10-02-2016, 12:32 PM
I have an approved work comp claim and the work comp insurance co my employer had at the time of my date of injury is paying me (PD now, pending settlement - already had trial - now up to judge).
The issue I'm still having is with my private disability insurance through my former employer (they let me go while on leave). Disability has denied benefits for both STD and LTD since last summer. I am supposed to be supplemented to 2/3 of my salary but I am not getting anything and EDD denied me also.
I ordered my claim file and now I understand why. There is a report in my file that I was unaware of, and the report does not state the truth. Not only is the information totally false that is written, but the doctor who wrote it isn't even one of my treating physicians nor is she in the same field / specialty that is required for my injury.
I went over the notes and in doing so, noticed two things. 1. I have an email proving that what was said to me in our appt is not as the doctor stated because I emailed some questions after the visit (this email was omitted from the claim file but I have a copy of it from my medical file and the online hospital system). 2. The notes the doctor recorded in my file PRECEDED my appointment, so the office visit notes were documented and recorded on the system by time stamp, before I ever met this woman. Yet, she felt the need to make up things, lie about a few more things, and then by doing that special PR-2 form (Primary Treating Physician's Progress Report), single handedly cut off my benefits.
I have no idea what avenue to take to get someone's attention on this matter. I have appealed with disability (lost) I have appealed with the hospital (lost) I tried to find an ERISA attorney (didn't go so well-no real money in it, apparently) so does anyone have another suggestion on where I might get some help?
Similarly, upon reading the notes by my private insurance company and as outlined to their 'clinical review team' for recommendation regarding my last appeal, information was misrepresented to the point where I was made out to be, according to their opinion, lying about my injury and not taking my injury serious enough to seek treatment. I'm not even going to bore you with the details on that other than to say, I submitted a five page document outlining all my steps and provided the who what where and when as to being blocked from actually getting treatment, yet the report says there is no evidence to the contrary to their findings of 'lack of intent' on my part. I am out of appeals, as in no more allowed because I lost them all.
I have reached out to some other types of attorneys but not holding my breath since they are not specifically ERISA attorneys. Is there anything I can do to bring attention to this issue?
The issue I'm still having is with my private disability insurance through my former employer (they let me go while on leave). Disability has denied benefits for both STD and LTD since last summer. I am supposed to be supplemented to 2/3 of my salary but I am not getting anything and EDD denied me also.
I ordered my claim file and now I understand why. There is a report in my file that I was unaware of, and the report does not state the truth. Not only is the information totally false that is written, but the doctor who wrote it isn't even one of my treating physicians nor is she in the same field / specialty that is required for my injury.
I went over the notes and in doing so, noticed two things. 1. I have an email proving that what was said to me in our appt is not as the doctor stated because I emailed some questions after the visit (this email was omitted from the claim file but I have a copy of it from my medical file and the online hospital system). 2. The notes the doctor recorded in my file PRECEDED my appointment, so the office visit notes were documented and recorded on the system by time stamp, before I ever met this woman. Yet, she felt the need to make up things, lie about a few more things, and then by doing that special PR-2 form (Primary Treating Physician's Progress Report), single handedly cut off my benefits.
I have no idea what avenue to take to get someone's attention on this matter. I have appealed with disability (lost) I have appealed with the hospital (lost) I tried to find an ERISA attorney (didn't go so well-no real money in it, apparently) so does anyone have another suggestion on where I might get some help?
Similarly, upon reading the notes by my private insurance company and as outlined to their 'clinical review team' for recommendation regarding my last appeal, information was misrepresented to the point where I was made out to be, according to their opinion, lying about my injury and not taking my injury serious enough to seek treatment. I'm not even going to bore you with the details on that other than to say, I submitted a five page document outlining all my steps and provided the who what where and when as to being blocked from actually getting treatment, yet the report says there is no evidence to the contrary to their findings of 'lack of intent' on my part. I am out of appeals, as in no more allowed because I lost them all.
I have reached out to some other types of attorneys but not holding my breath since they are not specifically ERISA attorneys. Is there anything I can do to bring attention to this issue?