Thursday, September 7, 2006

The Patient Strikes Back

This morning I faxed in my Disability benefit reassessment paperwork. Under a negotiated settlement with the State of California insurance commissioner, and both individual and mutual settlements with all 50 states, UNUM is required to reassess all CFS/fibromyalgia claims which were previously denied.

In my case, the initial claim was not denied because my diagnosis was CFS, but because the doctor’s written report giving the diagnosis and findings was typed on the doctor’s letterhead and not on the UNUM form. I have it on good authority from several insurance lawyers that this is bad faith.

They had my information handwritten on their forms, and a detailed typed report from the doctor giving far more information than would have fit on their form. Clearly, all the information they requested was there, it was the form in which it was given to them that was objectionable.

Since they required me to sign a statement that I am aware of the penalties for insurance fraud, I sent them a statement that I require them to sign stating that they are aware of the penalties for bad faith, and acknowledging that they have already paid substantial judgments, verdicts and settlements for doing exactly the same thing to other policyholders.  I think I will send this statement to them to sign every time they ask me to sign a statement saying that I'm aware of the penalties for fraud. 

I also sent them a copy of the negotiated settlement so that they know that I know my legal rights and will think twice about turning me down again.

In fact, their own doctor, whom they expected to certify that I was fully capable of returning to work, started off his examination by commenting that he couldn’t find what I had been prescribed by the rheumatologists for pain. I assured him that he didn’t see it in the medical records because they had not prescribed anything for pain, stubbornly insisting that the anti-depressants (which didn’t help in the least) would take care of the pain. His assessment was that their refusal to prescribe sleeping pills and pain pills, instead of anti-depressants which made me sicker, had resulted in my deteriorating too far to ever fully recuperate. Instead of telling UNUM that I could return to work immediately, he reported back that the best we could ever hope for was to eventually return half-time, but at the time, I wasn’t even up to that much.

Iatrogenic (doctor-caused) problems are the third leading cause of death in the US.  Thankfully, in my case, they didn't manage to kill me -- I'm too tough for that -- but they did cause me lifelong problems by insisting on treating me for depression I don't have, while ignoring my heartfelt pleas for sleeping pills and pain pills. 

If I'd gotten the sleeping pills early on, I might have recovered and gone back to work full-time, with only slightly more problems than I'd had from 1988-1999.  Instead, I basically went without sleep for 4 years until I got into the sleeping pill clinical trial.  Although it won't show up on a blood test (which is why they couldn't find anything), there's now physical damage caused by the lack of recuperative sleep, which means I'll never work full-time again, and will probably always have chronic pain due to physical changes to the central nervous system caused by unrelieved pain.

Since this is the opinion of UNUM's own doctor, I make sure to remind them of it on a regular basis -- the problem is not that I don't want to work, but that a series of doctors prescribed the wrong things, even when I told them what the right thing was.  Unfortunately, I couldn't turn back the clock and get to the right doctor before the damage was done.  I thought I was going to the best doctors, who advertised "innovative treatment" and their reputation as a research facility.  Little did I know that they only do research and innovative treatment into those things that will get them worldwide headlines; their history with treating chronic systemic illnesses is abysmal because they are 20 years behind the times on their knowledge of those things they aren't researching.