I live in Oregon. I have tried to keep this as brief as possible, but I have very thick piles of detailed letters, etc. explaining my carrier’s unethical and unconscionable business practices.

I have been battling with my insurance carrier over long-term disability benefits since the end of 1999. They claimed I was disabled from a relatively rare psychological disorder; this decision was made after a forty-five minute meeting with a psychologist hired by them, who had no experience treating patients with Chronic Fatigue Syndrome (CFS). She did not even check my BP or listen to my heart. It was both irresponsible and unethical for her to have diagnosed me with a psychiatric disorder after a single, cursory meeting.

This brings me to the Independent Medical Examination (IME), which is a fraudulent process that is set up to intimidate clients. It should be illegal. As the IME doctor is hired by the insurance company, it is hardly an independent process. They are told to come up with findings that discount the opinion(s) of the patient’s own doctors. The insurance companies have the nerve to claim their doctors are more knowledgeable than the specialists the patients are seeing.

Although I won my lawsuit against my insurance carrier, they are appealing the judge’s decision and have therefore been successful stalling my payment (as has been their consistent practice) for another 2-3 years.

Although I provided them with more than was necessary to prove my physical disability, they forced me to sue them to receive the benefits I deserved. They may settle with me before my case makes it to the appeals court, and have indicated this would require me to be excluded from being a client of theirs in the future. They would also require me not to disclose any information about my case. Their attorney told my attorney he feels “they need to swallow their pride” and pay me. This tells me they realize I have a legitimate illness, but are having a hard time losing this lengthy battle.

My insurance carrier’s procedures are fraught with stall tactics that eliminate clients. Their claims process is very long and full of loopholes. Many people are too ill or unable to function when they have a claim, are therefore incapable of dealing with the carrier’s lengthy process, and are forced to give up before they receive the benefit to which they are entitled. In addition, they harass clients, and create significant stress for already ill people. For example, they were instructed not to contact me after I hired an attorney. They persisted in calling me on the telephone, and sending me letters and redundant forms to complete.

My insurance carrier consistently spun the facts of my medical file, twisting certain details to appear in their favor, and overlooked pertinent, objective evidence proving my physical disability (i.e. my tilt table test where I developed “full syncope with at least 8 seconds of asystole”, my sleep study that said I have alpha intrusion, reduced sleep efficiency, and abnormal sleep stages that are consistent with CFIDS, etc.). In their responses to these findings, they literally did not acknowledge the items for which their doctors had no way to discredit.

It is not too bold to say that they blatantly lie, as well. On the telephone with my mother, my claims administrator told her they did not receive an important letter, but then quoted from it later in the conversation. Additionally, when I stated my doctors did rule out psychological causes for my illness, and mentioned the document we provided as proof, they claimed not to have received it. It seems awfully convenient!

Specific to CFS, my insurance carrier consistently and intentionally used out of date information to claim it is a controversial diagnosis and is not recognized by the medical community as a valid entity. We must not allow them to manipulate the facts in this manner so they do not have to recognize CFS as a disabling condition!

Added info from author’s mother:

There were a couple of things we thought of afterwards:

First, I’m not sure she mentioned that her case was an ERISA case. I thought that might be important for you to know. Our sense is that ERISA much benefits and protects the insurance companies and does little for the patient.

At the risk of pointing out the obvious, it seems to me the disability insurance industry is holding the government hostage. What a scam this is: The insurance companies enter into a contract with clients (whether the client is a business providing for their employees or the employees themselves). When a disability claim is filed, the insurance company fights like crazy to not pay. We know that some people can’t fight, so they give up. But, those who eventually prevail are REQUIRED that he/she go through the tedious and energy-wrenching process of applying for Social Security disability. THEN, if that is approved, the insurance company actually GETS some of that money to offset their outlay. HOW can that be legal?? WHY should the SS system subsidize insurance companies who were responsible for determining their risk with the client in the first place and entered into a contract with them? It’s fraudulent!!

In our case, our daughter won her case against her insurance carrier. They appealed. I think they appealed to buy time because she had not, at the time of the judgment, applied for Social Security. Frankly, she doesn’t want to apply as she feels she bought and paid for disability insurance from her carrier and coverage should be provided by them & the company with whom she entered into a legal contract. Why should the government have to pay?? WHY SHOULD THE CARRIER BENEFIT FROM WHAT SS PAYS? I think it should go the other way, if anything. This is the way it should work: If a person gets SS benefits, then the carrier should reimburse the government for their part of the contract they had with the client.