I’m having a tough time writing now, so please forgive me for any errors. I keep finding myself spelling words wrong, and sometimes using the completely wrong word. I’m guessing it’s a part of my memory loss and brain fog/focus issues.
As I’ve now spent a year working with lawyers and insurance companies to try to cash in the coverage premiums had been paid on for over five years, I wanted to share a bit of what I’m going through in the hopes that it gives faith, hope and a little direction to anyone dealing with similar issues.
I would also love to hear your stories on the subject, if you are down to share.
My Disability Coverage Process
Before I got chronically sick I honestly thought I was covered if anything ever happened.
I had a full benefits package with amazing health insurance and low cobra rates, plus short and long term disability insurance coverage.
There definitely could have been a bit more in my savings, but the idea in my mind was that I had enough to get me through at least a year of being sick with 60% of my paycheck being covered by my disability insurance.
This turned out to be an extremely naive frame of mind, and my experience this past year has not only taught me an amazing lesson but has left me with an understanding for how depraved, complicated, and greedy the insurance world can be.
I was lucky in that my disability benefits were fully covered by my employer, but many people have to choose whether or not it’s worth it for them to have extra taken out of their paycheck every month for something they will likely never have to use.
Personally, I decided to still take money from my paycheck each month to pay for extra coverage – generally my covered was for 40% of my income and I knew if I ever needed it I wanted 60% coverage.
Now, after over a year of being unable to work due to the severity of my pain and the side effects of my medications, I find myself still waiting for the payout from my insurance.
My savings have been exhausted and I’m living off of family, friends, and little bits from what I’m able to get through blogging or web consulting, and other random dirty work I can manage.
I have gone through many months of struggle to figure out rent, among other bills, which is a nightmare while coping with chronic pain and sickness.
All my credit cards payments have stopped and my credit score has plummeted, while we live off of dollar store meals, eating all the things I shouldn’t.
Every day I pray and wait that my insurance will come through and help me catch up so I can focus on the treatment I need.
But despite my insurance agent’s sweet and concerned tone, it is clear now that there is no intention for them to make this easy on me.
Is Long Term Disability Insurance Worth It?
This is a question I have asked myself repeatedly over this past year.
After I got sick, I filed my short term disability claim with my HR department almost immediately, and despite this I still had to wait two weeks for anything to kick in. This is where savings and hardship withdrawal from my 401K came in to save the day.
There was a little bit of back and forth getting the insurance company the information needed from the doctor and filling out paperwork, something I had to keep doing to update every month, but the delay in getting payment was never more than a week and having short term disability literally kept us off the streets.
This was how it was for the first 6 months of being chronically sick, at which point my short term disability ended and everything was transferred to the long term disability insurance company.
I was told that all the medical information I had sent in for my short term claim would be sent over to the other insurance company, so I just had to fill out some paperwork and submit my claim.
With the short term disability, I had become accustomed to my agent warning me if they didn’t have enough information to approve something so that I could send it to them, which led me to wrongly assuming it would be the same way with the long term disability.
Unfortunately, it wasn’t.
After a week or so of waiting to hear back on my claim I decided to call in and find out what was happening. My insurance agent seemed very nice and seemed to want to be helpful. She told me that I was eligible to receive 60% of my paycheck for up to two years for my condition, and I should be able to receive my first payment by the end of the month.
Then a couple weeks later I was told I needed to be interviewed by a nurse. When I queried this, as my doctor had already confirmed my diagnosis, I was advised that my case was approved by the nurse to be passed on to the executive who would give final approval on the claim. Again, I was given the feeling everything looked great and would move along quickly.
Without warning, I received a voicemail informing me that my claim was being denied due to lack of clinical information supporting my diagnosis. I was advised that I could resubmit my claim within 6 months with any additional information that would support it.
I called in to query how they could possibly lack clinical information since I had sent in a huge stack of test results and doctors notes, and I was told they were missing any sort of clinical test results from my MRIs or ultrasounds, or even blood tests. That seemed pretty impossible to me so I requested a packet of everything that had been reviewed to determine my claim denial.
Within a month I received a packet including a denial letter and a copy of my complete file. I was shocked to find that there were factually blood tests and other notes of test results included. I didn’t understand how, even if these things were missing, no one could have mentioned it and given me a chance to include it. But when I found it was included, I knew that they clearly had no plans to approve my claim the first time anyway.
As if that weren’t angering enough, my denial letter stated that my claim for long term disability coverage for PTSD was denied – yet my claim was for endometriosis and the resulting side effects, nothing to do with PTSD. Clearly, the insurance company did as little as possible to really address my claim.
I contacted a lawyer to assist me in resubmitting the claim, because I knew that I only had one chance to resubmit before I’d have to take on a legal dispute if they again disapproved it. Because I had to choose a lawyer that would do it pro bono, getting paid only when we won, this unfortunately meant allowing them the entire 6 months to get my claim resubmitted.
After filling out pages and pages of paperwork, notarizing written testimony, making video testimony, and interviewing with a professional vocational counsellor to confirm my inability to do my job, my claim is now finally being resubmitted – but the insurance company has 30 days they can hold on to it and 60 more days they can extend, if needed, so I can’t really expect to get paid anytime soon.
It’s pure, glowing hope – along with the knowledge and trust that my lawyers will get me the money I deserve – that makes me feel that long term disability insurance will absolutely be worth it because it will allow me to catch up on everything and pay for the surgery I need.
In the meantime, as I enjoy my third box of generic brand mac and cheese for the week, I’m just not sure.
Where is the Spouse in All of This?
A lot of people ask where my husband is and why he doesn’t help, so I feel the need to at least mention it.
If you’ve never been in a relationship with a person who is chronically ill, you might not understand the toll it can take on a relationship or a spouse’s ability to cope and function normally.
My husband seems to be coping very well, but he’s also had to become my caretaker of sorts.
I was the breadwinner when I got sick and he was my “housewife,” helping me with our personal business, animal rescue and household.
That was the happy life we led.
When I got sick, there was a point where he realized he would have to work and he did go out and get a job, but my constant need to be driven to the doctor or the ER, or my painful nights screaming that kept him up trying to comfort and help me, all made it very difficult for him to keep that new job.
I can’t blame myself or him for having difficulty with this, but with help we are making it work.
If my insurance claim finally does what it’s supposed to do and I get my payout, the hope is I’ll get my surgery done and get back to living a more semi-productive life.