My wife has contracted C.F.I.D.S. And as a result, is almost totally disabled. However, due to her stubborn determination, she eventually found a doctor who prescribed amphetamines to treat her primary symptom of unrelenting fatigue. (This is an acceptable treatment for C.F.I.D.S. To enable the sufferer to regain some functions of life.) This enabled her to return to work on a part time basis after 45 days.
However, prior to her being diagnosed, she was unable to get out of bed for three months until she found this doctor and neither we nor any of the specialists we consulted with could come up with a firm diagnosis. She was finally diagnosed at the University of Miami's, Jackson Memorial Hospital, where they have been studying the disease for over ten years.
They diagnosed the illness, afforded it a 100% disability rating and suggested she apply for permanent disability. Her illness and disability were subsequently confirmed by two other specialists, (one of whom prescribed the amphetamines which eventually estored to her some functionality). All provided reports as did her employer.
Due to her inability to work (or even get out of bed) during the disabilty period, she apparently qualified for Prudential short term disability under the terms of her policy. Despite the expert medical reports, notes and CDC definitions of the disease, affidavits from her employer, etc., that we submitted to prove both her disease and her disability, Prudential has refused to acknowledge her illness or the period of her disability for which we filed the claim.
During this process, we also found that Prudential had a duty, when denying the claim to provide us with their "internal operating procedures and guidelines used in making their determination" and a list of what materials were required to perfect the claim. They admitted they had no procedures, had no medical review of the claim, (and delayed our submission of the second appeal by falsely stating that there was a medical review which they would supply, and while waiting, provided us with a short deadline to submit the second appeal, which we had to do as required under ERISA).
This is especially important as the definition of C.F.I.D.S. States that all of the symptoms are subjective in nature (which has been recognized by the Courts) and they denied her claim based on a lack of objective evidence? In essence, they were going to deny her claim regardless of what we produced and regardless of her illness.
We are now looking toward litigation under ERISA which apparently preempts any claims for their fraud, and limits our damages to the few thousand dollar claim.
I would greatly appreciate any suggestions on how to proceed. If need be, my wife and I will publicize this matter on the front page of the New York Times!
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