Question
My father has been in STD Cigna and LTD with New York Life since Jan 2021, diagnosed Pulmonary Fibrosis due to Covid-19. Can insurance and ex job make him return to work?
During 2021 and 2022 there are restrictions from previous doctors, stating to avoid exposure to harsh cleaning products, chemicals, fumes, and aerosols. His job description is housekeeping as known as maintenance or custodian. Ever since he came to this country as a resident, same position. Well, different job locations but the same position. In 2021 after 3 months of hospitalization, was released with supplementary oxygen, and around Aug was offered rehab and proceeds. November underwent knee surgery which was causing him to do additional exercises example stationary bike. After he came out from surgery we noticed he was not using supplementary oxygen anymore, so we decided to make him begin walking around inside the house and backyard. Avoiding him to be exposed to cooking to home cleaning. We noticed Short breathing, consulted with doc gave him some inhaler meds. During that time the former job submitted an HR. Accommodation form, 2x, and was denied due to doctor restrictions. His health insurance Marketplace kept changing to the point we had to use a different doctor due to insurance coverage. We applied for SSD Jan/2022 due to his condition going on for over a year. Was accepted in 2023 around in Feb. Medicare insurance began in July/2023. As soon Medicare became effective we kept the new pulmonary doc ever since then.
There are notes and exams available. A recent Jan/2024 visit, pulmonary doc, and additional personnel from the pulmonary dept. The person just remained quiet the entire consultation. The pulmonary doctor brought up the question "Are you capable of returning to work" My father replied "No". with no further explanation. The pulmonary doctor suggested rehab. At this point, I thought here we go again trying to make him return to work. Pulmonary doc, "They are willing to offer you sedentary hand working". At that moment as soon he said: "They are willing". My head the person standing quiet is not who she is, unless I am wrong. I proceeded to say "What type of sedentary that will be, because an office job is not on his history education, in his country he only reached elementary, in other words does not have a certification or a degree". Then I looked to the person standing, "Two times they have been sending that questionnaire and daily activities offering sedentary job and I keep replying with the same answer, at the end has been accepted based on job experience and education level".
There is a debt an overpayment I believe it began at 9k in the insurance. We used the 10k from the SSD to pay for some medical debts and used the rest to continue paying his consultations. We told them we used to pay entire medical expenses. They offered us they could use the monthly payment and credit towards the overpayment debt. Is been over a year. They had frozen the overpayment before re-established and we are currently at 4k and frozen this time. Meaning there is no payment being processed.
Has not yet been denied but could go under review waiting for my father to go once again in rehab and push him to return to work. Not sure if I am wrong insurance is using rehab as occupational therapy or physical therapy. Rehab therapy is to try the patient to push him out from either reaching surgical or supplementary equipment or worsening under some health conditions. Unfortunately, there is no cure for Pulmonary Fibrosis, which is a reversible disease at any moment especially being exposed to chemicals as was mentioned above.
He still has short breaths and makes few stops. Uses inhaler meds. Wears masks in public places. His age is 63 with SSD Active.
There are notes and exams available. A recent Jan/2024 visit, pulmonary doc, and additional personnel from the pulmonary dept. The person just remained quiet the entire consultation. The pulmonary doctor brought up the question "Are you capable of returning to work" My father replied "No". with no further explanation. The pulmonary doctor suggested rehab. At this point, I thought here we go again trying to make him return to work. Pulmonary doc, "They are willing to offer you sedentary hand working". At that moment as soon he said: "They are willing". My head the person standing quiet is not who she is, unless I am wrong. I proceeded to say "What type of sedentary that will be, because an office job is not on his history education, in his country he only reached elementary, in other words does not have a certification or a degree". Then I looked to the person standing, "Two times they have been sending that questionnaire and daily activities offering sedentary job and I keep replying with the same answer, at the end has been accepted based on job experience and education level".
There is a debt an overpayment I believe it began at 9k in the insurance. We used the 10k from the SSD to pay for some medical debts and used the rest to continue paying his consultations. We told them we used to pay entire medical expenses. They offered us they could use the monthly payment and credit towards the overpayment debt. Is been over a year. They had frozen the overpayment before re-established and we are currently at 4k and frozen this time. Meaning there is no payment being processed.
Has not yet been denied but could go under review waiting for my father to go once again in rehab and push him to return to work. Not sure if I am wrong insurance is using rehab as occupational therapy or physical therapy. Rehab therapy is to try the patient to push him out from either reaching surgical or supplementary equipment or worsening under some health conditions. Unfortunately, there is no cure for Pulmonary Fibrosis, which is a reversible disease at any moment especially being exposed to chemicals as was mentioned above.
He still has short breaths and makes few stops. Uses inhaler meds. Wears masks in public places. His age is 63 with SSD Active.
Answer
Walt, while no one can force your father back to work, NYL can certainly deny benefits if they believe there is not enough support for your father’s claim for benefits. However, it sounds like there is a lot of objective evidence for your father’ condition. Always remember that it is your and your father’s responsibility to ensure that updated proof is constantly provided to the insurance company. Proof is typically in the form of medical records and letters of support from the treating providers. Please make sure that NYL remains well fed with updated proof so that they never have any reason to deny the claim. Should you wish to discuss his claim further, please never hesitate to reach out to us for a free consultation.
