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Appealing the Termination of my Short-Term Disability

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Unread 02-27-2013, 09:56 AM   #1
Join Date: Sep 2012
Location: Columbus
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Default Appealing the Termination of my Short-Term Disability

Any advice from someone that has been through it? Thankfully, my cognitive symptoms have lifted, so its not as daunting of a task as it would have been a month ago. I actually was "released to work" by my doctor yesterday, although I was laid off while on disability, so I won't actually be returning to work. My disability payments were put on hold while they reviewed my case on December 13th and then I was notified January 29th that my disability was terminated as of December 13th, because a medical review determined I didn't have post-concussion syndrome. HA! That was like a slap in the face. I am appealing to get the payments from December 13th to February 26th, more because I feel like an injustice was done than for the actual money. It seems wrong that you pay for insurance, and then you get screwed like this. I have new evidence to submit, so I'm hoping that will help, but I'm wondering if I shouldn't get my hopes up . . .

I also feel like this reflects badly on me to my previous employer, as if I was just trying to scam the system and wasn't really injured, but there's not enough money at stake to hire a lawyer over, and I'm afraid the insurance company knows that. Ugh!
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Unread 02-27-2013, 03:28 PM   #2
Mark in Idaho
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When was you injury ? Many return to play criteria use 6 weeks as a standard when there are prolonged PCS symptoms. Even then, they suggest a slow return to activity starting with a few hours per day of class and such.

Do you have a state insurance bureau that has guidelines to help you, maybe even a complaint process ? STD is often a high complaint issue because they want to avoid making payments at almost any cost. When they see you completely physically functioning, they know it will be harder for you to fight them. The invisible wounded issue...........Did they do any NeuroCognitive or NeuroPsychological Assessment testing back in Dec ?

I suggest you not get your hopes up. Instead, use this as a test to your ability to go through the process. Do not get a 'I want justice' attitude. It will be counterproductive to your brain health.

I wish you well with this challenge.
Mark in Idaho

"Be still and know that I am God" Psalm 46:10
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Unread 02-27-2013, 04:20 PM   #3
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Join Date: Nov 2012
Location: Ontario, Canada
Posts: 267

I was denied long term disability years ago for another invisible, but very real, medical condition and I could not go back to work at that time and desperately needed the money as a single parent. The appeal process was absolutely exhausting to my already exhausted mind. The good news is that with just a little bit more documentation my claim was approved and all was well.

I believe that sometimes these things get denied just to see if you will go away and not bother appealing. I say go for it and appeal, especially if you have new information, but try not to get emotionally involved and keep moving forward with your recovery and job hunt.

Good luck to you!

I'm a 39 year old, female, accountant. On July 2, 2012 I crashed my bike at the end of a 65KM road ride. I was fine that day but woke up the next morning to my current world.

Ongoing symptoms include: dizziness, blurred vision, light and noise sensitivities, cognitive problems, uncontrollable emotions/depression/anxiety, headaches (but they're getting better), mental and physical fatigue, difficulty communicating and sleep disturbances.

Currently seeing a fabulous Neuro Psychologist and vestibular physiotherapist and hoping to soon see a neuro ophthalmologist. I am currently doing 20 minute stationary bike rides daily, 20 minutes of meditating, 15 minutes of Lumosity and lots of resting. I have not been able to work or drive since the accident.

The things that have helped me the most since the accident are vestibular therapy, gel eye drops (for blurred vision, sensitivity and dryness), amitriptyline (10mg), and meditating. I am finally starting to see some slight improvements and am hopeful!

My brain WANTS to heal itself... I just have to let it and stop trying to get better!
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Unread 02-28-2013, 10:55 AM   #4
Join Date: Sep 2012
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Default Thanks for responding!

I was injured December 2011, then August 28th, and then November 16th, but I'd only been out on disability since September 1st. I had disability insurance and had been receiving 2/3 my salary.

I did have cognitive testing in December 2012, and it came back saying I had intermediate memory loss and my short term memory was right at the threshold of concern, but not over it. However, the psychologist who administered the test determined that my memory loss was not significant. The kinds of things I would forget though made working in my job completely impossible. For example, my husband told me one night not to use the kitchen sink because the pipe under the sink had become totally unsealed, and he needed to call a plumber the next day. So the next morning, I filled up the sink with soapy water, washed the dishes, and then drained the water from the sink . . . onto the floor. I called my husband to ask him if he'd told me not to use the sink--I had some vague recollection of him saying we needed a plumber for some reason--and he confirmed that we'd had a whole conversation about it. I just couldn't remember!

Anyway, I guess the insurance company latched onto the psychologist saying my memory loss was not significant, and that's how they are denying my PCS. However, I have new eye testing to submit, showing substantial problems due to the head injuries. I also have evidence that I had been seeing a psychologist. (In their report, they'd said that I had not been seeing a psychologist for my anxiety, which my neurologist had said was contributing to my cognitive symptoms. This wasn't true. I just hadn't mentioned it to them because I hadn't thought it relevant.) I'm hoping these two things will help my case!
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