Denied Short-Term Disability Benefits

Sweetwater TNYou almost have to be on your deathbed to collect short-term disability benefits from some insurance companies, as Robbie and her fiancé Ben discovered.

Ben says he can’t count the number of times he had to drive Robbie to emergency to get some pain relief. “Robbie had scar tissue on her uterus that caused severe pain and bleeding to the point where she couldn’t move,” says Ben. “I would have to carry her into hospital to get an injection of pain meds and she would be alright for a day or so, until the drug wore off.”

Ben says that Robbie, in her mid-30s, suffers from extreme PMS. Her periods were hell - heaving bleeding for several days. Her doctor advised a hysterectomy and Robbie was scheduled for surgery this past March. At that time she gave her employer a note from her doctor, which said that she couldn’t lift anything more than 10 pounds. Robbie is a certified nursing assistant so this directive put her job in jeopardy - she couldn’t lift anything so she couldn’t work. Her employer put her on FMLA but there was a glitch.

In early March, Robbie and Ben found out that their insurance company wouldn’t pay for the surgery. Apparently the hospital wouldn’t be able to accept Robbie so she had to find another doctor and another hospital. Not only did the insurance company deny surgery, it also denied her claim for short-term disability (STD) benefits.

It wasn’t until June before Robbie was slated for surgery. Meanwhile, she was unable to work and hadn’t collected a dime from Lincoln, her health insurer. Her insurance rep said that they wouldn’t pay short-term benefits until she had her hysterectomy. That was one small snippet of good faith: Robbie received a check that covered STD from the day of her surgery until July 17. Then nothing.

“We called Lincoln and got the run-around,” Ben explains “They tell us to call this person, that person says call someone else. Robbie then had to send another doctor’s note to the insurance company and we still don’t know if she will get benefits after July 17th.

“Robbie’s employer called her last week to let her know that her FMLA ran out and they could no longer hold her position. In other words, she was fired. They had already extended the FMLA four more weeks. Her supervisor did say that that once the doctor releases her she can re-apply for her job, which should be in another two weeks.”

Meanwhile, Robbie doesn’t know if the insurance company has acted in bad faith or if she will get another disability check. “At this point we don’t know if she has been cut off or not and she doesn’t know if she has a job. We have no extra money - my job pays just enough to cover our bills.

“We are asking an attorney to help with our claim so that Robbie is compensated for what is rightfully hers: she should be paid disability from March up until her surgery.”