Jump to content
CrazyBoards.org

Someone please help me...


Recommended Posts

I'm sorry that this sounds so desperate but I really need some advice.

I should start out by saying that I'm Canadian so I know a lot of you guys are in the US, but any advice would still be really appreciated.

Basically, I've been off work on a short-term disability leave since June 2005.  It's not through the government but from my private plan that I pay into through my work.  The reason I'm off is basically that I'm considered not mentally stable enough to work.  Diagnosis include: GAD, Panic Disorder w/ Social Anxiety, Pain Disorder, OCD and Borderline Personality Disorder.  I scored extremely low on some occupational scale that basically stated I couldn't work at any position until I had intensive CBT therapy to try and deal with my issues as I have not responded to any medications and therapy is what is most needed for BPD (so I've been told).  So, my private insurance through my work allows $1000 for psychology (I couldn't get into a psychiatrist which would be free in Canada but the waitlists are over a year long).  So, that $1000 gave me 10 sessions which ended in November.  At that point, both my psychologist, family doctor and psychiatrist (one was seeing me every so often as a favor to my family doctor but not for therapy, just for insurance assessments) told my insurance company I needed 6-12 months of thearpy before I could return to work and that they should pay for it because without it I won't be able to go back to work period.  They also advised the insurance company that when I do return, I be moved to a different position as the one I'm in is not condusive to someone with my condition.

So the insurance company says that they will look into it and I hear nothing until January.  In January they tell me I have to see an independent psychiatrist for a second opinion.  I'm told this is just to decide whether they will pay for more therapy and has nothing to do with me returning to work.  So I go and see their doctor and he was a complete idiot.  When I got there he actually told me he was expecting a boy who had been in a car accident.  Obviously that was not me.  Then he kept asking if I was the girl who had been in trouble with the law (wrong again).  So we spent half of the hour appointment just going over my basics as he had not read any of the doctors reports.  Then he did a mini-mental status exam (asked me to remember 3 words, spell WORLD backwords, recreate a drawing and fold a piece of paper and place it on the floor) and then sent me on my way.

A few weeks later the insurance company calls me and says that not only are they not going to pay for my therapy, but that I have to return to work in the same position immediately because according to their doctor "I'm fine because I passed the test."  My psychiatrist said that test is used almost exclusively for head injury cases and is useless in my case.  My psychiatrist also wrote the insurance company a letter stating that "sending me back to work in my current condition without the appropriate therapy would result in a potentially lethal outcome."  The insurance company's response was that "they don't deal in What-Ifs and that if I kill myself, it's not their problem."  Nice huh? Especially since I've been suicidal for months.

So I don't know what to do now.  I have until the end of March which is when I'm expected to be back at work and my doctors say I can't do it.  I have consulted a lawyer (just to see) and they think I have an excellent case, but I don't know if I'm up for that.  I'm dealing with one of the largest insurance companies in Canada and the company I work for is a large financial organization with deep pockets.  So I'm really scared.  They said the case seems open-and-shut, that they think they could get my benefits reinstated, my therapy paid for and get a lump-sum for pain and suffering because the insurance company acted on "bad faith"  Problem is, while I'm fighting (which could take 2 years) I'm not getting paid anything.  So they said I could try and apply for something called ODSP (if there is anyone from Ontario reading this, apparently that's like welfare for sick people) and that I would probably get that which would sustain me while I fight.

What do you guys think? I really don't know what to do.  I also didn't receive my direct deposit pay yesterday even though I was assured my pay was going to continue through March and I've almost killed myself on several occassions.  I've considered going to the emergency room and seeing if they will hospitalize me...but even that is just a short-term fix.

Thanks for reading this, I know it's long...any and all advice would be greatly appreciated.

Kelly

Link to comment
Share on other sites

Greengal -

This is long reply, so get comfortable!

I was off work for nine months also on private employee/employer paid disability insurance and I had to fight like hell to get any money, not fun when you're MI, actually barely possible so I know how awful it is for you right now. 

I had major depression but was also unable to work, and it took months before I was able to convince the insurance company to pay me any money at all.  I ended up taking out my retirement account to live on and paying tax penalties for doing so. I'm in the U.S. so don't have the same social services available to you, but we have lots more bombs and stuff!!  (Just another sick joke from yet one more frustrated Yank!)

I think in your shoes I'd talk to that lawyer again, or another one if you weren't totally comfortable with them or want a second educated opinion before committing to a legal action.  I'd take lots of notes during the meeting, and because I sometimes freeze up, I'd write down my questions ahead of time so I don't forget them during the meeting.  One question I'd have is whether or not you have to use the company doctor, or can pick one of your own since the company doctor really does sound like an idiot. 

I'd also contact whatever social services the lawyer mentioned to find out what's available, even if you don't really plan to use it.  It will be helpful to know what's there, and if you do need it, typically in the States any type of government assistance takes a long time to get started.

My other advice is to keep a notebook by your phone and document everything as best you can, because you can be sure the insurance company, doctors, etc. are.  Even something brief like "Called Mr. X on from ins. on Mar. 1, discussed xyz, he said I need to submit form b."  Things like that will jog your memory later and help when you have to argue because you'll have all your facts laid out in front of you so even if you feel flustered you can just keep referring back to your list of events.  It will also be quite useful to your lawyers in the event you go that route. 

My diary like that was quite helpful to me because my insurance company kept trying to do things like tell me I didn't respond within the 30 days allowed from the date of a letter.  But I had kept the envelope, and although the letter was dated March 1, it wasn't postmarked until March 15 so I got to write back and point out the discrepancy.  Things like that made them look stupid and ultimately helped me win against them.  I also sent everything to them by certified mail which requires a signature for delivery so they couldn't deny they'd received something. 

Most importantly, if you are suicidal, please get help either by calling your doctor, a helpline, or getting to the hospital.  There are meds that can definitely help with suicidal thoughts and get you away from the edge of the abyss.  That will also make all the rest of this seem a little less overwhelming. 

For what it's worth, I was also working for a very large corporation (12,000+ employees) and had disability insurance with the largest disablity insurance provider in the U.S., and I eventually got my money out of them, although I won't say it was easy or fun.  But it sure felt good when I finally got the money I was owed!

I wish you lots of luck getting through what I know is a very difficult time, and please keep us posted on your progress both with your work hassles and also how your head is doing, the main thing.

 

Link to comment
Share on other sites

Greengal,

You have the right to appeal the decision.  Have your doctors provide further information specifically adressing symptoms of your MI that would prevent you from working.

I went through the same shit and I appealed and won and they wire transferred me the back pay the day I won.  You DO NOT have to go back to work while you are appealing.

Fight it, fight it, fight it!!!  Just keep giving them info until they approve it.  it's very typical.  Insurance companies suck.

Good luck!

Link to comment
Share on other sites

OK, were this me, my first response would be to rent a truck and buy a shitload of fertilizer.

But then, I'm a big meanie, so a lawyer would probably be even worse.

So yeah, I'd say stick with the lawyer, grab whatever benefits you can during the interim, and fight.  Do hospitilization if you must--A,  you have to keep as healthy as possible; N, if you end up hospitalized one or more times during the process, it can only improve your case and show them what frickin' schmuks they are.

I also think fighting them is actually the healthier way to go--giving up and giving in rarely does anyone any good; they're fucking with YOUR health by doing this; make them pay for it!  You trusted them to be there when you needed it, they weren't, so stick it to 'em and get what's rightfully yours!

I know it looks to be a long, hard fight, but in my view, the prize at the end is worth sticking to it--God knows, if things are bad NOW. they're not gonna get any better if you don't have something to look forward to.

And, aside from gettin' yours, I'd really rather you didn't have to get stuck somewhere that's almost certainly going to be harmful for you.  Please, whatever happens, take care!

Link to comment
Share on other sites

I am very sorry to say that here in the US, hospitalization is the only way to get medical care in many states. I've been hospitalized 5 times. Not always because I was really suicidal, I just had to tell them I was to get into the hospital to receive basic psychiatric care. Otherwise, I'd never have been seen by anyone and would have ended up 6 feet under like my dad.

Keep the fight and keep the faith. I'm trying to get disability and I'm working too, which for the disability board would prove I can work. Fuckers. Prove I can work when every day I have panic attacks over work? Fucktards.

Link to comment
Share on other sites

Heya GreenGal,

Ugh.  I've seen too many people in your position.  I'm with ya hon.

1.  Have a good lawyer and document *everything* as some of these well-meaning Americans said.  They *know* litigation and they're right.  Keep a big file with copies of *everything.*

2.  Worth applying for ODSP.  This is indeed "welfare for sick people" as you put it.  The Ontario gov't pays you a pension monthly (not a hell of a lot, but hey) and covers a fair number of Rx drugs.

3.  That "independent" psych is an idiot.  For *sure* push **hard** for another assessment.

4.  I don't know where in Canuckistan you live.  But some family docs here do psych.  Call up the GPPA (GP Psychotherapy Association).  This is covered by OHIP.  Also, if your employer is *so* obsessed with putting you to work, do they have an EAP?  An employee assistance program should have therapists they cover.

5.  Call up your local Health Unit and your local CMHA.  They at the very least have counselors for free.  And, they almost always have a psych consulting for them.

Showing up in emerg is sometimes all you can do.  This at least gets you referrals to community agencies, in most communities.  But yah, last resort, as emerg is full of icky viruses.

That's all I can come up with for now.  If you don't feel comfortable sharing details with us it's okay, that's why I tried to be generic in my Long List of Stuff (I do a lot of Long Lists.)

If you have questions about WSIB or ODSP or CPP Disability I'll try to answer, no promises I can, but I'll try.

I have filled out a *lot* of these forms.

Good luck with these insurance idiots.

--ncc--

Link to comment
Share on other sites

I'm sorry that this sounds so desperate but I really need some advice.

<{POST_SNAPBACK}>

Kelly,

First I know there is a special room in hell marked for insurance company execs who make these capricious life and death decisions.

I'm on SSDI for orthopedic (sp?) reasons, basically my back has broken and can not be fixed; however, while the determination was being made, I was also out of work, not receiving any income, had to move out of my house, spiraled into a major depressive disorder and the plan I had to check out since my husband died almost 5 years ago nearly came to fruition.

Fortunately, though I had no income, my long-term disability policy at work, covered my 900$ a month insurance premium for me and my 2 kids.

I was vigorously interrogated by the long-term disability analyst who had my case. In the end, we sort of got friendly, but she was brutal. It was key that they ultimately approve me for LTD, because that would VASTLY improve my chances for expedited approval for the federal SSDI, which is permanent coverage.

I don't want to include details that are irrelevant since our countries are different, but our cases sound similar and I want to just emphasize this one element:

Stay in treatment of ALL sorts no matter what you have to do. People like you and me we really NEED all those treatments so its rather a no-brainer, but should you lose all your funds, push the treatment issue HARD. Even if you can't get treatment, apply EVERYWHERE. Because when you are evaluated by the various levels of bureacracy (sp?), I know the key thing they look at is, "is this person in treatment."

My medical records are about 1 foot high at this point. Not because I'm ripping off my government, but because I'm that broken. And I was lucky in that I could continue to seek and receive care from my various specialists, but if I had lost my insurance, I would have gone to the ER, welfare, wherever, newspapers (I did that when my husband was dying and got dicked around, but that's a whole nuther story).

Treatment, treatment, treatment. They want to see medical records, affirming your infirmity. And I would go with your lawyer's suggestions because the a-hole pdoc who evaluated obviously is on the payroll of the insurance company so WTF is he gonna say? That's why I say there is a room in hell for those greedy bastards with no souls.

I hope this helps, it's disjointed because, as I said, I had a lot of factors that would be comparable if you were down here, but I know dick about Canada, except that it's cold as fuck and Vancouver has hot hockey players.  ;)

I'll try and keep up, I know how nerve-wracking it is. I almost lost my life over this bullshit and chronic pain.

Best of luck!

S9

Link to comment
Share on other sites

Heya GreenGal,

Yeas!  Duh, how could I forget.

Any old test, therapy, assessment, specialist, that you get sent to, ***do it.***

No matter how dumb it seems.  Really.

This *always* looks good for you.

Thanks S9.

--ncc--

Link to comment
Share on other sites

Archived

This topic is now archived and is closed to further replies.

×
×
  • Create New...