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Denied Disability - HIV and fatigue
Dec 30, 1998

I am a 30 yr old male who has experienced extreme fatigue and anxiety over the last 3-4 months. My CD4's have dropped from 316 to 182 and my platelet count continues to be an average of 90K. I have had a lot of added stress at work lately and my physician feels that the stress along with my current drug therapy (Crix,3TC,AZT and Viramune) is the cause. Temporary solution, 4 weeks of rest away from work and therapy through my EAP.

Now my disability carrier is denying my claim as not medically necessary. When the leave is recommended by my primary care, my specialist and my counselor, how can they make this determination?

I need some assistance as I do not feel the disability company is looking at the entire picture. What information is most important to my appeal of this decision? I am afraid of losing my job and my benefits. This added stress is not helping matters much.

Regards,

Denied Disability

Response from Mr. Molaghan

Hello I'm sorry to hear that you're having such trouble working the system. People with HIV and AIDS have new challenges when trying to use disability benefits. Prior to the "redefinition" of AIDS as anyone having a CD4 count less than 200, a diagnosis of AIDS entitled a person to immediate presumptive disability. Most private and public disability programs now depend on "functional assessment" rather than a diagnosis or lab work to determine a person's ability to be "gainfully employed." Determining disability used to be primarily up to the physician and the patient, but that has been replaced by insurers scrutinizing reports and also auditing copies of the medical record to determine if development of the disability is documented over a period of time. Questionnaires are also sent to physicians with inquiries such as "Can the patient sit at a desk for at least 4 hours doing sedentary work? If no, explain why?" If disability has been denied, and it is agreed between the patient and the physician that a disability exists, then the claim should be appealed. This might require assistance from an AIDS service organization that specializes in benefits counseling. If you don't have such an organization in your city, you can contact AIDS Benefits Counselor's (ABC) in San Francisco for advice on how to proceed. Good Luck.


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