Short Term Disability Was DENIED...help

Updated on November 12, 2008
H.N. asks from Portland, OR
4 answers

I been working for a faily large company for about 3 years. My doctor took me off of work at around 25 weeks. On the FMLA paperwork he describe my condition as "due to complication of moderate-severe depression & Hepatitis C". I just found out today that my short term disability claim was denied, the insurance company said that my medical records does not show that I am being treated for these conditions on a regular basis and that I am still capable of working with stress & depression. My questions is...Has anyone of you been through similar situation and what did you decide to do? Did you appeal the claim? Do you think I should appeal it? and if so, what other documentations do you think would help. I did some research online and found that most appeal claims were also denied. Do you think it's worth it to do so?

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Z.A.

answers from Seattle on

Appeal.

Talk with your doctor's admin staff to find out what papers you can send in. It may well be too, that they either have a social worker on staff who can help you, or can point you in the direction of one who can.

Call legal services.

Talk to HR at your comapany.

Appeal.

The only person who stands to lose anything is you, if you don't. You've followed medical advice. You've done the right things. Don't let other people profit from you doing what you're supposed to, while you get screwed.

Hang in there

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P.M.

answers from Portland on

I have heard that claims are universally denied the first time, and that virtually all people who have been granted disability have had to fight for it. I have a sister who is one of those who finally received disability after at least 3 appeals.

Medical care and disability in America do not have to be adversarial, and we may soon have the chance to look at whether we want a more progressive system. The U.S. is the only wealthy, industrialized country that requires its citizens to fight so hard or pay so much for the care they need.

I hope moms who have not seen the movie "Sicko" will make a point of seeing it. I find Michael Moore pretty annoying, but he makes some astonishingly clear points in this film. You'll be glad you saw it.

Most inspiring was seeing how much better and stress-free health care is in other nations, and how satisfied citizens are to pay higher taxes for the benefit of all. And for most people, my own research suggests that "higher" taxes would still be considerably lower that what we pay now in total, between private and employer-provided insurance and medical care that is far more expensive than it needs to be. A profit-driven medical system does not take care of us, and it does not take care of good doctors who have to buck an absurd system to provide our care.

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M.S.

answers from Portland on

I read an article in the paper a while ago about disability, and a case manager stated that they are instructed to deny all claims the first time. Upon appeal, most are still denied. The article showed stories of many people that were undeniably disabled but were denied and died waiting for approval. Basically, I recommend that if you feel you are entitled to it and need it, then keep appealing and get a lawyer on your side if you have to.

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M.P.

answers from Portland on

yes! I've been thru it. From whom are you requesting disability? If it's from your employer it will be much easier to appeal. Have your doctor write another report that states your pregnancy combined with these two conditions makes it necessary for you to take leave.

I thought that you can have an FMLA leave for pregnancy alone. Are you requesting pay along with the leave? I haven't worked for several years and so I don't know enough to know how the FMLA is structured now.

I requested a leave from Multnomah Sheriff's Office for medical reasons. I was so tired and couldn't keep up. I was having a lot of pain and eventually had surgery. I also was a single mother to an adopted emotionally disturbed child. The doctor said that I needed to work half time so that I could get more rest and reduce my stress. I did not expect to be paid.

The Sheriff's office denied my request. I appealed and Multnomah County had me evaluated by a psychiatrist and a medical doctor. I took a couple of written tests administered by the psychiatrist who then recommended the leave. The county medical doctor looked at my medical records, talked briefly with me and after saying I don't know why the county sent you to me. Your doctor's report says it all. I could repeat the tests but the results would be the same. He also recommended a half-time work schedule.

I think this process took less than a month. I worked less during this process and when my sick leave was gone the doctor wrote notes verifying that I was ill.

One of the reasons I had to ask for the leave is that the office was disciplining for misuse of sick time. Because of the amount of time I missed I fit the description of someone misusing sick time.

I learned several times during my working life that there are a lot of employers/supervisors who do not understand what it's like to be sick and have a prejudice against people who are.
I was terminated from a temp job because I called in telling them I had to take my 76 yo mother-in-law to the emergency room as I was told to do by her doctor. The supervisor said that if I didn't come in within the next hour that I needn't return at all. The temp agency said that this supervisor had terminated several temps and for me to not worry.

Anyway, definately appeal! You have nothing to lose and much to gain!

Again, I think that your pregnancy combined with your other health conditions require that they by law grant you leave. It's only small business' (I think it's with less than 10 employees) that are exempt from this law.

I looked back to see your previous posts and saw that you asked about how/when to tell your employer that you were resigning. I am confused. I was going to suggest that you talk with your immediate supervisor when you make your final decision. I've known several mothers who didn't tell their employer until a couple of weeks before they were due to return. After all it's quite likely that many women don't actually know if they can manage when not working. Or find that they do want to stay home once they start preparing for going back to work. There is no right time to tell your employer.

Could you be having difficulty now because of what you've said prior to this request for a leave? If so, talk again to whom ever you talked with earlier and clarify your position.

I had to do an awful lot of talking with supervisors so that they would be clear about what was happening. Much of my need for open communication was the result of being one of the earliest women hired to be a deputy. So I had to deal with 2 prejudices: being a women and being ill.

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