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Mental Monday: Income Insurance Claim Issues

06 Jan 14
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(c) Megan S, December 2013

I really need some help and advice! Please read this and let me know if you can help either in the comments or by email.

As some of you may know, when I first left work completely in May last year I put in a claim for income protection under my work places insurance policy.

8 months later and I’m still jumping through hoops to try and get this sorted. Twice now the insurance company has “regretfully declined my claim” because I do not have an official diagnosis from my doctors clearly stating what they believe is wrong with me.

I’m at a loose end, unsure what my next step should be.

Obviously, I am working with my doctors to try and get a definitive diagnosis but they’re all more interested in treating my symptoms and trying to get me well enough to return to work. We’ve seen the doctor assigned by the insurance company and his report stated that he couldn’t give “a substantive physical diagnosis” but would expect me to be well enough for a graduated return to work early this year.

This does not only effect me but also E and my extended family as I have had no income since I used up all my leave at work around 6-7 months ago.

Have you experienced these kind of issues with your insurance claims? If so, how did you resolve them?

Do you have any suggestions on what steps I can take to move this forward?

No Comments

  1. jmlol January 6, 2014 at 9:44 am

    You might have to go to a lawyer 🙁

    • Megan S January 6, 2014 at 9:45 am

      You may be right… we’re hoping to avoid that though if we can 🙁

  2. lesterland January 6, 2014 at 10:59 am

    Hope you can find a doc that can give a diagnosis and all. Insurance companies are in business, like all others, to make money. And that means giving away as little money as possible. Yes, you may need a lawyer, but that means s/he will take at least a third of what you get. Of course two thirds is better than nothing. And that assumes a lawyer will take it on contingency, which will depend on whether s/he thinks there is a chance of winning.

    No, life isn’t fair. Sure wish it were.

    • Megan S January 6, 2014 at 11:52 am

      Thanks for the information. I’m going to try and avoid lawyers as long as possible, so we’ll see how we go.

  3. Trisha January 6, 2014 at 11:02 am

    Have you explained the situation to your doctors? I wonder why they’re so hesitant to give you a diagnosis. That must be so frustrating.

    • Megan S January 6, 2014 at 11:53 am

      We’ve tried explaining to the doctors. The problem is half of them don’t believe in ME/CFS as a real diagnosis. Will be talking to my GP again next week about it and see if he’s able to help. The specialists just keep skirting around the issue.

      • Trisha January 6, 2014 at 1:37 pm

        That must be really frustrating. How can they treat you for something they don’t even believe in? I hope your GP will be more cooperative so you can get the insurance thing going. Good luck!

        • Megan S January 6, 2014 at 1:38 pm

          Thanks Trisha 🙂

  4. Fr. Eddie Tatro † January 6, 2014 at 2:12 pm

    *Gentle Hugs* I wish I could add more than all the others Meagan. All I can do is keep you in my prayers.

    • Megan S January 6, 2014 at 2:39 pm

      Thank you Eddie, I’m happy to know I’m in your prayers. 🙂

  5. Claire January 6, 2014 at 4:39 pm

    Oh I’m so sorry that it’s so frustrating for you! I’m applying for insurance myself at the moment, but the issue is that I drove myself into the ground to finish my contract with the school so I could do a handover to the new teacher coming in. Because I didn’t officially quit because of the illness and worked until the end of my contract it’s unlikely that they will pay me.
    The answer seems to be getting a diagnosis, or at least an official form from your doctor stating that the reason you have not worked in so long is because of illness. Even if the future payouts and ability to work are unsure, surely there is enough evidence that there was a medical reason for you to not be working.
    I don’t know what area you are in, but Victoria there is a Dr. Oldmeadow that is a CFS specialist, and did my diagnosis. The GP’s at Blackburn North medical centre are very sceptical about CFS but will confirm a diagnosis of CFS if everything else has been excluded.
    Good luck – the stress of this is the last thing you need right now, but just try to gently persist – I’m sending good vibes your way!

    • Megan S January 6, 2014 at 5:05 pm

      Thanks Claire. I have already provided them with plenty of evidence that I definitely have a medical condition, they just seem to want to find a loophole out of paying. This, I guess, is what you should expect from insurance companies. I’m hoping my GP will be able to help next week. I’m not from Victoria, I’m from the other side of the border. 😉 E has been looking into the possibility of me seeking treatment over there though if we keep struggling here.

  6. Just Another F-Bomb January 6, 2014 at 11:58 pm

    Sorry Megan, I’ve got no words of advice other than to keep fighting back. Insurance companies are in business to make money, not give it away. Good luck to you!

    • Megan S January 7, 2014 at 8:03 am

      Thanks Leslie 🙂

  7. Jumping_Jenny_444 January 7, 2014 at 5:10 am

    I’m sorry to hear that you’re going through a very frustrating situation. 🙁 I know how it feels to have a doctor that doesn’t believe you and thinks it’s other things. Perhaps you can try getting a second opinion from another doctor. I’ll pray for you that everything works out! <3

    • Megan S January 7, 2014 at 8:04 am

      Thanks Jenn, my current GP believes me. I’m just struggling to find a specialist (which is what the insurance company wants).

  8. Life Beyond My Window January 8, 2014 at 10:14 am

    I live in the US and was denied SSDI the first time I applied. I hired a lawyer and won on appeal, but it took 11 months before I received any money. Don’t give up and if you have to hire a lawyer, do it. But you are going to need a conclusive diagnosis. I had to take cognitive functions tests, as well as, see a rheumatologist, pain specialist and a behavioral therapist.

    • Megan S January 8, 2014 at 10:37 am

      Thank you for sharing your experience. We won’t give up and will keep fighting to get the money we’re owed.

  9. someonesideaofluxury January 23, 2014 at 8:43 pm

    Ask your GP for a referral to a rheumatologist, who should be able to give you a diagnosis. My GP referred me to a general physician (a more experienced, in-depth general doctor) who made my diagnosis, but also referred me to a rheumatologist who confirmed it.
    I’m struggling with my employer’s insurer as well, so I sympathise.

    • Megan S January 24, 2014 at 1:22 pm

      Thanks, I’ve finally got a confirmation from a rheumatologist. I’ve sent a letter to the insurance company with the rheumatologist’s letter, so I’m back in the waiting game.

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