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STD denial. My next step?
Oct 31, 2002

In March of 92 my tcells had dropped to 103, I was suffering from Thrombocytopenia, neuropathy and chronic fatique. My doctor thougt it bes that I take 3 months of Short Term disability to try and get my counts up, change my meds to help the neuropathy and chronic fatigue. It worked, my tcells shot up to 370, thrombocytopenia is much better as is the neuropathy and fatigue. My ST disability plan through my employer has denied my STD. Claiming that my Dr's documentation was not enough to support it. I appealed with a letter from my doctor. Again it was denied stating each diagnosis was not supported well enough with documentation as to how each treatment would help my symptoms and that fact that i was not sent to a sleep clinic for the chronic fatigue. Even though my return to work supports the fact that the treatment and time off did help, can the insurance company do this? What should my next step be? Can the California Insurance commission help in my battle against this New Jersey based insurance company?

Response from Ms. Breuer

Oh, you have my heartfelt sympathy. Battles with insurance companies when you already feel sick are truly perverse life events. But I confess confusion: did you mean to type "March of 92"? Is this really ten years old?

Yes, do not hesitate to involve the California Insurance Commission, and/or a lawyer. Don't mis-hear me: I didn't say sue them. I said get a lawyer involved to ask questions about what aspect of your claim is leading to claim denial. This is too important to be left in the hands of folks like us who don't speak Insurance every day. If you have a good friend who works for an insurance company, you might seek that person's advice, too. This doesn't make any sense right now, and it sounds as though your claim form and the claims adjuster are speaking two different languages. Please don't hesitate to pursue this. Is there any way your employer could help, or would you prefer that they not know your diagnosis--a perfectly reasonable preference?



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