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Archive for the ‘Case Stories’ Category

Please read below the account of one insured’s experience with Student Loan forgiveness for total disability. It seems to me the “deal” isn’t what it’s cracked up to be.

Submitted by a blog reader and supporter. Thank you.

“I just have to vent about how disturbing the whole student loan disability process and how unorganized and  untimely it really is.

Forgiveness of student loans by reason of total permanent disability is handled by a company called Nelnet. They claim they are the exclusive provider of this service for the US Department of Education. When your loan is forgiven, you have to make less than the US poverty level for 3 years, otherwise your student loan is reinstated.

Three years ago when my loan was forgiven eveything went fine. But then, as you warn on your website, I claimed too much income (wife’s job) and my loan was reinstated. 

I do not believe Nelnet has any access to tax records. They just ask you to sign a statement that you didn’t work, or if you did, how much. I regret so much we answered that truthfully.

If you make too much, then you have to pay the loan again, and Nelnet gets the money. See the conflict of interest? Nelnet gets the money if your loan is reinstated, and they are also the one to decide if you are too disabled to work. They don’t do medical reviews, just doctor signature on the form or SSDI with a 5 or 7 year medical review (we are 3 year). So their only weapon is a delay.

It took them a few months, but many months ago, they claimed to be starting the reinstatement of the loan, with them as the collectors. I completed a new disability forgiveness paperwork and had the doctor sign it. Submitted it quickly. On the new applications, they have a 4 month timeline, but on these reinstated applications, they make clear on the phone they have no requirement for when they will review them. They will hold off requiring payment on the loan for 4 months, but after that, they want payment.

It’s been more than that. They STILL haven’t processed the disability application. They claim their Information Technology Department is still working on it. But the loan servicing part says a payment is due just a few weeks from now. I tried calling and asking for a forbearance for reason of disability. She granted a one month reprieve on the loan payment, with longer available after they review documentation. Nelnet insisted they needed the original SSDI approval, not a current statement (printable of the SSA website). The next day, they rejected it as too old. More significantly, the loan payment date changed, from in a few weeks to now PAST DUE of $50 with another payment due in a few weeks.

It makes me so mad that they can take forever to process this disability application claiming their Information Technology Department is working on it, but require payments from the loan which clearly the Information Technology department already worked on. And then make due dates earlier and claim something is past due days after saying it was due in a few weeks.”

(I think in cases like this I would give my Congressional Senator a call for assistance. Technically, these untimely decisions could result in Nelnet compensating you for interest on all of the payments you’ve made since requalifying for loan forgiveness. Give your Senator a good swift kick in the butt to do some work for a change and help you resolve this mess!)

 

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MetLife’s reputation as an unfair disability insurer was well-earned today and the company’s representatives should be ashamed of themselves. I received a call from one of my insureds who was recently diagnosed with cervical cancer and recently came out of surgery in a great deal of pain.

She asked me, from the hospital, to contact MetLife and ask for an extension for sending in her forms which she had been working on prior to the new diagnosis and surgery. She was not able to speak to me for long and I could tell she was in a great deal of pain.

I contacted MetLife and began speaking to a Customer Service Representative. I tried calling earlier, but received a busy signal when I entered in the claims handler’s extension. This time around I opted for the Service Rep. who when I informed her that my client had been hospitalized and received surgery promptly said rudely, “So when is she going back to work?” With that, my response was, “Excuse me?”

One of the things I say the most on the blog is, “Disability insurers know nothing about disability”, and to be honest, as a consultant, I find myself often defending the rights of disabled insureds to be treated with respect and compassion. When I asked to speak with a supervisor I was told that “someone would get back to me”. In essence, the manager refused to handle the problem.

Later, I did receive a voice message from the original claims handler, but when I returned the call she didn’t pick up. The customer service rep was rude, continuously spoke over me, and just wanted to know “when she was going back to work.” Incidentally, this claimant has been on claim for about 10 years now for another impairment, so the issue of return to work wouldn’t have been relevant anyway.

Apparently, in order to get an extension for paperwork, I would have needed to tell the rep when my client’s next doctor’s appointment would be – yet another really dumb question for someone who just came out of surgery.

The only time I could get the rep to be quiet was to finally say to her, “Do you not care about Marcy?” (Not her real name.) There was a quick moment of silence before the rep again chatted incessantly over me about next appointments…when did she last see her doctor etc.

I would like to share with those of you managing your own claims that there should never be a time when your insurer should be allowed to treat you with disrespect and lack of compassion. In fact, for my clients, I defend these basic rights every time I come across claims handlers, who above all else, lack basic qualities of human compassion.

What would have been so wrong for MetLife’s rep to simply say, “I’m sorry, Ms. Nee, that your client is having such a hard time. I’ll make sure your request is documented and sent to the claims handler. She will probably get in touch with you about the extension. Thank you for letting us know.” Do they not think?

In any event, I consider MetLife’s handling of a simple notification of hospitalization and surgery to be an unconscionable disgrace.  Those who know me can probably guess what my next step will be.

However, please know that all insureds and claimants have the right to be treated with dignity and respect when you contact your insurers. As a claims consultant, I insist on that basic right every time.

 

 

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Heading To Canada?

Most of us already know the devastating effects of trying to obtain health care under our current systems in the United States. Despite a growing disparity in the Healthcare Marketplace, the issue of health care has become a real political issue that half of the country isn’t happy with.

Here is an email I received. It portrays a sad situation, however, some US citizens are considering immigration OUT of the United States to Canada just to receive proper medical care. From what I’m hearing, other than medical care, Canada might not be a good choice to establish permanent residency considering other aspects of life.

“… I have traveled and am arranging to relocate full or part time to Canada and am looking at cities and immigration options. I had one doctor say I have kidney disease, overfunctioning, in 2013 and gross overfunctioning reverified by a test in the past year.

The good news is I thought diabetes would rule me out of immigration there but a doctor said they don’t rule out for diabetes per se (they invented insulin and it is affordable unlike the US)  but body organ damage specfic to kidneys and creatine test would keep me from immigrating, as well as possibly age. So I am checking. The good news is my creatinine test has generally been normal, close to abnormal or within normal ranges so I would not be automatically ruled out if it tests ok on the  normal tests. I hope US and Canada have same standards. I did have higher readings last test just a little above normal but the nurse who read it  said it is considered normal enoughl. If I look to immigrate, I feel I need to do it now before that body organ damage occurs and keeps me here forever.

They were so nice and helpful. I feel safer. I had hypos and they helped, got direction, helped me get a gratis lancet device, retail humalog 325 or 350 usd here and about 25 usd there. I was sick a bit of trip and stayed in recovering from gross glucose and they were so helpful. Dropped an insulin vial when I went low and they found it and remembered me and got it back to me.  I was impaired and they were just nice and safe.

In the US I have been slapped by a first responder firefighter when I was low, separated from my glucose meter and insulin by police by their unawareness and luckily I was well enough to get it back, I was left to get no help not even 911 when I started to go into a hypo in a taco bell drive thru driveway where I live, too impaired to remember I had glucose, and I was run through the ringer with 4 cancer scares and then a  precancer scare the last 2 years luckily mostly clear except for the mass amount of radiation (in Canada there is medicine that reduces dna damage from ct scans by half, and not approved here btw), an awful and totally preventable hospitalization if I was properly diagnosed, and meeting catastrophic limits the last two years for all this insane care. “

Again, this is a sad situation, but for some people the only option.

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Sometimes I wish I could be the fly on the wall at Unum when certain situations hit the fan. It’s not that I want to gloat, or “rub it in”, or even find some new way to discredit Unum, but on behalf of insureds and claimants everywhere to be able to say, “we gotcha!”

Sometimes things do not work out the way Unum wants them to. For instance, I’m reminded of a female client who, for the last 6 months at least, was harassed, threatened, suffered an unjust SSDI estimate removed from her benefit, filed a complaint, and finally yesterday was awarded SSDI benefits.

This particular client, (let’s call her Mary X), filed for benefits sometime in January and immediately became the recipient of Unum’s chasing for constant updates. Lately, Unum’s strategies are to send out threatening letters advising that if they do not receive SSDI updates immediate estimate reductions will take place.

I’m sure Unum’s motivation revolved around the client’s date of disability in 2014 and the possible award of at least $2,400/month from SSA. That’s nearly $86,000 in retroactive overpayments and, of course, Unum couldn’t allow any claimant to keep that amount of money or risk the claimant spending it.

Unum began offsetting my client’s benefit in an out-of-contract move to at least benefit by reducing the financial reserve. After my client decided to file a complaint for breach of contract, and with my help, Unum refunded the estimated amount but continued to allege that “because SSDI decisions usually took 10 weeks (where did they get that information from?), it intended to offset for another estimated amount.

Please believe me when I tell you that Unum left no stone unturned in continuously harassing and causing my client financial harm because of the as yet un-awarded SSDI benefit.

Yesterday, we got word from SSA that my client’s application for SSDI was approved but that she became eligible for benefits in May 2017 and is eligible for benefits beginning October 1st. (Remember the 5 month waiting period?) My client would receive $2,498 beginning in October 2017. Period. This outcome was not a surprise to my client who was hoping Unum could not benefit from taking a large overpayment from her.

Oops. Is Unum still looking for the large overpayment? Since my client had not yet received her October benefit check, no overpayment is due.  The only thing Unum is going to get out of all of its hard work is the future offset from benefits.

As I said earlier, I sometimes wish I could be a fly on the wall to observe the “No $200 Pass Go” looks on the faces of those who worked so hard to harass claimants toward company goals. Gosh, that’s probably a big disappointment!

If Unum’s Offset Coordinator hadn’t been quite so aggressive and harassing about chasing SSDI I would have considered this situation more normal and customary.

Still, a smiling fly on the Unum wall once in a while probably isn’t a really bad thing!

 

 

 

 

 

 

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A Surveillance Suspicion

I received this case by email this morning and I’m posting it here because I’m sure my answer will help others as well. Thank you to the person who sent me his/her story. It often takes courage to share disability experiences and I want to acknowledge how important you are to others and to the process.

I am a huge fan of your blog, whose guidance has proved invaluable during my horrific adventure with long-term disability.
My concern over the past couple of months or so is that I feel as if every one of my visits to the gym has been monitored, either by someone taking video with a cellphone or with a wristwatch phone, or more recently someone simply watching me and then taking a surreptitious photo of me with a cellphone at the end of the workout.
I only go to the gym for classes and to swim. My disability is a serious mental health issue for which my psychiatrist “prescribes” in addition to medication and psychotherapy, a regular exercise routine. So I’m not doing anything that I shouldn’t be doing. But it is extremely unnerving to feel as if I am being watched and videographed/photographed every single time I go to the gym.
Now my therapist, pushing back against my paranoia, tells me that I’m just not that important for the insurance company to have me surveilled for such a long period of time. Before you agree, let me lay out a theory.
My theory is that the insurance company has contracted surveillance from a boutique private investigator who specializes in surveilling this particular gym network (only about a half dozen gyms within a tight geographic area). He spends a lot of time at the gym and coordinates with free-lancers, all of whom have gym memberships, and they are conducting surveillance not just on me but on a number of people on disability.
This spreads out the cost and because the focus is on the gym, you don’t have to worry about the high-cost, high-risk undertaking of following people one by one. It’s more like shooting fish in a barrel.
If this is true — and I fully embrace the possibility that I am just being paranoid, because, well, paranoia is a feature of my illness — it is especially creepy because you are always under surveillance (not just over a three-day or seven-day period) and you are being surveilled by your fellow gym members (and I suspect a handful of gym employees who are helping out).
The way this appears to work is that the person(s) doing the surveilling will arrive late to the class (after you have claimed your spot). They take water breaks at odd moments, spending a suspicious amount of time with their phones or holding their Apple watch at just the right angle while you continue your workout. Then when the workout is over, they will follow you out with their phone/camera. My strategy is to wait to be the last one out and it is always a waiting contest with the suspected surveillance gatherer, who waits until she can’t wait any longer.
Although this is an ingenious system, if true, I feel it is a huge violation of my privacy. Indeed, the fitness manager assured me about a year ago, in writing, that it was against gym policy for members to take video of other members without their express permission.
It’s even more a violation because the gym network is affiliated with a hospital and offers physical therapy and nurse checkups as part of the membership. It specifically markets to people with injuries/disabilities!
I have become afraid to go the gym and when I do go I feel so stressed out that I end up feeling worse rather than better after a workout.
Do you have clients who have expressed a similar concern or do you think I am simply being paranoid? I don’t feel that everyone is surveilling me. There is a group of about six people who are consistently behaving suspiciously.
I noticed somewhere on your site that you offer a minibook on surveillance to your clients. Alas, I am already paying a (wonderful) lawyer and can’t afford to hire you as a consultant in addition. Is there anyway you can offer your surveillance book for sale?
Thanks in advance for any advice you can give. If you want to publish my letter in part or whole you have my permission but please do not provide any identifying information about me (i.e., my email moniker, etc.).

Again, thank you for sharing your experiences with me. Although I usually defer people back to their attorneys for information when they have one, I’m choosing to answer your concerns anyway because your story could easily be someone else’s.
To begin, insurance companies are all about the money. A three-day surveillance team might charge from $1,500-$2,500 for each surveillance request. The constant surveillance you suggest would require that you are receiving more than $5,000/month benefit. This doesn’t mean that your insurer has not conducted surveillance, but it does mean that I question whether any insurance company would incur the high costs of surveillance for non-wealthy claims.
In the normal course of using surveillance, insurance companies request a three-day surveillance, usually Thursday, Friday and Saturday for the “quick hit” to back-up an otherwise weak denial. Placing investigators under cover in a particular gym suggests that the insurance company is seeking far more information than it really needs to deny a claim. And again, it would be pretty expensive to do this kind of thing.
Insurance companies do not have the means, nor the wherewithall to install permanent investigators in a particular gym. Insurers are not the CIA and they don’t conduct covert operations per se. It’s not that your claim is unimportant, it’s that insurers do not spend the kind of money it would require to set up under cover investigators at a particular location.
The fact that you have a behavioral claim rather than a “physical one” also tells me that your therapist has an excellent opportunity to document the fact that regular exercise at a recommended gym is part of his/her treatment plan to return you to health. It can be documented in patient notes and recorded on the update forms you return to your insurer. You do not have to be afraid if you are following through with your therapist’s treatment plan and recommendations. In fact, your psychiatrist can actually write out a prescription for you to exercise in a certain way at a gym.
Bottom line, insurers will not spend the kind of money you are suggesting here to permanently hire surveillance at a particular location, nor are they likely to engage in surveillance for more than three days. I’m not suggesting insurers only conduct surveillance once, but they do it in different intervals of time.
I encourage you to speak with your psychiatrist about documenting your exercise regime into the patient record and also including it in a written treatment plan. In addition, remember that your time in the gym is in fact a mental health requirement and that any insurance company would find it very hard to deny your claim when your provider is recommending that you do it.
I really can’t provide copies of my proprietary material to those who are not clients, particularly those with attorney representation. However, if you consider the above answer I think you will know how to handle your time in the gym medically, and present it to the insurance company as a credible part of your treatment.
Thank you again for sharing your case history with me and about 800 daily readers of Lindanee’s blog. If you have any other questions please feel free to contact me.

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Even Disabled Animals Need Support

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Emergency Room(I received the email below describing how someone taking opioid medications was recently treated in the Emergency Room. I think perhaps insureds will find medical personnel unsympathetic with the amounts of medication some of you are taking.

It looks like hospital staff will not provide medications for emergency care that are at levels to do any good. This individual had several failed back surgeries and suffers from chronic back pain. There is going to be an awakening for those who have already risen to high levels of pain medication tolerence, particularly when there are new injuries requiring emergency care.

I’m not sure a letter from the prescribing physician will do any good. No emergency room physician is likely to “top off” opiate meds, even when there is a new injury for fear of overdosing the patient.)

I have been extremely ill due to my fall down my basement steps. 6 cracked ribs which are still healing. Due to the $4000 per family member deductible from Aetna for each family member I could not afford to stay overnight in the hospital.

The hospital staff in the ER were also very uncooperative regarding my pain. I had my pill bottles brought to the ER to prove why their doses were not doing a thing for me. I chose to go home and treat myself after calling my physician. 

What I went through is info others should be made aware of. If a person has been prescribed opiate pain medications for a long time they will not be taken care of adequately by any hospital. All patients on pain meds need to carry a letter from their doctor at all times. The letter must state the current drug (s) prescribed and the mg/hour. This letter needs to be signed by their doctor and on stationary which includes the doctor’s DEA# and emergency contact phone #.

Feel free to post this info on the blog. People are treated like animals in an ER and are not believed when they explain their current pain mgmt situation.

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