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What types of medical conditions are most commonly challenged by disability insurance companies?


  • What Types of Medical Conditions Are Most Commonly Challenged by Disability Insurance Companies?

The claims most commonly challenged by the disability insurance carriers are the claims that are subjective in nature, claims that don’t have objective medical proof, such as MRIs or x-rays that can show for instance herniated discs. Subjective claims include fibromyalgia, chronic fatigue syndrome, even so much as depression or other mental health disorders.

A lot of these policies even now have a two year limitation with regards to this where they will only pay you a maximum of two years of benefits during your life time of the entire policy. Subjective claims are challenging in nature because it’s going basically on what you report, there’s no way to measure it, no way to test it, no way to show validity.

Usually in these claims as well, for instance if it is fibromyalgia and you’re claiming that you have severe pain and you can’t leave your home, more often you’ll be put under surveillance and they’ll follow you to determine what exactly you’re doing on a day to day basis and try to find any reason and then deny your claim based upon what they see or observe.

There are 6 opinions so far. Add your comment below.

Arlene:

I have purchase STD and LTC from CIGNA because I work as an CNA where I lift patients all day and on my feet 12 hours a day, with scoliosis. It is very painful. I am 49. I was diagnosed 33 years ago and had 2 back surgeries.

My question: I know it is a matter of time before I am no longer able to do my job. Will I have a hard time collecting benefits? I have read the horror stories concerning CIGNA, is there anything I can do to prepare myself? I live in Georgia.

Thank you,
Arlene

Attorney Greg Dell:

Arlene,

There are lot of things you can do to prepare yourself for filing a disability insurance application. As a starting point I would suggest you watch our video on the application process. Contact us for a free consultation to discuss your potential claim.

John Robinson:

I have been on disability since mid-2009 when I was injured. Cigna is my LTD company and has been great thus far. Now that it has been over 3 years they assigned a new claim manager who requests paperwork and reports over and over again. I found out today that they re-submitted my claim for a medical review and will be “discussing my case tomorrow.” Obviously, I am concerned.

I receive Social Security disability and was approved on my first application. I am concerned, however, about surveillance. I have debilitating migraines 5-6 days a week. Some last hours, but most last days. During these episodes I cannot function to do basic things. Maybe one to two days a week, when I am without a headache I can function and walk with a cane instead of a wheel chair or walker. I can sometimes go to the post office or store when I am not having an episode. I try never to drive due to medications, but on occasion, when I feel up to it, I have driven and even gone to the store. That is not the way my life is normally. Normally I spend the day in bed and am on about 7 medications.

If I get a denial at this point, and am cut off, what do I do?

Attorney Greg Dell:

John,

It is normal for the disability insurance companies, especially Cigna, to do medical reviews of your policy. It sounds like you have some very serious medical issues and that Cigna should consider to pay you. If you contact us privately, we can discuss your claim and some things that could be done to strengthen your claim.

Ric M.:

I have RSD / CRPS and am not able to west socks, shoes, or even pants due to the pain in my left leg. I even had to wear flip flops and shorts in the snow the past 2 years. I sleep 45min to 2 hours a night bease of the pain. I have lit relatons hips and family membets because of it. Plus, I was in a roll over car accident and now I have to have my C4,5, & 6 fused. I also have degenerative disc disease. My pain mgmnt Dr wants a spinal cord stimulator put in. Lumbar and sympathetic nerve blocks never took long enough to be worth anything. I have been collecting LTD from AETNA and now they want an FCE done. I already get SSI as well. Since this is a neuro disease what would be my best way to tackle this?

Attorney Stephen Jessup:

Ric,

Please feel free to contact our office to discuss your claim. If Aetna is requesting an FCE they are definitely investigating your claim to determine your entitlement to continued benefits.

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