(Let me start out by saying I have kept a journal tracking everything that's happened and been said to me since October 8, as well as copies of everything I've received or sent to Prudential and other doctors).
These have by far been the most stressful 6 months of my life. I was put on medical leave by my orthopedic surgeon on 8 October. I have had 3 prior anterior cervical discectomies with fusion. When I filed my Long-term disability claim in late October with Prudential, I had no idea what to expect or what type of runaround I would be given.
My company only offered LTD coverage. The elimination period was 90 days, and after that 90 days, I was supposed to start receiving disability payments from Prudential. When my 90 day period was up, I begin talking to the 1st of 3 Prudential disability claim representatives re: my claim and my medical history. I explained in detail to them what my medical history is.
This first representative told me that all my doctor needed to submit besides filling out the claim form was one year's worth of medical records. Which is exactly what his office sent. This is what I was told on 11/19. I also faxed copies of a second opinion and EMG that I had done prior to December 30.
On 12/4 and 12/11, I left messages requesting that the representative call me re: the status of my claim. On 12/12/03, I received a call back saying that my claim had been turned over to a different claim representative. (Rep #2) In talking to reps 1 and 2, they gave the impression that my original claim would be approved. Seemed pretty cut and dry to them.
On 12/30, I talked with the 2nd rep that informed my that my claim had been denied because of "self-reported pain" medical records and that I could file an appeal. (My orthopedic doctor was very upset. He said that even though he's the doctor and knows my history, that Prudential is basically saying I'm not disabled and he doesn't know what he's talking about.) That the appeal shouldn't take the entire 45 days, that it would probably be completed in 1-2 weeks. If the appeal were approved, I would receive disability payments dating back to 30 December is what rep #2 told me. (Now mind you, I've been out since October 8. I used our savings account to help tide us over until my original claim was approved, which would have been 30 December expecting my disability payments to start in January.)
Now I was looking at another 45 days for Prudential to process my appeal. I questioned the 2nd rep why she only asked for 1 year's worth of medical records, when what I have didn't just start in October. I faxed this question over to them and received no response. When I called Prudential on 2/5 to check to make sure there was not any additional they needed besides what I had faxed (and mailed) to them as a part of my appeal, the rep was short with me and told me that Prudential has 45 days to respond to my appeal.
I informed my company on 31 December that Prudential had denied my original claim and that I would be filing an appeal. I faxed (and mailed) to them everything I could think of: medical records dating back to list of all medications I had to take to help ease the pain, a write-up of how my life has changed since October, a document outlining what a typical day is like for me, results of MRI and Nerve Conduction Study that was done. I still couldn't understand why Prudential only asked for 1 year's worth of records. The write-up that I received from Prudential basically took everything these 3 doctors had written re: my condition and reworded it to use against me. How else would these doctors know what I'm going thru if I don't keep them up on everything?
In addition to everything going wrong with Prudential, I had to quit my company in order to be able to withdraw some of my 401K monies to keep us going until either my appeal was approved or if denied, filing a claim with ERISA. My company's 401K plan was not set up whereby you could file hardship and make a loan. Our program offered no loans of any type.
While Prudential was reviewing my appeal, I also talked to a lawyer on 2/18, since I had no idea what other reasons Prudential might come up with in case they denied me yet again. I had to pay the lawyer $200 for the initial review of all events and documentation leading up to my visit with him. That way if Prudential denied me again, he would be ready to file an ERISA lawsuit.
(Don't laugh, but on the 18th after having seen my lawyer, I lost my SUV, or I thought I had. I filed a police report that my SUV had been stolen and had my daughter come to the police station to pick me up. I had her circle the block so that I could show her where I thought I had parked my truck. Sure enough I didn't remember that I had parked my truck a block over for the exercise. All I could do then was cry.)
My husband has stopped my children and granddaughter from asking me questions, cuz with all the pain medications I take, I couldn't remember anything they had asked me and any answers I gave them. This is just really the short version of everything I have been through.
Finally on 3/3 Prudential approved my appeal. This was done with rep #3. Rep #3 also led my company's Director of Administration and myself to believe that I qualifed to get payments that retro back to October 1 vice 12/30, which would have meant that I would be receiving 6 months of back pay vice 3. (On Feb 4 I went on leave and on 24 Feb I had my 3rd neck surgery. I was out of work until 1 May. The 3rd rep explained to her that since I had been out of work for 85 days, that this would be viewed as a disbility and I'd get 6 months backpay. Not. She come back and told my Director that it didn't qualify as time towards my disability and I would not being received 6 months of backpay, only 3.
I still have no idea when I should be receiving back pay or when I should start receiving my monthly payments. What I've been thru, I would not wish to happen to anyone. If I hadn't gone thru all of this myself, I wouldn't believe it either.
Vycurtis
Fredericksburg, Virginia
U.S.A.
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