I found this internet post unexpectedly while doing some web surfing today. This is what happens when people can’t work, not won’t work, but can not work because of a health crisis in America, and I don’t think it’s an uncommon occurrence these days:
I have worried and worried about posting this, but decided, in the end, to do so. I was forced from my Paramedic job last year due to disability. My lawyers are handling this, but it could be up to two years before the government decides if I get disability or not. I had to close my tattoo shop due to this disability. (COPD, CHF).The problem is, I am a recluse in my small town and have no friends, nor any family. I did manage to get food stamps, but no monetary assistence. The problem is, I have Dogs I have to feed and proprty tax to pay or I lose my house…plus several other things that I need money to pay, main thing at this moment being heat.
I have always considered the denizens of the JD my family, so I swallow my large chunk of pride and come here.I don’t want any of you to consider this begging, even though it so clearly is, but I know nothing else to do. I have been everywhere and done everything I can do. There just ain’t much out there by way of help for a 64 year old dyke with a lot of pencils. I can’t sell my computer, because it is the only outlet and link that I have…that would kill me. It’s an old one, anyway.
So…and this is so hard for me…if any of you could afford a small contribution so I could feed my dogs and the tax man, it would be beyond appreciated. I will pay you all back whenever I get my first disability check, I swear it. This is KILLING me to ask. But if you can, please send it to:
Tammy T. Peaden
121 Burrus Place
Tarboro, NC
27886
PH # 252-823-2563I thank all of you in advance for anything you can do, even if it is only a prayer. And please forgive me for the audacity to ask; I simply had to try every door I knew. Thank you guys for listening.
I don’t know Tammy personally, but I have read some of her poetry before and it is very good in my opinion. Here’s one award winning poem of hers (scroll down). I can’t vouch for her claims, but since I know of her writing, I thought I would pass this along. Since she posted this on an open board, I don’t think she’ll mind.
The larger issue is that today, there are thousands of people like her, who cannot work but who have to fight to get their disability claims approved. It shouldn’t have to be that way. In a decent, civilized society it wouldn’t be necessary. You wouldn’t have insurance companies that can deny your health benefit and disability claims based on nothing more than the sheer desire to maintain high profits. I speak from personal experience. My disability claim against a major insurance company was denied, not because I wasn’t disabled but because I couldn’t prove, as a matter of law that the insurance company had acted “arbitrarily and capriciously” in denying my claim.
Any time an insurance disability policy is part of an employee benefit package, it is regulated by federal ERISA regulations. When an insurance policy is purchased privately by a person through an independent insurance agent, these policies are not governed by federal ERISA regulations. When a disability benefit is governed by ERISA, the procedural rules governing a lawsuit for benefits are slanted heavily in favor of the insurance company.
When filing a claim for benefits under an ERISA disability insurance policy, it is imperative that the appropriate steps and procedures be taken in the case. Unlike other lawsuits where a claimant will have the opportunity to come to court to provide proof that they are disabled, in an ERISA disability case there is no trial. ERISA disability insurance cases end up in Federal Court where the court reviews the decision of the insurance company under an arbitrary and capricious standard.
When a court reviews a decision under an arbitrary and capricious standard, the court reviews the insurance company’s file to determine whether the insurance company abused it’s discretion. In the typical claim for benefits under a disability insurance policy, unless the claimant takes appropriate action, the insurance file will contain very little information in support of the application and overwhelming evidence that supports a denial of the application.
Essentially, disability insurance companies have put together a business plan that maximizes premiums and minimizes the payments of benefits to the people covered under those insurance policies. The standard claim process provides for a certification by the person’s treating physician that they are unable to perform their previous occupation. Typical forms that the physician is asked to fill out are one to three pages long and provide very little information regarding the claimant or his/her claim. Typically, an insurance company will ask for one years worth of medical records and then review this information to determine whether benefits should be paid. It is common for these companies to hire outside physicians to read these records and then write lengthy reports in support of a denial.
Despite the abundance of evidence demonstrating my inability to work, the insurance company met that standard by sending my medical records to a medical doctor I never met, and based on his review, he declared that I was not disabled. When we took the case to federal court, it was dismissed on summary judgment.
The presiding Federal District Court Judge wrote that despite there being credible evidence that I might indeed be disabled, he couldn’t rule that the insurance company had acted in violation of the “arbitrary and capricious” standard in denying me benefits under the disability policy I had contributed to as a partner in my law firm because that one doctor who the insurance company employed had given his opinion that I was not. I was advised not to even bother applying for Social Security Disability because the denial of my claim by the Insurance Company and my lack of a definitive diagnosis would likely have resulted in denial of SSD benefits. In fact, as of 2005, only 52% of disability claims filed for SSDI benefits were approved by the Federal Government, a startling low number. Yet by 2008 the approval percentage had fallen even lower, to 38% of all claims filed.
Over the past 10 years, SSDI benefits rose dramatically by 98%, even as the percentage of applications approved dropped from 52% in 1998 to 38% in 2008.
Imagine that. You can’t work because you’re disabled, but you have almost no chance of getting approved for benefits if you are covered under your employer’s defined benefit plan, and less than a 2 in 5 chances of being approved for benefits from the Federal Government. Even assuming some cases of fraud, you can’t tell me that all those people who are being denied benefits are trying to scam the private insurance companies and the Feds. If my wife hadn’t been employed at the time, I would have been without any health insurance, and been forced to declare bankruptcy and apply for Medicaid. Assuming I would have qualified for that, which is no given.
I don’t blame Tammy (and I imagine many others similarly situated who are out there) for humbling herself to beg for her daily bread. What other options do we give people in such dire straits? Today, I saw in a coffee shop a poster for a benefit by a Boy Scout Troop for a young man with brain cancer, to help cover the costs of medical expenses not covered by insurance. That’s the America we live in, one in which the unfortunate must hope and pray for the kindness of strangers to come to their rescue. Help, which for most of them, never arrives.
So, all you healthy people who think you have adequate insurance in case of a catastrophic medical illness or disabilty, think again. What happened to me, to Tammy and to many others in every state in this union of ours could easily happen to you.
