Insurance Companies Reluctant to Pay Claims

By Jane Mundy, Staff Writer
Lawyersandsettlements.com
February 20, 2006


Carey Johnson (not her real name--she requested anonymity due to an ongoing issue with her insurer) has been disabled since 1991. She has also been battling with her insurance company for the past 15 years for compensation that is due her. Carey never knows from one month to the next if her disability check will be in the mail.

She suffers from fibromyalgia, a form of arthritis that is recognized as a debilitating disease by the medical community. But apparently some insurance investigators have decided they know more than the best medical doctors in the country. Even more than the medical team at Stanford University!

Everything was OK for the first two years; Standard Insurance made regular payments as per her claim and coverage. But this is how the company deceived Carey… she was also suffering from depression. Who wouldn’t be when diagnosed with this terrible affliction that happened overnight, at the age of 40?

She was advised by her doctor and the insurance company to make a claim based on her depression – that way her claim would be processed faster because nobody knew much about fibromyalgia in 1991, nor was it recognized as a legitimate illness by the medical community.

Standard told her they would pay benefits based only on her depression. As far as they were concerned, fibromyalgia did not exist. "I had to go to a brutal interview with Standard’s doctor – he made me touch a fingertip to my nose, then asked me to touch my toes (which I couldn’t do) and said it was all in my head.

"I was sobbing and angry at the same time. I was trying to be polite to this doctor but his tone was awful; he made little slurs about everything being in my head. My primary doctor said to go ahead and sign, even though I would be covered for only two years. During that time I could build a case, which I did.

"After my diagnosis, about six months later, I finally started to receive benefits," says Carey. Then she went to two specialists, including a rheumatologist at Stanford University, both confirming that indeed she had this crippling form of arthritis. "I thought I was safe because Standard finally agreed that I did have fibromyalgia – it was a disease, it was real. But about one year later, I got a termination notice and they just cut me off without warning.

"I had medical expenses. I told them to reinstate me and to fax their reasons why they cut me off. They kept sending me pages of my policy highlighting that I was depressed. Of course I was depressed – it was a side effect of fibromyalgia.

In fact they were making her illness worse, stressing her out, adding to her depression. Carey subsequently found out through the internet that there are many disabled people like her, fighting similar problems with their insurance companies.

Here are a few tricks her insurance company resorted to in an attempt to terminate payments:

"They offered to send me to, and pay for, rehabilitation that specializes in fybromyalgia. Luckily I read between the lines: Then they say if you are able to go to rehab, you are able to work! Of course if I can work, my payments would stop. Not only that, I could be charged with a felony and ordered to pay back all my benefits.

"Next, I was sent a letter stating that they wanted to buy me out. The offer totaled about one-third of what I would get from now until I reach 65. Then a woman called from the insurance company, very chatty, like my new best friend. She asked questions such as, "What is your typical day like, what time do you get up, what do you do for fun, hobbies?" To which I answered, "Nothing much, I have arthritis." They are fishing. "What about volunteer work, you sound like a nice lady, I bet you do volunteer work?" If I went to the soup kitchen and volunteered even once, I would be cut off.

"The most recent attempt to terminate my claim was last September, 2005. I got a letter with a long form attached in teeny print. They want me to sign a privacy release form, giving them permission to see all my medical records to determine that I am disabled and haven’t been working. In other words, they are fishing to see if anyone in my family had arthritis – if you have a pre-existing condition you don’t qualify for benefits."

Talk about devious! Some insurance companies go to great lengths to try and terminate your claim.

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