a good Atty. “now” fired the first one, missed my reconsideration date to present new information, I’ve come this far and I’m not about to give up now ! I agree with your husband, you need to fight this and get what you deserve… they “count” on people giving up… sort of their way of weeding out those who really need it. It’s an horrible way to do business especially when it comes to a person’s health and lively hood. Thank you for your thought’s and Prayer’s 
How scarey that must have been for you! Glad you have found a good attorney to help you thru this whole thing. Sometimes they make you feel like you are the one in the wrong, that somehow you have done something wrong or are fabricating things. At least that is how they are making me feel at this point. I know deep down it isn’t true but they sure do make you start doubting yourself. My “annie-versary” date is October 17 - will be 9 years that I suffered, and survived, a ruptured aneurysm. Their timing is never good when it comes to a decision being in their favor but when it comes at the anniversary date of surviving a rupture, it is just a little more difficult. Thoughts and prayers are with you.
I hope you turned a complaint into the medical board (easier said than done when you are feeling miserable and in pain). How horrible for you to go through that.
I am currently on SSDI because of the side effects from cancer treatment (not because of the cancer, the side effects). I, too, went to court when I won. They had a "work specialist" who stated that I could not work in the field that I used to and would not be able to hold a job in most fields. I did hire an attorney for this appeal - social security only allows a certain percentage of the back pay if you win (or a cap if the percentage is larger than the cap allowed by law).
Good luck on the SSDI and your health. I, too, having worked all my life in stressful management jobs, really missed the work. My memory is so bad now, but I do so much volunteer work that it is fulfilling and find that I am really fulfilled by that.
Best of luck and let us know how the court worked out. It took me several weeks after the date to find out they approved me for SSDI. Let me know if you have any questions.
Sherri
Thank you Jen,
I had my hearing this past Monday.... everything went well, so now I just have to wait for their decision hoping for the best !
Just read that the BAF has a dvd that we can give those in our communities to educate them which I think is imperative in our care ! This is huge for me since no one knows how to deal with me, on any level....
Thank you again for your thought's and Prayers,
Beckie
Sherri,
I have complained to every entity on our State and National level..... NOTHING ! This guy is frankly untouchable, there are no checks and balances for physician's... All I get is talk to an atty. well, he is one and as with the Medical field it's the "good ol boy's club" I even went out of state to see a new Neurosurgeon, shocked by what I was hearing. That Doc called "my" surgeon an idiot, or rather said "what are those idiots doing up there?" and then when I posed the question as to how the Barium is still there without the hardware he replied "I'm not in a position to pass judgment on a fellow colleague" O M G ! and then he said, has anyone scanned your Brain sounds more like a Brain Tumor to me.... we had a 2 1/2 hour drive home and pretty much bawled all the way... just what I didn't need !
Went to next Dr. appt. and demanded a Brain scan.... the reply I got was " well it's in there, just what we expected, you actually have a brain" and then he laughed.... NOT funny. Then while gathering my Medical records got a copy of that scan, and there are a few things they missed or just decided not to say.... my annie was undetected on this one but the other side of my Brain has lesions.... I know what this means and have thought for a few years, with that hardware that was used if a person is allergic to Barium which I am, it can cause a Neurovascular injury, MS..... theres soooo much damage that Barium can cause it is astounding. So much research I've done could make your head spin, as I decline day by day.....
Sherri had my hearing and all went well, so now the wait and see game....
Memory ? ? what's that ?? besides all the other crap I have to deal with "that" is what get's me the most.... I want it back !!! it's difficult for people to understand that part as well, and the different "you" become after the procedure, I just keep hoping that that other 90% will take over what I've lost !
Thank you so much for your thought's and word's, it means a lot :)
Beckie
Hi Sue,
I have contacted my Congressman which did help, I and been waiting for a long time for my hearing and with in weeks of me contacting my congressman I got the call that I had been scheduled !!!! I wish I had done it much sooner ! as they are there for "us" the people..... still waiting for their decision, so fingers crossed ! my retro goes back to March 2005, Just a real nerve racking process !!!!!
Thank you for your thought's and comments !!
Beckie
JenRap, do not give up what ever you do. You have the right to get a lawyer and appeal this stupid doctor. I had my annie clipped June 6th, 2011 and left the hospital a month later on. On July 8th, 2011, I applied for SSI and SSD and was turned down for both, even though my neurosurgeon specifically said I can't work. I got myself a good attorney, and it will take till March of 2013. But I am a patient person and believe I paid into this and I deserve it just like everyone else!!! Saying prayers for you and god bless you.
Thanks, Amy