2014-01-23

A couple weeks ago I mentioned my problems with an insurance company.  This is the latest on the story.

I previously posted twice about the matter.  Here is the first.  And the second.

I rely on my disability policy from my last place of work.  I won’t name the insurance company, yet.  But, I will if it gets ugly.

They sent me a letter, two days before Christmas, telling me to go back to work.

You lazy bum!  I kept thinking the letter contained those exact words, as I read it again and again.

Yes.  I took it personal.  At first.  But, then, as I researched, I began to see.

Disability fraud is rampant.

For example.  In a couple counties bordering Kentucky and West Virginia, as much as 15% of the population receives some form of disability.  One lawyer handles most of the cases.  At 25%, this guy must be very rich, even after paying off a judge and some doctors.

My insurance company needed to know that I am not one of ‘them’.  So, as they paid my short-term disability claim, they also demanded a physical evaluation by my doctor.

But, my neurologist wouldn’t help me.  As a policy, he doesn’t provide help with disability claims.  His secretary was adamant.

I have heard hospitals and clinics commonly refuse to help with claims.  They must think it is outside the realm of medicine.  So I had to take my records back to my primary-care physician.

She had not seen me in almost two years.  I remember her smile as she asked, “What’s new?”

“Well, I have muscular dystrophy.  Here are my records from Mayo Clinic.  Will you help me?”

I saw her at least three times over the summer, as my insurance company kept hounding us.  They wanted more evidence.  Phone calls and letters.  Follow-up exams and forms.  I can see why some medical institutions won’t waste their time.

Evidently, they were never satisfied.  They were just biding their time until they could drop me.

We don’t believe you.  Go back to work.

I consulted with an attorney.  He was friendly and sympathetic.  Then we discussed fees.  He wanted 25% of the lifetime settlement!

I kept thinking, This is all I have left to survive on.  Why do you get 25%?  It’s a straightforward case.

I asked him how he thought his fee was moral.  He never answered directly.  Instead, he told me what other lawyers charge.

But, after some conversations with the insurance company, I learned what they wanted.

So, this past Monday I paid to have a functional capacity evaluation.

A functional capacity evaluation is typically performed by a physical trainer with special certifications.  A subject is put through a battery of physical examinations, as well as tests designed to simulate the type of work performed.  The evaluator summarizes his findings in an objective, legal-medical dialect of English.

In my case, there was an interview, and a review of medical records.  Followed by strength and agility exercises.  He pushed me to the point of failure, so he could to accurately describe what he was seeing.  He also took lots of photos.  As he escorted me out, afterwards, he told me what he saw, in the dialect spoken by insurance bureaucrats.

I try to see insurance professionals as people.  But, I had no sympathy for them on Monday.  By the end of the exam, I was weak and shaking.

About six hours after it began, I left for home.  Muscle spasms left me too tired to do anything.  I just tried to keep myself awake until bedtime.

Tuesday, I was still in too much pain.  But, yesterday, I started writing.  Today, I have enough energy for editing, but not much else.

I don’t, yet, know the final cost.  I will get the bill before I receive the report.  It will be somewhere between $1200 and $1600 for everything.

And, when I heard that, I thought, sure.  If that’s the cost for a report that will hold up in a court of law,  I will pay.

It’s also more palatable than what a lawyer would leave me to let me live on, in exchange for his services.

So I gladly antied-up for Monday’s torture.  I can afford the cost, both financial and physical.  And, after a week I can forget about it.

I made the decision a couple days after my second post on this matter.  And I spent the remaining time, until Monday, blissfully writing.  It was definitely worth it.

I enjoyed each productive day.  Essentially, I feel like I bought myself a two-week writing vacation.

A worry-free mind is priceless.  Especially when it is affordable.

I’m hoping this will be enough.  Common sense tells me it will be.

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