Attorneys for Principal Financial Disability Claims
Principal Disability Benefit Claim, Denial, Appeal and Lawsuit Information from Disability Lawyers- A Mental Health Limitation disability benefit denial by Principal Financial after 24 months
- Principal Financial Group - Disability Insurance Claims, Denials & Lawsuits Help
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Disability claimants are often seeking information about Principal Group long term disability reviews. We have created this page where insurers can post reviews and comments about Principal Group disability claims. Our attorneys respond to most comments posted by our visitors.
Principal Financial Group was founded in 1879, in Des Moines, Iowa, where it is currently headquartered. In 1879, Bankers Life Association was founded by Edward Temple, a banker from Chariton, Iowa, and five other colleagues. In 1909 after the death of Edward Temple, the Board of Directors voted to reorganize the business into a mutual life insurance company.
In 1941 the company issued its first group health insurance contract. Within the next five years, group health insurance accounted for a third of the business. In 1985 Bankers Life Company became Principal Financial Group.
The Principal Financial Group is a global financial services provider which offers a wide range of financial products and services, and is the U.S. leader in 401(k) plans. The company is composed of six business units: ‘Retirement & Investor Services’, ‘Global Asset Management and Real Estate’, ‘International Operations’, ‘Life, Disability and Group Health Insurance’, ‘Specialty Benefits and Wellness’, and ‘Banking’.
During the 1990’s the company expanded to markets outside of the United States, including markets include Argentina, Brazil, China, Chile, Hong Kong, India, and Mexico. In October, 2001 the company became a publicly traded corporation. In December 2005 Principle opened its first offshore unit in Pune, India, by the name Principal Global Services. In February 2008, Nippon Life Insurance announced that it would increase its stake in Principal to 7%, making it the largest single stakeholder.
The Principal Group is a Fortune 500 company and currently lists assets totaling $236.6 billion as of March, 2009.
Disability Attorneys Dell & Schaefer have provided and offer the following legal services for disability claimants that have a long-term disability insurance policy or disability income policy purchased from Principal Group:
- Application for long-term disability benefits with Principal Group
- Application for short-term disability benefits with Principal Group
- Monthly claim handling of Principal Group long-term disability insurance claims
- Appeal of a Principal Group denial of long-term disability benefits
- ERISA appeal of a Principal Group denial of long-term disability benefits
- Lawsuit against Principal Group for denial of long-term disability benefits
- Lump-sum buyout of a Principal Group long-term disability insurance policy
- Department of Insurance complaints against Principal Group for wrongful delay and denial of long-term disability benefits
I filed a short term disability claim on January 19th and was paid for two weeks through Feb. 18th, 2012, with a note to review for additional benefits. My doctors have sent several letters and additional information about my condition yet they have denied my claim. Because my disability is based on mental health issues resulting from my job (racial discrimination claim against employer), I believe my employer has had some impact on the results. I do know the insurance company has been in touch with her. Even after asking what was need, they still denied the claim after submitting the information.
Brenda,
Please contact us privately and we will review your denial letter to see if we can assist you.
I have Principal Financial disability for 18 yrs. through work.
Last Jan. I had 4 spinal multi-level laminectomies and fusions and was promptly paid short term disability without incident. After 4 months, disability was stopped as Principal deems 4 months the maximum length of time required to fully recover from this type of surgery. Perhaps their rule of thumb is one month for each laminectomy?
Despite my doctor’s refusal to sign a return to work order for another 60 days until my back heals enough to begin resuming normal activities. And my doctor’s office phoning Principal to say the same. And the fact that this type of surgery is not even deemed successful until a year passes to determine if calcium growth around the fusions has occurred or if further surgery is needed.
Principal determines the length of your disability. NOT YOUR DOCTOR OR YOUR RECOVERY RATE. The company needs to list each disability they will cover along with the time they will allot for each so customers don’t get fooled into thinking they will be covered for their entire recovery time and instead go down the drain financially because they don’t recover fast enough.
Bullying the sick and hurt is shameful.
Debi,
A four month recovery for the type of surgery you had is ridiculous. Especially when your doctor has not cleared you to return to work. Most people with your surgery do not return to their jobs. If you have been denied, then contact us privately to review your disability denial and let you know your options.
Thank you so much Greg. Good to know I’m not crazy or just too slow to recover :)
I have pursued the matter with Principal and my doctor. My doctor called Principal again. My agent took it to Principal’s medical panel, who did agree that due to the extensive surgery it might take a bit longer than the normally allotted 4 months to recover. So I have been given another 60 days. Thank goodness.
Again, bullying sick people is SICK. I got a taste of what disabled people have to go thru, and it’s cruel. I spent a month staying up nights way too late worrying about why I was being cut off and hoping my savings could take the hit financially. Never thought taking the time to recover would be an issue. After all, my insurance was for this type of worse case scenario. I never dreamed I would have to use it. I have worked for the last 45 years. Without incident. I am not a lazy bum or a liar. To have someone insinuate I am was beyond offensive. Those who are in much worse shape deserve to be treated with respect. Instead they have to resort to the law to find a bit of fairness they deserve. No one needs the mental anguish, and degrading insults, while trying to recover. Or having to prove how badly they hurt. Shoot, one look at x-rays should tell anyone that.
Hello. I was informed that once social security approves your claim and states that you could never return to work under the medical conditions you have and you are not at an age or physical capacity to be re-trained for future employment of any other kind. Principal or any other LTD Insurance carrier can not force you to return to work nor refuse your benefits. Is this in fact, the truth? Principal has inundated my primary care with requests every 3 months for my condition. If I can return to work. She BOLDS the NEVER portion each and every time. I find it interesting. When I first got sick and my physician stated you can not go back to work, Principal’s Representative stated to me after I placed my claim “No one ever uses this LTD” I asked “Then why do you sell it?”
The other interesting fact about Principal, is that, I discovered MENTAL ILLNESS does not warrant any LTD coverage. So anyone looking to go out on LTD for any mental illness, e.g. depression etc… it’s a no win for them. They require physical limitations or disabilities. This is my impression of them. They took every penny of my retro Social Security check and then billed me for $834 more than Social Security paid me. I couldn’t win. I was sick. I had so many medical bills hanging over my head. But they won, they are the big dogs and we are nothing! They also tried to send a PI to my house to interview me, at that point I hired an attorney. Felt a PI was NOT a medical person and had no right to ask me medical questions. Felt very violated. My primary said, have them come to my office, I’ll video them interviewing you. Plus, she said she would answer all medical questions. That was some dirty works… they really tried to violate me.
Wishing anyone the very best with them.
Lisa,
Unfortunately, whoever informed you of such is wrong. Being approved by the Social Security Administration is not a guarantee that your private disability carrier will continue to pay benefits. All too often we see claim denials even after someone has been awarded SSDI benefits.
Principal approved my LTD claim, but I later learned they had ignored all of my physical health issues and selected only one non-physical issue (depression) which means they only have to pay LTD for 2 years. Have you successfully challenged this position? Is there a statute of limitations?
Susan,
Yes, this has been successfully challenged in the past. Please feel free to contact our office to discuss how we may be able to assist you in transitioning your claim to a physical medical condition outside the scope of the two year limitation.
I work as a medical transcriptionist. I have lupus and have been unable to work since November 20, 2013. Principal is supposed to pay me 60% of my wages while on STD. I have questioned the amount because according to my calculations the amount I am receiving is very low. I was informed by Principal that my employer reported a base hourly rate at 40 hours a week. As a transcriptionist I am paid by production, not by the hourly rate. I receive the hourly rate only when I take vacation or sick days. I am also a team lead and receive a supplemental salary for those duties. This salary was not reported to Principal either. Based on my 2012 W2, there is about a $20,000 difference in what my actual wages are versus what Principal is paying me. Basically my employer has falsified my wages. Is this legal? Can they get by with this or do I have a case to fight? I have called my employer and they will not return my calls.
Donna,
First and foremost I would obtain a copy of your policy to determine how Principal is to calculate your pre-disability income or earnings based upon the terms and conditions contained therein. I would also bring your concern and problem to your employer to find out why your income was being reported the way it was to Principal.
I am a full time employee and went out November 26th, 2013 for a partial Hysterectomy. I have turned in all of my paperwork to file for STD and was submitted a check for just about 4 weeks. I am still not cleared by my doctor to return to work due to compilations from surgery – stress incontinence of the bladder and severe chronic pain in the pelvic area also still very tender around the port holes in my lower abdomen area. I will be out until the 25th of February and now the physical therapist is requesting my OBGYN to keep me out for another two weeks after that. However Principal is telling me recovery time for hysterectomy is six weeks and my doctor has me on no limitations so they can no longer pay me. I am just about to lose my car and many other things because of this. What should I do? Is this even legal seeing I have paid hundreds into short term and long term but when I need it to help me I get ripped off!
Julie,
You need to have your doctor document continued restrictions and limitations that would prevent you from returning to your job. If the doctor is not providing specific information to Principal to support the continued time off of work, Principal could easily justify denying continued benefits.
I had a Principal Financial group long term disability insurance from work. They kick me off after almost two years of coverage. The told me was able to do some kind of job. I applied for SSDI and it took almost 30 months to get my day in court. I won and the judge up my disability to the day I went out 2009. My long term insurance was to pay me the difference in pay until 65. Called PFG they told me they called my case and tuff luck. But if they closed my file wrongly do I have a case?
Ron,
If you did not appeal the denial of your benefit in the time allotted under ERISA you could be potentially barred from filing suit. Furthermore, there could be a concern as to whether the Statute of Limitations to bring suit has already expired. Please feel free to contact our office to discuss your case.
I work in the financial field and have back issues that limits me from working full time. Many Years ago I took out a policy with Principal Group that would cover me and I thought this was wise. Little did I know I would be dealing with this issue in years to come. My Medical records and MRI’s and EEG and Dr. all backs up my stated problems and limitations. However, because I waited a period of time to file a claim and was between Dr’s care, my partial disabilty for that time period and forward is in question. My agent did not make me aware of all these hoops and requrements and he knew the time frame as I discussed with him along the way and was never properly advised. These policies are very complicated and I work in the financial field and yet the ambiguity around the language and the hoops you have to jump through is mind boggling. It certainly makes you question why you pay to have such misery in dealing with a company when it is supposed to keep you in times of misery and sickness.
D ALAN,
I assume your claim is still pending a decision. If so, please feel free to contact our office to discuss how we may be able to assist you.
I was approved by Principal for LTD in 2005 and SSDI in 2007. It is now 2014 & Principal is having me see an Occupational doctor to determine whether or not I can work. I am 46. My health has not changed. I believe this is the beginning of their way to deny further benefits to me since they see me as a person they have to pay benefits to for a long time. Nine years of benefits, why now?
Kelly,
It is unusual that after 9 years on claim Principal would begin a full out investigation of the claim. Please feel free to contact our office to discuss your claim further.
Principal’s short term disability insurance is all lies. They will deny your claim any way they can. I had an existing marginally high blood pressure. No indication in any of the propaganda they use to.get your sign up that this means they can take your money but really not cover you while they review let underwriters slow play athe process. God forbid you get hurt and file a claim almost two months after you signed up. Even tho all you had wrong was hbp that you told them about already, they will now include your new injury or illneas to decide they arent going to insure you, even tho it has nothing to do with hbp. Cheap shot Principal! I guess if my new injury happened just a few days later, you would already have approved me for STD insurance and would have to pay my claim for my injury. Hope you are proud of the lack of morals and integrity this takes all over about $360 a week for a couple months-just long enough for me to get surgery so I can go back to work. Now I am going to get evicted, cant get my surgery because I don’t even have money for the copay, I get to starvr cuz you all used an injury not in evidence at the time of enrollment. Breach of good faith, bad business practice, destroy a poor mans life all over 360 a week?
Charles,
What is the status of your claim at this point? Are you back at work? In appeals?
I am not at work, have to get surgery to get release. I was supposed to have disability ins effective 4/1/14, my hernia occured on 5/10/14. They are taking both my HBP plus my hernia to deny me insurance. I’m about to be evicted, can’t even get food, I’m screwed. Don’t have the money to get my HBP med refilled. This is what they have done to me.
Charles,
Are they claiming that the conditions are pre-existing as defined under the terms of the policy?
After all of this, I am essentially too poor to help. There isn’t enough money involved for anyone to help right a wrong. This says so much for what our country has become: a place where powerful rich corporations can do anything they want to the people that are the least able to fight. How can it be right for this company to conduct business in such an arbitrary manner? To deny coverage that would allow someone barely above federal poverty level to survive, get the necessary medical treatment and return to work.
With all the bad reports as to how Principal and ERISA screw the people, why isn’t there some kind of class action suit to make these entities do the right thing?
The high blood pressure is what i defined as pre existing at enrollment. It was a check box. The info they gave was just that pre exist wdnt be covered for 12mos. The hernia is a new injury, not on any list, and happened over a month after i enrolled. They told me they lumped the 2 together in undrrwriting, which together they decided not to give me ins. Its the wierdest thing ive heard of. They have nothing to do with each other and my hbp only needs 1 5mg pill a day, barely is hbp.
Charles,
The insurance companies work within the context of ERISA, and the rules that dictate the legal procedure of same. The only way to change the nature of the law is through a change in the actual law – this requires Congress to act. Until such time, the insurance companies will continue to work within the parameters of the law often to the detriment of many insured.
So, is there anything that can be done for me? I have yet to receive anything in writing from them, they are so slow.
Charles,
How long has MetLife had your application? Under the law they are entitled to 45 days to render a decision, with the possibility of a 45 day extension. Please feel free to contact our office to discuss your claim.
Hi, I have just been notified by my Neurosurgeon that after my MRI, EEG and needle test that he is recommending that I go out on LID. My conditions include 4,5,6 Radiculopathy, Bilateral carpal tunnel (had previous surgery to repair both wrists), Fibromyalgia and I believe peripheral neuropathy. I also have damage in my neck, I am on full time Pain medication both Lyrica and Nucynta. I am 52 years of age, a high level manager in an IT company for the past 23 years, with 31 years total in IT. I am in constant pain throughout my extremities. My doctor has assured me that I have nothing to worry about (he is the Chief of Neurology at a local Hospital in NY so I trust him) and he will write up report that he feels cannot be denied. I have not notified work about my intention as of yet, I have an excellent LTD executive policy with Principal. My biggest fear is that I will go out on Disability first STD and then LTD and at some period of time the insurance company will deny my claim. Being unemployed at 54 with no income source and not being able to work with my condition would be devastating financially to myself and family.
What are your thoughts on my chances, should I continue to work as long as I can or is that bad? Do I need to get 2nd and 3rd opinions before going out sick? At what time should I engage your firm to start handling my case, after I file, before when LTD kicks in?
Thanking you in advance for the response.
Mike,
I am sorry to hear of the difficult choices you must ponder. Unfortunately, no one but you can determine when the time to stop working is. However, there does come a point when your continued efforts only serve to further impact your health in a negative way. Please feel free to contact our office to discuss your options and for a free review of your disability policy.
Hi. I have been receiving LTD benefits from Principal for almost 2 years. I have cognitive Deficits and Ptsd from an auto accident on the highway. This was proved via neuropsychology exam one year ago. I spent 15 months in vestibular and speech rehabilitation therapies. Principal has requested an IME. My deficits are shown by excessive yawning as my brain fatigues. What are your thoughts about a successful IME?
Lisa,
Without a better understanding of your medical history and the facts and circumstances of your claim it would be difficult to provide any opinion as to the success of an IME. With that being said, your policy most likely requires you to submit to an IME at Principal’s request. Failure to do so could result in your claim being denied. Please feel free to contact our office to discuss your claim.
Does The Principal use private investigators to follow, photograph claimants?
Matt,
Yes, Principal is known to use investigators to conduct surveillance as part of its ongoing review of your claim. If you have concerns regarding the status of your claim please feel free to contact our office to discuss.
It took 5 weeks & numerous phone calls to Principal before I got a decision on my short term disability claim. I was put on FMLA short term disability by my employer because of neck, shoulder, back & hip pain due to herniated discs, disc degenerative disease & nerve pain. I have been seeing a pain management doctor for 7 years because of the pain. I have been a receptionist for over 20 years where I am constantly sitting. Last year in november I was in a bad car accident. This exasperated the pain. I missed many days of work since for excriciating pain. I had been on all kinds of pills, had injections & physical therapy. Even with all of this proof Principal still denied my claim. They told me not to try to appeal because I would just be denied again. The people there are rude & condesending. What can I do so my appeal is accepted & approved?
Roxanne,
I am shocked that they would tell you not to appeal – as it is your right. Please feel free to contact our office so one of our Disability Attorneys can review all of your claim in greater detail to determine how we can assist you in securing your benefit.
I’m trying to get a copy of my IME report from Principal. My claim representative is dodging my calls and emails. How can I get a copy?
Lisa,
Unless your claim has been denied an insurance carrier will not typically release an IME report to you or a legal representative. That being said, you can request in writing that they send a copy to your treatment provider and then obtain it from him/her.
I was carjacked between a jobsite and my place of employment. Workman’s comp denied the claim because I stopped alongside a disabled car on the freeway and was car jacked and beaten. It’s been three years and have needed continual health care only to further decline in my health. We have Principal long term disability that has a monthly benefit of 60% of predisability earnings, with a max of $9,000. My annual taxable income is around $340,000. I will be 62 in March and work in a high tech job. I suffer from a TBI and chronic back and hip pain which I have now been trying to get better for 3 years. I have just had my salary reduced 60% and demoted and have had my salary redlined at 120,000. I’ve continued to work but really am not able to do my job intellectually and suffer significant pain. I still have kids in college and high school. I planned to work till 70 to meet my retirement goals and family needs. my youngest daughter has significant learning disabilities (IQ 60) as well which requires most of my wife’s time to care for her.
The denial on workman’s comp was I checked to see if someone was in distress while between jobs. I never got out of my car, only rolled my window down part way left the door locked, the whole event happened in seconds. I would like to have an opinion on what my best alternatives are.
Bruce,
You most likely have a strong case to make for disability based upon any conditions you suffer from on account of the attack. As worker’s compensation has determined that it is not an applicable work comp claim, then Principal would not be able to potentially use any language that may be contained in your policy that excludes disability claims stemming from workplace accidents. Please feel free to contact our office to discuss what options you have available. If you do not already have a copy of your employer’s disability policy I would highly recommend you obtain a copy.
Is cirrhosis of the liver a LTD claim, no surgery, just medications and fatigue? No follow up with doctors for six months, just pain medication and medications to control symptoms, just been diagnosed three months ago. Could I be eligible?
Anita,
Any medical condition can form the basis of a claim for disability. However, it is a matter of showing how the diagnosis results in disability. To be eligible for benefits you have to satisfy all the provisions of the policies relating to same. Please feel free to contact our office to discuss how we can assist you in filing a claim for benefits with Principal.
Dear Firm,
Both of my grandson’s have been diagnosed with ADD, ADHD, OCD along with BiPolar & BiPolar type 2. The youngest of the boy’s is the one with ADHD, OCD and BiPolar 2. Neither has yet to even complete school. What avenue do you suggest in trying to get a type of disability?
It is obvious that these conditions have stalled any chances of a normal life. Both have documented diagnosis by our family primary physician along with our psycologist. The youngest of 17 has insurance as of now, but it will not cover him much longer. They oldest of 19, does not and has had to stop being treated. The insurance is by the state. Due to our family’s means to a limited income.
Thank you so much for any suggestions.
Nana,
If they are not employed and eligible for coverage under a group disability insurance policy, then there only option may be applying for social security if they meet the requirements for same. You will need to consult with an SSDI attorney to discuss the possibility of same.
My name is Ms. Glenda Laboy. I just got my disability claim approved by ALJ on Dec 1, 2014. Backpay be from Oct 1, 2012 what ALJ told my lawyer. The lawyer said he gets 25 percent of the backpay. I have been drawn LTD from Principal Life Group INS. Does Principal Life Group INS has to take in concern of the lawyer to get 25 percent of my backpay. And I drawn 950.00 SSDI. Do Principal Life Group INS still has to pay on my claim until 65 or does it stop when I draw my first check from Social Security. I have not got my papers from AlJ approved my disability yet. Or my awards letters from Social Security yet. I do want to pay Security Life Group INS. back what they pay me every month, drawn disability but want make sure they do me right.
Glenda,
Principal would not be entitled to seek repayment of the portion of SSDI paid to your attorney. As long as you continue to meet the definition of disability under the policy, Principal will continue to pay you benefits until such time the policy ends or they determine you are not disabled under the terms and conditions of the policy.
I am 64 years old and have always worked hard and been very active. I currently work and have done this job in the oil field for over 7 years. I am required to climb ladders and do physical labor as well as ride rough roads in a pickup truck 10 hours per day. About a year ago I started having a great deal of pain in my leg muscles and this has gotten progressively worse. I push through the pain daily because I like to work. I did go to my doctor who ran MANY test to determine the reason. Now he wants me to stop work and see a specialist in 2 months (available appointment) but I fear with the economy and layoffs, that I won’t have insurance when this time comes. After reading the comments here I am afraid to file for a disability because if they refuse me, then what? No income… The list of his evaluation includes Heart Stent 2 years ago, Polymialgia, (2) Lower abdominal (back) degenerating disks, and we are seeing the specialist for overall muscle inflammation which he hasn’t named yet. My question is, are these conditions considered pre-existing? My policy has been in force for 1 year 8 months. Do they consider all or just pick the most recent? It is hard to walk across the room much less climb ladders. Please advise…
Thanking you in advance.
Suzanne,
Most policies will waive pre-existing condition provisions if you have been covered under the policy for more than a year. Please feel free to contact our office for a review of your policy and to discuss how we may be able to assist you in filing a claim under your policy.
I have standard long term disability insurance policy. My coverage has compassionate care benefits in which I applied for since my husband suffered a ruptured tendon. My claim rep is requesting 10 years of my medical history and 5 years of tax information since I am self-employed. They never mentioned to me that they would look back at MY health records for 10 years and I have a 90 day waiting period. My claim rep indicated that they did tell me that with my application and he feels that I left out a lot of information. I really do not know what to do and I am wondering if this is legal?
Chandra
Chandra,
We will need to see a copy of your policy, to include a copy of the application you completed to obtain same (it is typically attached at the end of the policy). Please feel free to contact our office to discuss what your carrier may be investigating.
I have a short and long term disability policy with Principal through my employer. After the birth of my son, I suffered from postpartum depression which prevented me from returning to work for 10 months. Despite supporting evidence and letters provided by my medical doctor and psychotherapist, my claim was denied. I appealed and was denied again. I am currently in the process of filing my final “voluntary” appeal as afforded to me under EIRSA, however I am unsure how to proceed. I requested, and received, a copy of every single document they used to make a determination on my claim. From what I can tell, they are taking issue with the fact that my doctor did not better document my condition in my medical file, specifically including “objective evidence” and “testing” to confirm the diagnosis they provided me and substantiating my functional impairments. I am so tired of fighting for the benefits that I deserve based on the policy I paid for. Any advice would be greatly appreciated.
Thank you,
Erika
Erika,
As your claim history is detailed, please feel free to contact our office to discuss how we may be able to assist you with your voluntary appeal.
I filed for short term disability on July 6, which was my pre-op visit. Had Surgery July 13th. Time out for recovery will be 8weeks. I was approved for Short-term disability and payment on July 13. My employer and Short-term disability agency states that all PTO has to be paid out prior to receiving payment from Short-term disability. Also that the instead of receiving the weekly payments from short-term disability company my employer requested that the payments be sent to them and they distribute the payments on the regular pay schedule. I am on my 5th week and second pay period and have not received payment for PTO time and only received one payment from short-term disability which is the very first check they sent out in July. I am having anxiety attacks as a result because I am stressed from talking to HR to Short-term disability agency and no one seems to be able to help only saying I will receive the other payments at some point. Basically what looks like when I am able to return to work if I don’t loose my mind first. When deciding to have this surgery I was under the impression that I would receive 40% of my pay as well as PTO which is the amount budgeted for to cover my time off. However I have yet to receive a fraction of that. I am stressed which in turn is not helping my recovery or overall health as I also have lupus which flares with stress. I’m trying to remain calm but life is happening and i have bills to pay. What I want to know is do I have a case to sue my employer?
TKennedy,
Your ultimate question does not have an ultimate answer based on the information you provided. We would need to review a copy of your short term disability policy and any correspondence from your employer and Principal as it relates to your STD claim and PTO in order to determine what your actionable rights are.
I have been on long term for almost 3 years with principal due to Bladder and kidney cancer and a car accident that has injured my back. The cancer has returned 4 times and have had 4 operations one of witch removed my left kidney and some of my bladder. I have also been seeing a pain mgmnt. doc for my back, getting injections and pain meds. Now they want me to see their doctor to evaluate me. Can they do that? If so, could this doctor with one appointment discontinue my bennifits?
Sam,
Principal has the right in its policy to have you examined by a doctor of its choice. Failure to attend could result in your claim being denied so you really have little choice in the matter. Unfortunately, the IME could be used as a basis to deny the claim, but that isn’t to say that is what will happen. Please feel free to contact our office to discuss your claim and Principal’s request further.
I am 56 years old. I have been receiving Long Term Disability benefits from The Principal and SSDI for five years. The reason was severe and advanced idiopathic peripheral neuropathy, most like genetic or auto-immune mediated. This diagnosis was backed up by repeated nerve conduction studies and a rural nerve biopsy. I have had several surgeries to correct foot deformity and have had multiple fractures and dislocations of bones in both feet. I have chronic nerve pain and fatigue, and need to rest in bed several times a day. Since going on LTD I have also become diabetic, and have been diagnosed with glaucoma, hearing loss, and severe spinal stenosis. A nerve conduction study indicated that the spinal stenosis was not causing the peripheral neuropathy; the neurologist said there was no reason to ever have another conduction study as my nerves are essentially gone.
Last week I had a partial replacement of my left knee. Today I received a call from The Principal inquiring about the procedure and the physical therapy I am receiving. Why would The Principal take an interest in this, as it has nothing to do with why I am receiving LTD benefits? I am very concerned that they are going to somehow declare me able to work once my knee has heeled, as this is the only reason I can think of for monitoring my recovery. Is this possible? Should I be concerned?
Kevin,
Disability insurance benefits will be predicated on any medical condition that affects your overall ability to work. It is not unusual that Principal would want information as to the surgery and PT notes. However, it does warrant some caution and reminder to Principal of the multitude of other problems you are having preventing you from working. Please feel free to contact our office to discuss your claim in greater detail.
I developed sciatica in Aug 2015. Principle ins is my std provider. It took them over 2 weeks to issue any cks because they we looking for preexisting conditions. They then withheld further cks while they delved thru the Pecos 6 mos of records w my previous pain mgt dr. I have never had sciatica in my life. Today they disallowed my claim, not for sciatica, but because I initially presented w lower back pain. I have had lower back pain since discovering bulging lumbar discs from a precious mva in 2003 that resulted in a cervical cage. Since “lower back pain” was noted in my med records from my x pain mgt dr they denied my claim. I recently had aCT scan that showed the bulging discs we the cause of my lower back pain however ruled out them being the cause of the sciatica as they are not impenging on the sciatic nerve. I have had chronic back pain. The sciatica is recent and not related. How do they get away w this? I now stands to lose my apt, car, med ins as I cannot pay the premiums to my employer in my absence, and everything I own /owe on. This is criminal. All over a measly $378.00 a week.
Rayann,
Please feel free to contact our office to discuss the denial and your rights to appeal. How long have you been with your employer and/or covered under the policy? Most STD policies do not contain pre-existing condition provisions- that is typically the realm of LTD policies.
Principal in-house nurses seem to have the power to override my VA doctor’s orders to temporarily not drive while I have been having synoptic episodes that are possibly tied into combat related PTSD and/or various heart related medications, with 50% of my work time being behind the wheel of my car and no other office work suitable to my experience and knowledge. It has now been four months with no resolution to my Principal short-term disability benefits.
Joe,
Are you still out of work? Principal has not paid benefits in four months? A review for a claim for benefits should only take approximately 45 days at most, with STD reviews being typically much shorter. Please feel free to contact our office to discuss your claim.
Two important ways that Principal harms disabled employees:
1) They will approve your disability claim under one of the mental illness categories (such as depression) just so they can stop paying your benefits after 2 years. It doesn’t matter if you have multiple physical ailments. They just ignore those.
2) If you are disabled for 12 months, they will terminate your employment.
The government needs to investigate.
Jim,
If Principal has approved your claim under a mental health limitation but have physical conditions that cause disability you can challenge this decision. With respect to termination of your employment- quite often if you are no longer covered by FMLA or under a work contract an employer will terminate a position after a certain period of time. Please feel free to contact our office to discuss challenging Principal’s contention that you are only disabled from a mental health condition.
I have been disabled for over 10 weeks and Principle kept saying the forms incomplete so they needed all the medical records from my doctor, including office notes. After many calls and explanations I was told I was all set. But alas, I hear nothing from Principle for several days so I call and find out my case was transferred to another agent. Now I am being told that I need to provide all the doctors I have seen over the past 5 years and they will need to send all their records to Principal and I must prove that I have become disabled after the policy started on January 1, and not before, even though my physician who is overseeing the entirety of my health has already provided a date that proves I am covered.
I have never felt like I was dealing with a bunch of crooks and con artists this bad before. I have never worked with a company, or people that are so obviously stalling before.
Mike, is this a policy you purchased on your own? From what you’re saying it seems that they are investigating to determine whether or not there are grounds to rescind the policy for misrepresentations contained in the application to purchase the policy. Please feel free to contact our office should you have any questions.
Purchased short term disability through my employer with this group. I’ve been out of work since 2/29/16. Haven’t received the first pay. Contract is I’m supposed to get 60% of my pay. They denied me and I went through and done all they asked for. My doctor has sent a physicians certifaction, office notes and narrative notes. I sent it all in and no one has even been assigned to my case yet. They told me they have 45 days to make a decision. As of right now they owe me over $4,000. I have 5 kids at home with no income. I’m out because I have psoriatic arthritis. My husband had a knee surgery with major complications and it just caused my arthritis to flare really bad. I can’t work right now due to the medications I’m having to take.
Louann, if they uphold the denial of your claim on appeal please feel free to contact our office to discuss what your rights/next steps are. Hopefully they will not need to take the allotted 45 days to render a decision.
I have received long-term disability for over 8 years from principal due to an auto immune disease that has stopped me from ever working again. Principal withholds my check about once a year requesting that my doctor send in a medical review at times this has hindered my ability to pay my rent or utilities every report states that I can not return to work. I believe they are intimidating me by these tactics. Is it legal and is there any way I can get lump sum settlement for my ltd policy? Their tactics are very stressful.
John, please feel free to contact our office to discuss your claim in greater detail to discuss how we may be able to assist you.
I went off of work may 29, 2015, with a blood clot in my leg. I have had vein surgeries in the past to alleviate pain and discomfort, all of which I took vacation on a Friday and returned to work Monday. This was different, my family and I were unsure of my future to put it lightly. I had surgery July 15, it was the soonest they could get me in after all the initial consults; ER department trips, doctor visits, referral, you know the drill. It was a lengthy, in depth, thorough surgery, correcting some other vein/vascular issues within both legs. However, when I awoke I was in excruciating pain. My lower back was on fire, a pain I have never felt. Furthermore, my midsection through lower half was numb, tingly, and sharp radiating pain set in after a couple of weeks post surgery. My lower extremities go numb, give out, I fall down, my back was and is killing me.
Throughout the recovery time that should have been, my pain and immobility was worsening. My doctor decided we should run some tests on my back and body to find a cause, ensuing with; x-rays, CAT scan, MRI, and Doppler imaging. An anomalie was found within the L5-S1 vertebra. I suggested physical therapy to try and stretch some of the pressure on my spinal cords. The back doctor suggested surgery or at least some injections. After my physical therapy was terminated due to lost medical benefits, and I had the injections my symptoms still remain. The therapy was roughly September through November, and the injections were Dec first.
Principal paid my short term after some minor delays through SEP 6, then told me they had to review for long term benefits. I received my denial just before Christmas, stating it was a preexisting condition. I was giving a 180 day appeal deadline, roughly 3-4 weeks before said time I sent an appeal letter along with all relevant medical records, tests, doctors notes, therapy report… They said they have 45 days to reply, but now they sent a proof of good health letter request. I had opted for this insurance in March of 2015, when my employer changed our carrier plans. the only reason I got the insurance is because my buddy almost died last year and his disability is the only thing he can provide for now. Who would of thought I would actually have some health problems. I am a college educated 34 year old fiancée and father of two, who has never had a gap in employment since mid-late teens. I have always provided responsibly, I cant but feel I am being starved out and given the runaround.
please send help, and thanks for your time,
Christopher
Christopher, I am not sure the reason for the proof of good health- was this from a different department? If the claim is already in appeal review then there would be little we could do to assist you until such time a potential denial of benefits issued. That being said, please feel free to contact our office to discuss your claim further.
I have recently filed for STD. I had to apply due to a compressed fracture of my L2 that happened while I was on home time. I’m a tractor trailer driver. I received a letter within about 2 weeks and they approved me from 2 days after (May 24, 2016) the injury happened (May 22, 2016) to mid August 2016 which was requested per my doctor. They issued a check for the weeks of June 14, 2016 to June 27, 2016 for $390.74. A day after I receive this ridiculously low check, I receive a letter from Principal financial that as of July 5, 2016 I can return to work unless they hear from my doctor with new results. They claim that because I’m on light duty, my job is considered light duty. Ask any truck driver if their job is light duty dealing with those tractors and trailers, hardly. It takes up to 3 months for a vertebrae to heal, I’ve only had about 5 to 6 weeks of healing. I still can’t bend over, and I have a hard time walking up stairs. I still can’t lift anything over approximately 10 pounds without significant pain. My doctor is very busy and I have doubts he will supply them with the needed information to keep me off work for any longer. I’ll be finding more out on Tuesday July 5th when I speak with Principal and my doctor on what exactly is going on, why I didn’t receive full back pay, why it was pay for mid-term of my time, etc. If my vertebrae doesn’t heal properly there’s the possibility of surgery which I would like to avoid, so I’ve been doing exactly what I was told to do by my doctor (wear a back brace until I go in and see him again, light duty, rest). Will I need consultation on this? Honestly I’m at a loss on how they can determine I can go back to work with a broken bone, and not just any bone but a major body holding one that was essentially crushed.
Lisa, please feel free to contact our office to discuss your claim. Hopefully, your doctor has provided sufficient information to Principal to continue to extend your claim without the need of legal assistance. That being said we are more than willing to discuss all your options further.
I was diagnosed with breast cancer in 2011 and I had a double mastectomy in 2012. At that time I did not have STD coverage with Principal. However, I did purchase STD in January 2016. I made the sales representative very aware of my pre existing condition and I was told I would be covered as long as my breast cancer didn’t return and cause me to be out of work. On July 20th I was sent to the hospital by my family doctor because they thought I had a blood clot in my lungs. The angiogram was clear. So, extensive blood work was done. I was then referred back to my oncologist because my estrogen level is 4 times the normal limit. My oncologist has scheduled with my Gynocologist to have my left ovary removed. I’ve already had a hysterectomy. So the left ovary is all I have left. I am extremely fatigued, vomitting daily, and very achy. Principal has yet to approve or deny my claim. The representative on the phone said this could be stemming from my breast cancer. I am shocked! This has nothing to do with breast cancer. Yes, I am being seen by my oncologist but at this point I have no cancer diagnosis. Can they deny me for having an ovary removed because its related to breast cancer? I had no idea they would be so hard to work with or I would have never purchased the policy. I have done all the leg work, from faxing in all doctors records to prescription records and giving them the contact number for every doctor. I feel they are searching for a reason to deny me now. The representative originally said I had to provide Oct-Dec of medical records to show 90 days prior to the policy. Now they have decided to go back to Sept, 120 Days. This is just another stall or attempt to deny me. This can’t be legal. Thoughts?
Rachel, depending on the language used in the policy to determine the look back period for the policy, Principal would be within their rights to conduct the review they are. However, the extent of same would be unknown without the ability to review the policy and any correspondence they have sent you to date. Please feel free t contact our office so we can review the documents and discuss your rights.
I went on short term disability August 1st of 2013 I had to get my left thumb total reconstructed. After 6 months of short-term I went on long-term. My company told me I had to be 100% to return to my job. I work for a company that makes high explosives I was a nitroglycerin operator. Around October of 2015 for no reason they terminated my disability I didn’t receive any phone calls or received anything in the mail. I’m a father of four girls I lost my house my brand new truck and motorcycle was repoed. Also I could not afford to pay my insurance through my company so I had to go on State Insurance unfortunately my orthopedic surgeon did not accept that insurance I was scheduled for a second operation two totally fuse my left thumb. So I had to find another orthopedic surgeon that took state benefits so instead of having my second operation November of 2015 I had to wait until March 31st 2016 just to see my new dr. I was still on all restrictions I got my second operation on April 11th 2016 during this time I was on short term disability to January 2016 I was denied my payments 3 times I went through the proper procedures I had doctors notes. Today is September 23rd 2016 I have not received a payment since January I was told today I was denied that they found I could do other occupations I am 43 years old unfortunately I have a learning disability when I was younger I’m still under doctor’s care I do not even start physical therapy I am going to lose my second house I’m going to have 4 children homeless it is very heartless and discriminating there be a law against this
Ray, have you received a formal denial letter denying the benefit? If the initial denial occurred in October 2015, there are concerns as to time expiring to file an administrative appeal, but your indication that you just received notice of another denial could extend the time. Please contact our office to discuss your situation in detail.
Good day, I am receiving long term disability benefits for a year, with principal financial, I have been a service
Connected disabled vet for 40 years, is my v.a. disability which is service connected from 1975, are the v.a. disability payments considered income by principal ? I am 65 and should receive 1 more year be if it’s from principal. Thanks jimmy
Yes I understand I have a time line. I did that time line three different times. My LTD benefits went from a denial to approved. What I am saying is I was denied for the fourth time. I only received payment up to January 18th of 2016. And on April 11 of 2016 I had my second operation. So I am still disabled I didn’t even start physical therapy next doctor’s appoint is not until December 13th. My last th re checks were all over $10,000 because of my denial and taking the right steps to get it aapproved at this time it is just discrimination.
Jimmy, you will need to consult with a tax professional/accountant to determine if your Principal benefit is considered income for purposes of reporting to the IRS.
I am 57 years old. I’ve been receiving LTD for 5 months and received a letter saying I am approved until full retirement age as long as I abide by the policy. Today I received a call from Principal saying I also have a life insurance policy with them through my previous employer that Im eligible for, and they are going to sign me up as long as the doctor states I’m unable to perform “any”job. Currently under my LTD plan it states I am unable to perform my current occupation for 2 years, then it changes to “any” occupation thereafter Why are they offering me life insurance at no cost and they want my Drs to say I’m unable to perform any job to get the life insurance? Is it some sort of trick that will affect my LTD?
Tera, they are not offering your any new life insurance or acting in a way to affect your LTD claim. Most employers provide disability and life insurance policies. Under the life insurance plan you are eligible to have the premiums waived if you are disabled (Waiver of Premium or WOP). As you noted, unlike a disability policy, the standard for receipt of WOP benefits is disabled from any occupation.
I have been on long term disability for 2 years and Principal Finance took away my benefits in October 2016. They made me see an occupational doctor and he said I could do some sort of work. My doctor has me on limitations of not being able to sit for more than a half hour, no walking get or standing for any period of time, and carry no more than a gallon of milk. I have diabetic neuropathy and complex regional pain syndrome, I have had a torn tendon in my right rotator cuff since 2009, and arthritis in my neck and back. My doctor will not let me work. Is it legal for them to take away my benefits? I am at the stage of being able to do a voluntary appeal. What are my options they left me with no income what so ever, no way to pay any bills or buy food and everyday essentials, or pay to upkeep my vehicle. HELP!
Tammy, unfortunately, it is very legal for Principal to deny your benefits if they determine you do not meet the definition of disability. If your policy is an employer provided policy then your administrative appeal is incredibly important in the event of future litigation. Please feel free to contact our office to discuss how we can assist you in appealing the denial.
How can I find out what Principal Life Groups definition of disabled is?
Tammy, the only way to know how it is defined for purposes of your policy would be from the policy itself. Each carrier can have multiple versions of the definition.
I had a lawyer for my long term disability claim but they wouldn’t sue them for me because the company I worked for sent them a letter saying I didn’t work but 3 hrs a day what a croc I worked 10 to 12 hrs a day and lifted 50 lbs or more all day long. Principal owes me 60,000 as of now and I need some help to get it. If y’all can help me please let me know.
Daniel, we would need to see copies off your denial letters and your policy to determine how we may be able to assist you.
My deceased husband has a disability policy with Principle. He was paid by Principle for 7 months and then died. His policy had a survivor benefit of 3 months net pay. Principle told me that because he was eligible for SSDI that he would not receive the survivor benefit because he should have received SSDI. My husband never even applied for SSDI. They told me to recoup the amount of the survivor benefit from SSDI. I went to SSDI and tried to file a claim. SSDI stated he would only receive one month payment ($2000). The survivor benefit is worth $12000.
I don’t understand. Please help! What happen to $12000?
Michele, I am sorry to hear of your loss. We would need to see a copy of the disability policy to determine any rights you may have. Most policies do pay out a 3 month survivor benefit at the gross benefit amount. However, Principal is known for writing policy language that differs in various ways from industry standards. We would need to make sure there was no caveat to receipt of the survivor benefit. Additionally, if you have not inquired – most employers provided both life and disability insurance as part of an employee benefits package. When someone becomes disabled there is typically a waiver or premium on the life insurance policy – so if he had life insurance and you have not made a claim I would strongly recommend you look into same.
I was sent a check from principle insurance for STD from my job after waiting a very long time. I broke my foot and had to go to the hospital. While there I had my eye looked at and my finger do to another incident. They now received a report from the doctor that says my foot was broken due to a fight and was told not to cash there 2000 dollar check that I’ve been waiting for. Is this legal for them to do?
Justin, I do not know the legality of their request, but if the policy has provisions that indicate benefits are not payable if the injury causing disability was due to a physical alteration, or something similar, they would have a right to re-collect the money. If you did not break your foot during a fight I would strongly advise you to clarify that issue with Principal and your doctor as soon as possible.
Hello. I filed a claim June 6th before my surgery. June 13th Principal approved my claim and said that they would issue a lump sum payout for the time I was out June 13th to July 25 but my job said I work 35.5 hours. I work 38-40 hours week and I bring home after taxes 350 every week and I’m only getting a check for 674.78, for 6-8 weeks I’m out. I don’t think that adds up. If this case I need return to work but knowing that’s not an option but I can’t pay bills with that check. I would have made more working receiving my checks every week for 350. My co workers said they were getting checks every Wednesday and sum was way more then what I’m getting and we worked same hours. Please help, I have to be out another 4 to 5 weeks.
I am receiving LTD pay from Principal. I was told once I am approved by SSA I will receive back pay from SSA and when I did I had to pay Principal back for they had paid me with the monies from SSA.
Is this correct?
Toni, if your policy was an employer provided policy then almost certainly the policy would contain language that would indicate SSDI as an offset to the monthly benefit to be paid as well as indication of a repayment being due to Principal based upon the back benefit check from the SSA.
I was placed on medical leave after suffering from vertigo and later diagnosed with Meniere’s Disease. I was put on Meclizine and Klonopin and Prednisone. During these episodes of vertigo, I was not able to stand or lay down. I was out of work for a month and came back to find out that my claim for benefits was denied because my doctor failed to write “yes” to restrictions. However, my primary care physician is not the main person I was dealing with. Principal neglected to inform me that they needed this information from my ENT who is the person that officially diagnosed me while I was out on leave. I sent 200 pages of my medical information that dates back to early October when this began through December and they are still staying they need to see the doctor say “yes” top restrictions from work. Every single note and test and medication is in my chart!
Maybe I’m crazy, but if a person drives to work and cannot stand up or lay down, wouldn’t that be a restriction? I sent everything they needed along with a note asking them to reconsider this claim and I expect for them to approve it. This is absolutely ridiculous and is putting me in financial hardship because I am not receiving my full pay from work after exhausting all of my long term sick.
Michelle, will your ENT complete the applicable Attending Physician’s Statement? The APS will allow the doctor to place all restrictions and limitations he/she is imposing on you. Although it is ridiculous, a doctor needs to specifically certify a disability. Please feel free to contact our office to discuss your claim in greater detail.
My name is Ali. I got sick end of 2016 to end of 2017 I have overhead expense policy with Principal Financial for 16 years. After receiving so much medical record, financial, interview in my home, constant accusation
a both my medical record, time of claim every record show them I was truthful to them. Felt like they offended my integrity, however they wanted before receiving facts since they could not find any other excuses. They denied my claim because I had put my office under my wife name 5 years earlier. They ask for contractual agreement that did not ever though may need so dined my claim given 180 days.
I do not want money willing to donate or as a cost the fact that sell a policy that has no value at the time of disability, creating so much obstacle, primary Doctors become so frustrated that may effect receiving care
if can take my case a both 75,000.00 for one year policy. Could be the expense of attorney they have all paperwork in place confirmed with 7 pages that I have provided everything medical and disability was correct
other than contractual agreement.
Ali H.
Ali, please feel free to contact our office to discuss Principal’s denial of your claim to determine how we may be able to assist you.
I was paralyzed from the breast down, had a Laminectomy hematoma extraction t3 to t9. Learned to walk again 3 years later I received regular disability due to my injuries, but Principal’s doctor decided after 5 minutes with me in which he got no reflexes and I could not walk on my toes for him, that I could work part time. Now they have denied me my long term disability on that, records that are actually wrong and are over a year old. However, I did have a doctor of my own say I could do a couple hours a week sedentary work. I am not qualified for office work, I am a factory rat, who also has a neurologic bladder. I have to cath myself at time and at other times I urinate on myself. I also cannot do anything sitting down out in front of me for more than 20 minutes which seems to have gotten lost in translation every where but to my Pt and the judge. Would hiring a lawyer help?
Darcy, you certainly should speak with an attorney. You can go to our website and complete an online consultation request of simply call in and ask to speak with one of the attorneys.
Have you successfully defended a client (vs. Principal Financial Group) with multiple injuries due to Transvaginal Mesh implants and subsequent surgeries?
Val, with those specific fact requirements, no. We have, however, successfully secured disability benefits through Principal for clients suffering from various chronic pain conditions, which would share similar factual arguments with the disabling condition you have identified. Please feel free to contact our office if you would like to discuss your situation in greater detail to determine how we may be able to assist you.
If Principal offers a buyout and you don’t take it will they start their harassment with their of paperwork and denial? Also buyout is 11 months less is this standard.
Jan, I have not experienced retaliatory actions form Principal for refusing a buyout offer. As to your second inquiry – a buyout will always be appreciably lower than the full benefit paid over time. Please feel free to contact our office if you would like to discuss the buyout offer from Principal.
Very simple question:
My policy has 90 day elimination period
I have so far had a normal Pregnancy, and I am scheduled for C-Section in September
In my policy contract, under “Exclusions and Limitations” it states (verbatum):
“LIMITATION DUE TO NORMAL PREGNANCY OR CHILDBIRTH:
If the elimination period for Your Disability Benefit is less than 90 days, then normal pregnancy and normal childbirth are not covered Sicknesses. However, if the Elimination Period is equal to or greater than 90 days, then normal pregnancy and normal childbirth are covered Sicknesses subject to the definition of Disability”
From this I gather that they will consider normal pregnancy and childbirth within the definition of Disability because my elimination period is 90 days, correct? But I called Principal and they said they will not cover my maternity leave. Could you please help me understand what I am entitled to?
Thanks!
Claudia, in order for us to give you a specific answer to the inquiries posed, you would have to send us copies of the policies you are covered under. Should you desire such, please call in for a free consultation. However, from what you describe above, it would certainly seem that a normal pregnancy and childbirth would be covered as a Sickness under the policy. Please keep in mind that suffering from a sickness or injury is not enough to get benefits under the policy, you also must be “unable to perform the duties of your own occupation.” So while you may be able to get benefits for childbirth, you also must prove that the child birth has prevented you from performing the duties of your own occupation for 90+ days.
Hello, I’m writing this on behalf of my wife. Her vision has degraded to the point that she no longer is able to see a pc screen without extreme headaches within a few minutes. She has had both eyes surgically operated on 3 times to stop a severe progressive condition forcing to leave her job after 12 years. The doctors cautioned her that the surgeries may slow the worsening of her vision but not stop it. Due to a high level of further risk damaging both eyes, all three doctors said they won’t risk any more. To the point. Principle was her employers LTD carrier. She filed a claim and started receiving her monthly benefit check after a ton of paperwork was submitted.
After two years to the day, they stopped payments advising my wife she had to re-file an appeal. She has submitted all of her updated doctors reports who all say she can’t do any work that requires administration computer work. Since then, she has been diagnosed with severe progressive joint and tendon disease and advanced fibromyalgia. With these conditions along with her vision loss, she has submitted all doctors statements from diagnosis to employment status conclusions. All physicians categorically said to Principle that she cannot go back to work. Principle has now seen fit that with a ton of submitted paperwork from an army of doctors, Principal via letter to my wife now requires her to see “one of their retained eye doctors” which would delay the claim yet another 45 days. Now we’re up to eye doctor number 6. When does it stop or is she to expect what the handwriting on the wall is clearly showing…that they don’t want to pay and will do anything not to pay. She is on a no income life now and my retired social security cannot handle all the bills coming in. That’s her entire story. Thank you for listening.
George, it sounds like your wife is a victim to the very common 24-month denial. It is unfortunate that Principal will not accept the opinions of the numerous doctors who have seen your wife but it is very likely they have the right to have her evaluated by their own doctor. If the appeal is denied, I encourage you to contact one of our attorneys to discuss your options.
Principal relied on a “paper review” from a physician who never examined me. He determined that I’m capable of performing any occupation and then placed certain restrictions around his opinion (shouldn’t work with the public, etc). They did not seek the opinion of a vocational specialist because there isn’t a gainful clause under the any occupation definition (their reason when I inquired). When did physicians become qualified vocational specialists capable of determining what jobs I can do? Given that he put restrictions on his own opinion, should Principal not be required to retain a vocational specialist in order to determine if there are in fact actual positions that I can do since the physician isn’t in a position to opine once my age, education and experience qualifiers are factored in and need to be taken into consideration?
Their “independent” physician is so on the ball that he took it upon himself and changed the definition of total disability to “being hospitalized” and was stupid enough to put that in his report. He also failed to answer their written question where he was to explain why his opinion differed from the treating physician. (You know, the one actual question that could technically be considered substantial medical evidence under abuse of discretion review had he chosen to answer it even if his theory wasn’t correct).
They must have had to search under a lot of rocks to find this Rhodes Scholar. But, Principal is choosing to rest it all on his opinion and I’d like to know how the courts would likely consider his standing as a vocational specialist proxy.
APC, it is difficult to know what they courts would do or how they would weigh the opinion of Principal’s consultant under the appropriate standard of review. Notwithstanding, it is not uncommon for a doctor to impose or recommend restrictions and / or limitations on account of your disability. Its presumed that your doctors are doing exactly that as well when they provide you with restrictions and limitations and advise you should not work in your occupation or any occupation. Please contact our office to in order for us to further discuss your case and questions.
Caesar, I’m not sure that addresses the question. I understand the physician determining restrictions, but once they’re determined should it not then require a vocational specialist to determine based on age, education and experience if there are actual positions in my area that exist given those restrictions? Principal just let the physician decide that I can do any job and I believe that he is only qualified to determine any restrictions and then a vocational specialist would determine if there are appropriate jobs available. Do courts generally permit insurance companies to use the physician for a role that Is outside his scope of qualification (in this case as a vocational socialist)?
Individual own occupation with transitional rider. Private practioner almost 20 years same practice. Over 90% small procedure based. Fell in parking lot last winter. Multiple degenerative changes exacerbated. Still working full time with medical only workers compensation claim open.
Have modified posture, instrument grasping techniques, allotting additional time to perform procedures, decreased patient load. While some days are harder than others, every day there is pain. The pain carries over into personal life and activities.
MRI studies reveal significant cervical and shoulder changes. Unlikely to ever be able to perform the substantial duties of work in the customary way again.
I love my work, alot. I would like to continue to do the aspects of my work that I’m still able to for as long as possible. Is this a situation where a claim should be filed?
Do I need to be completely out of work to file for disability?
Doc, I am sorry to hear of all the issues you are having due to your fall. In all likelihood, the policy you have coverage under allows for a Partial Claim for disability benefits where you will not need to be completely out of work to file a claim and receive benefits. However, in order to truly answer your question, we will need to review a copy of your policy. Please contact us at your convenience and we will gladly review your policy and have a free phone conference with you.