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Dr's responses to disablity forms

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  • Dr's responses to disablity forms

    My husband recently had an ICD implanted-5/25/05. He was a truck driver, delivering and installing appliances was also included in his job description. Now, he can no longer do this. According to the DOT, he is disqualified from ever being able to do his job again. However, the insurance company denied him his disability, based on the dr's response to the disability claim form, I am assuming. We found out this past Friday. We told his drs., that the procedure and implant would preclude my husband from ever doing his job/avocation ever again. Did they not listen??? What is our recourse here? We have disability coverage for the car payments, but if what the dr wrote on that form went to the insurance company, no wonder he was denied...it stated that he was only totally disabled while he was in the hospital having the implant done...but the EP dr., on the discharge papers told my husband not to drive for at least a month...any input would be appreciated.

    Thanks, barb

  • #2
    I'm not sure how private insurance companies view disability. I'll be finding that out soon. I just filed with my insurance company at the hospital so we will see.

    As far as social security disability goes. They are very hard to get. As a matter of fact I think it is like 60% that are turned down on the first try. I know I was among those that were. I'm now being told I should go on the transplant list! But, in social security's eyes I am not disabled yet because I can still communicate with people and take care of my daily needs.

    When basing disability they don't base it on your current job. They base it on if there is a job in the national economy that you could theoretically do. It doesn't matter if that job isn't even in your state or that very few positions will accept you. I mean pretty much they told me that if I could talk then I could find a job somewhere where that is all that I have to do.

    Pretty messed up huh?

    Mary S.

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    • #3
      I think SSI disability is denied unless you can't hold any job at all. Is there anything else your husband can do? I know the frustration. My mother has been fighting for disability because she's had cancer off and on for 3-4 years and even just had a bone marrow transplant a month ago. They're still denying her at the moment, although she's appealed. I hope you get some answers soon.

      Reenie
      Reenie

      ****************
      Husband has HCM.
      3 kids - ages 23, 21, & 19. All presently clear of HCM.

      Comment


      • #4
        Re: Dr's responses to disability forms

        I wasn't even looking at Social Security. I went to their web-site and they say they don't pay partial disability. These forms were for short term disability, to cover his income while he is incapacitated. Even the short-term only pays 50% of his weekly income based on a 40 hr. week, which he never worked. I am not sure what our next step is. I would like to know what the dr's told the disability insurance people. I printed off the Federal Motor Carriers health qualifications, stating that drivers with HCM and ICD's are disqualified from driving. We are going to contact the insurance company and find out why he was denied his short term disability...I guess we'll go from there....there's a part of me that wishes we would have never had the implant done..I know it was needed, but the ramifications are enormous.

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        • #5
          I will suggest a few different steps.

          You need to review the policy and see how they define disable. You will want to pay special attention to time - ie if they say you need to be out for 7 days before the policy kicks in or similar language.

          You need to get a copy of the form / letter the doctor sent.

          You need to check your state laws to see what coverage, if any, is available for disability.

          You will likely need to file an appeal, contact the insurance provider and ask for the procedure to do so.

          If you need any more help please call the office.

          Good Luck,
          Lisa
          Knowledge is power ... Stay informed!
          YOU can make a difference - all you have to do is try!

          Dx age 12 current age 46 and counting!
          lost: 5 family members to HCM (SCD, Stroke, CHF)
          Others diagnosed living with HCM (or gene +) include - daughter, niece, nephew, cousin, sister and many many friends!
          Therapy - ICD (implanted 97, 01, 04 and 11, medication
          Currently not obstructed
          Complications - unnecessary pacemaker and stroke (unrelated to each other)

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          • #6
            I'm sorry that I misunderstood which type of disability you meant. I agree with Lisa, check the policy and see how it reads. I hope you get this resolved quickly. Do you live in Missouri or Illinois?

            Reenie
            Reenie

            ****************
            Husband has HCM.
            3 kids - ages 23, 21, & 19. All presently clear of HCM.

            Comment


            • #7
              Re: Dr's responses to disablity forms

              Missouri...I contacted the STD insurance co. They stated they hadn't received medical support for the claim from either of the doctors. I then contacted the ep. His assistant faxed me copies of the letters that were sent between the ep's and cardiologist's office. He also sent me a copy of what was sent to the insurance co...very helpful..
              I then contacted the cardiologists office. What a nightmare! They are saying they aren't responsible for the aftercare of the icd and that the disability should come from the ep...this is ridiculous. Not only that, the cardiologist didn't tell my husband he could no longer do his job, the DOT did!!! Also, that my husband should apply for unemployment. What the heck????!!
              Not only is this wearing me out, it is really aggravating me....

              Comment


              • #8
                Barb,

                It really DOES wear you out, and since many of us have been in similar situations we understand your frustration. When you're dealing with several different doctors and/or specialities, they will often pass the responsibility off to one another because nobody wants to be the one to have to answer for their responses. Meanwhile, the patient is stuck in the middle with no income and no resolution in sight. What are you supposed to do for income while these jokers make up their minds?

                On another note, your husband should not have any problems collecting unemployment compensation if he has filed for it. Due to his HCM diagnosis and ICD implant, he can no longer perform the job he was hired to do. You have the information from the DOT to back you up, as well as the diagnosis from the doctors. He does not have to qualify as being disabled to collect unemployment... he simply must show that he can no longer do that particular job.

                My previous work required heavy lifting and digging which I am no longer permitted to do with the HCM. My unemployment was granted because of this.

                Has your husband been offered another position within the company that does not involve driving or other hazardous activities? His employer does have some responsibility in trying to accomodate the current situation, and if they cannot do this, he should be eligible for unemployment.

                As far as the disability issue goes, like others have said that is rather individual to the particular rules of the insurance company and the state where you reside. I do hope everything starts working out for you soon. Hang in there.

                Jim
                "Some days you're the dog... some days you're the hydrant."

                Comment


                • #9
                  Disability

                  My sister worked for social security, and I worked with a doctor who was on the approval board for social security. When I first got sick they both gave me some good information. They both said 90% of approvals are based on what your doctor writes. Social security has specific guideline's ( anyone can request their handbook). I was just reevaluated in 2004 and had no problem. My sister said that some doctors know how to really fill out the forms and others don't. Sometimes no matter what' they still turn you down but the handbook is very helpful...

                  Karen
                  Karen Cicconetti
                  Heart Transplant 1998
                  Don\'t take your organs to heaven
                  Heaven knows we need them here

                  Comment


                  • #10
                    I remember there is a very important measurement tool that most disability examiners like to see. It was very specific to physical mobility as in bending over , lifting , pushing , pulling , crawling, stooping. It gave categories for how much, how often, how heavy, how long, when, where , how. The restrictions had to be very specific and make reference to short term or permanent, based on the specific condition. This was what the medicare disability board seemed to be interested in and my insurance companies ( life) still send periodic forms of the same to me to forward to my doctor after I do my part. They do ask some of the same questions. They are looking for words like permanent vs temporary . The premiums for my insurances are paid by the disability waivers as long as I am fully disabled; partial disability will not constitite payment of premiums by the disability waiver. My car was the same . When I had payments left at the time of my disability the rider kicked in to make the payments.

                    My doctor lets me fill these forms out and she signs. I enclose a stamped addressed envelope so it moves along faster. I hope this helps. Having policies with disability riders was a foresight some guardian angel must have led me to before my diagnosis. I just wish I had had the same for credit cards.

                    As all of us with HCM know, we go along making our way in life and planning that we will have a bigger piece of the pie as we age and are planning for our old age. All it took was a turn down the road we did not plan to take ... The HCM Road.. to find pretty darn quick that the picture we had painted for our life and that of our family aint necessarily gonna look like the picasso we had planned for ...Right? I quess my advise or approach to the relatives that don't want to get screened... Go get all the insurance and disability riders they can possibly manage and sock as much money as they can away . When it comes to catestrophic events, none of the creditors want the stuff you used the money on when you thought life would be a bowl of cherries.

                    Pam
                    Dx @ 47 with HOCM & HF:11/00
                    Guidant ICD:Mar.01, Recalled/replaced:6/05 w/ Medtronic device
                    Lead failure,replaced 12/06.
                    SF lead recall:07,extracted leads and new device 2012
                    [email protected] Tufts, Boston:10/5/03; age 50. ( [email protected] 240 mmHg ++)
                    Paroxysmal A-Fib: 06-07,2010 controlled w/sotalol dosing
                    Genetic mutation 4/09, mother(d), brother, son, gene+
                    Mother of 3, grandma of 3:Tim,27,Sarah,33w/6 y/o old Sophia, 5 y/o Jack, Laura 34, w/ 5 y/o old Benjamin

                    Comment


                    • #11
                      Hmmm... Although I had never thought of it before, Pam you make me think that maybe my life DOES look rather like a Picasso although I had envisioned something more like the Hudson River School. I guess I am pretty thankful for the Picasso look even if it is a bit chaotic. Within just over one year my husband was forced into early retirment ten years early, my daughter graduated from college, she got married, I quit my job, we moved to China, and I got diagnosed with HCM as well as with a severely degenerated spine and a number of digestive and eye problems. In spite of these, I enjoy life, have a grandbaby on the way, love my students, and am deeply grateful that a combination of pacing, meds, and radioablation have made my HCM much more tolerable than in the past. Go Picasso!

                      Rhoda

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                      • #12
                        Rhoda, you made me laugh. Of course you are correct . My Piccasso is sort of a Pollock version with paint thrown everywhere. However, it still does have many Picasso like qualities. There is very much to be thankfull for in my life as well. Thank you for pointing this out so that I can describe it better. I realize over the last 5 years with HCM diagnosed and treated that even though life is different and more difficult for me, I have learned to see life through alternate vision and I AM WEALTHY in so many ways because of it.

                        Pam
                        Dx @ 47 with HOCM & HF:11/00
                        Guidant ICD:Mar.01, Recalled/replaced:6/05 w/ Medtronic device
                        Lead failure,replaced 12/06.
                        SF lead recall:07,extracted leads and new device 2012
                        [email protected] Tufts, Boston:10/5/03; age 50. ( [email protected] 240 mmHg ++)
                        Paroxysmal A-Fib: 06-07,2010 controlled w/sotalol dosing
                        Genetic mutation 4/09, mother(d), brother, son, gene+
                        Mother of 3, grandma of 3:Tim,27,Sarah,33w/6 y/o old Sophia, 5 y/o Jack, Laura 34, w/ 5 y/o old Benjamin

                        Comment


                        • #13
                          Actually,

                          Now that I think about it right now my life is kinda like the Screamer. Seems like I'm always yelling at some pea brained doctor these days!


                          mary S

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