I have a disability insurance policy that I pay through payroll deductions. Can they legally deny a claim?

I have been off of work ill since 11/1/2007. I have post herpetic neuralgia (nerve damage in my forehead from a shingles outbreak in 1999). I have filed a claim on this before and it was honored; now, I have filed again and the insurance co is giving me the run around. Its ok to file as many times as needed; but, their argument is that I have not seen a treating dr since my absence. I have seen my diabetes dr and he had been prescribing my meds for this but since they are questioning him, he referred me back to my specialist who can't see me until 2/22. I treat this illness with med and I still have meds and I take it; it only makes me sleep and when I awaken sometimes the pain is still there. I take it again and sleep again. The insurance co says I should be able to work. I can't because the pain is constant and causes me to miss work too much--my boss agrees. Is the ins co justified in denying my claim? Many meds have been tried-same results. PHS has a mine of its' own.HELP!

You are being denied because you do not have a doctor's order indicating your disability, at least not one which they will accept.

The severity of post herpetic neuralgia varies widely in those affected by it. Hence, the insurer is not going to take your word without a medical certification from a specialist.

You may have to wait until late February for such certification, and with any sort of luck, the insurer will give you 'back pay' from the time the disability triggered your work absence.

I know this sounds difficult for you in your situation, but please understand the number of questionable claims which such insurers receive. In order to maintain control of claims, they will, in nearly all situations, require medical certification of the condition you are claiming.

Good luck.

Yes they can. Your disability increases the cost of your boss's disability insurance. Your boss has absolutely no control over this. Why do you think that companies do a background check on potential new hires?

You should go to your first specialist. Why are you avoiding him? He can give you another pill that may make you less sleepy.

Unfortunately, a few people out there abuse disability insurance so when you fail to follow the instructions of the insurance company they give you the run around.

Cheers and good luck!

Yes they can.

The disability policy has specific conditions and terms. If those are not met - then they can deny coverage.

Since they told you to follow up with your specialist - do that. And it may be a good idea to just continue to follow up with him for this condition and see your diabetes for the diabetes only.

I can't believe that in my haste to answer this question, I forgot to answer the question!!!

First of all, YES they can deny a claim. In LTD language, there are basically 2 threshholds for qualification: disabled from your OWN JOB; disabled from ANY JOB. The "any job" is the equivalent of Social Security's "gainful employment" - any job for which your age, education, and past job experiences equip you to perform.

You state that you filed a claim and it was honored. This was probably for your own occupation/job. You now state: "The insurance co says I should be able to work. i can't because the pain is constant and causes me to miss work too much..."

In order to get your Ins. co to change its mind, YOU have to document that you condition's SYMPTOMS impair your normal daily living activities - both home and at work - to such a degree that you cannot perform work of any kind.

In the info below, I explain how to do this, and it's all for free.

Good luck, hope that this helps. Sorry for the rush to explain WHY I wanted to help you, and forgetting to answer your question!! I see that my answer was voted 2X as "not good"! I'd have voted that way too based on my original answer!!!

Again, sorry, and good luck!!

This question was MEANT for me to answer!!!

My yahoo name is disabilitylady; my website is: http://www.disabilitykey.com

I am a Disability Advocate, Educator, and Expert Witness who has assisted over 2,500 folks WORLDWIDE attain the disability insurances - whether LTD as you are asking for assistance with, SSDI, and/or SSI.

I myself am on LTD and SSDI; I was an HR Executive for over 30+ years; I've been successfully managing the myriad symptoms of MS for over 45 years.

When it became my time to trigger LTD and SSDI I put my Federal Auditing expertise to work and put together a process that got me approved the first time around, when the normal time to approval is 3.5 years!!

I've documented the process and it is now my passion, mission, and God-DRIVEN role to assist others; at no cost!! AND, my process leads to a 96% approval rating for all who DO THE WORK, follow the process, and qualify!

To see more information about me, please visit my website. Also, please visit the Message Boards at the But You Don't Look Sick website, under Work Related and Social Security: http://www.butyoudontlooksick.com

Finally, email me and I'll send you the Summary document I prepared to explain what you need to do to be successful.

Good Luck!

you may want to contact am employment attorney, file
a complaint with both the labor board and the state board
of insurance.

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