Work asked me to take STD and now they won't pay

[verysleepyinsc]

I hade been missing about 1 day a week and at first my employer suggested an Intermittent FMLA saying it would protect my job and my absences could not be used against me in my annual reviews.

About 2 month later I was feeling worse and started missing 2-3 days per week. I was sleeping through 4 alarms and usually slept 14+ hours.

I was originally dx with IH in 2003. Scored a 2 on MSLT. Went back to Sleep dr prior to FMLA leave and he had me take 100 mg Provigil at bedtime. He said if this does not work he would try Xyrem. At first Provigil seemed to work but it eventually kept me awake until 4:00 to 5:00 in the am. Stopped taking Provigil and told my GP. He did not understand the Provigil at bedtime.

I have not been back to sleep (dr earliest appt I could get was 11/29) but I have major concerns about taking Xyrem since I live alone. Isn't it paralyzing? In case of fire at least I have a chance of waking up now.

I was out of work on Oct 1st, 2nd & 3rd. When I reported on Oct 4th, I had a meeting with HR. They knew I was going to have Surgery for an incisional hernia in November and asked me to go ahead and take STD. They told me to finish out the day and then have my dr complete short term disability paperwork. I went to my GP since I could not get in with my sleep dr right away.

My GP completed paperwork and submitted. The STD insurance company kept putting off approval of my claim. I had surgery on 11/01. Now they are saying they can not approve the claim because I have not had testing since 2003 and since I was already out of work, they will not pay for the time off due to the surgery either! I am going to appeal but now I have no money and my landlord is calling every day for my Nov rent!

Insurance Co says that HR could not force me to go on STD but I did not feel I was given any choice!!

NOW WHAT AM I GOING TO DO?? ANY SUGGESTIONS??

I do have a Sleep dr appt on 11/29 and a Neuro Consult on 12/05 so maybe they can help me with an appeal. The Insurance Co advised me to wait until I have seen both doctors before I submit new info. because they only allow 2 appeals. This leaves me in a huge mess.

[verysleepyinsc]

Update.

Saw my sleep Dr on 11/29 and he is going to help me with the appeal

Saw Neuro on 12/05 and she had absolutely nothing to add. Said I should just do what the Sleep Dr recommends.

Started taking Xyrem on Dec 7th. Not much change so far. Increasing dosage tonight from 2.25 grams to 3.00 grams.

[Countingsheep]

My first suggestion....

Find a good ERISA lawyer, and try to get a free consult. These guys know the ins and outs of employment law better than anyone.

Second, don't give up, and don't give in... These STD plans are designed to harass you into getting back to work. Honestly. They made my docs fill out paperwork every 3 business days for the full six months of STD coverage I had... I swear, it was only to see if I would give up.

Third, perhaps your doctor can write a convincing statement that there has been no change in your condition, and there is no reason for another full-blown sleep study to justify your symptoms. We shouldn't have to take successive sleep studies every couple years if there is no point!!!! Also, your doc should mention the difficulties finding meds that work for you. (I also have IH, and I'm currently not on any meds - - they don't really help me anyhow).

Talk to the HR rep who told you to go out. Ask him/her to step in on your behalf, and talk to the STD handlers. If you have support, also talk to your former manager. Perhaps they can help you. It's better for them to help you thru' this rough spot smoothly, so you could possibly get back to work in a more timely/peaceful fashion!

GET THINGS IN WRITING!!!!!! Any actions you take could be brought up later. I have been out of work for four years, and one of my attorneys just asked me to show documentation of my inability to work at the end. I had a pile of e-mails showing how I was taking taxis to work, falling asleep in the parking lot, making errors, etc... And, this was backed up by awards and stellar reviews prior to this behavior. It proves I wasn't a purposeful malingerer.

Sorry to ramble. I can imagine your frustrations. I've been there. Let me know if I can be of further assistance...

P.S. Don't be afraid of the Xyrem. It works wonders for a lot of people! There are also other stimulants the docs could try with you if you wanted... There is still a chance you could find a good regimine!

[verysleepyinsc]

I won my appeal after threatening to contact ABC News. This was a CIGNA STD claim.

I went back to work 12/19/07 because I had run out of money and this appeal was not received until July 2008.

In June 2008, I missed work for 9 straight days. Slept through all alarms again and XYREM wasn't working. My Employer stated I had to file a STD claim since i missed more than 7 days. We had new STD insurance co (Met Life) and they approved my claim within days. I used this information in my Appeal to CIGNA.

In August 2008, I missed 5 straight days of work. Again the XYREM stopped working. The Dr. increased dosage again. 4.5 grams on first dose and 3.75 on second. Two days after I went back to work with an excuse I was called to HR and terminated.

I am now extremely worried. Xyrem just isn't working. I lay there and have crazy thoughts running through my head but I do not go to sleep. Sometimes, I find myself exhaling loudly and realize I was holding my breath!! Othertimes, my thoughts turn to the problems I am facing (monetary - I am probably going to be homeless) and I end up crying and I can not control my emotions.

I am single (never married) and middle aged (4. I have several pets that depend on me (4 cats & 1 dog). I was almost evicted when I was fighting for STD in 2007 with CIGNA and I know my landlord will kick me out immediately if I can't pay my rent. COBRA is 435.00 per month and there is no way I can pay for this. i only have enough for 2 months rent.

I am extremely worried. I contacted by Sleep Dr and of course they want me to come in for an appt to discuss problems. I really can't afford the cost but I guess I have no choice. The attorney i contacted wants me to see is they will say I am totally disabled so he can file a retroactive LTD claim. Based on posts here and my STD experience it looks like that could take to long to help me.

Oh well, I guess there are a lot of people in the same boat as I am.

[Countingsheep]

Oh brother... what a mess. My LTD carrier is CIGNA. They paid me for two years, then cut me off. I've been fighting them for years, and they just decided to reinstate me. What a joke. That was almost six months ago, and they STILL haven't paid, so now I'm suing them anyhow... I assume you saw the Good Morning America stories trashing CIGNA? Here is a link:

http://abcnews.go.com/GMA/Story?id=4724106&page=1

Yes, it can be a long battle to get the benefits we deserve. And, only those with the financial resources and support systems (or generous attornies) to fight, are able to go up against these monsters.

Listen to your attorney. Sounds like a good one. If you aren't well, a good disability attorney is a gift. I lean on mine HEAVILY, as I don't have the energy to fight. They do it for me.

Do you still have family that could help you in your time of need?

By the way, you should IMMEDIATELY apply for social security disability! That way, even if LTD benefits don't come through, you will have another possibility for financial and medical support. Ask your attorney if they handle it, or if they have a recommendation for a social security attorney.

I'm so sorry you are going through this. Believe me, I get it. It's unbelievable what these insurance companies try to pull. I truly believe they can be pure evil.

[LexiFaye]

I know this is an old posting, but now I'm terrified because my manager came to me and told me it was time to think about STD..... I have N, Fibro, Depression, Anxiety, PTSD.

Any advice on the first steps? I am going to fill the paper work out, but now I'm terrified. AETNA handles long term, but my own company administers the short term...

Please. someone give me some hope!

[Countingsheep]

LexiFaye,

Most important question, do YOU think you need to go out on disability? Are your symptoms interfering with your ability to perform your job? I don't know you, so sorry if you've already rehashed this elsewhere on the site.

Also, do your doctor(s) support your disability? You MUST have a doctor's support, or this won't go further.

Your manager probably thought he/she was doing you a favor. BUT, I bet HR would be really pissed. Get your manager to put something in writing if he will. The HR side may possibly work against you. Their job is to have every position filled.

My manager made the same suggestion to me six years ago. The company did everything they could to get me back in the job. In fact, I went out on short term, then I DID go back for a few weeks before going out for good again. During my short term disability, they pestered my doctors about twice a week, even tho' there was no change. When I finally went on long term disability, it was even a bigger battle.

There is light at the end of the tunnel. So, be hopeful. Just try to get as educated as you can manage. Trust me, it's good to make smart decisions up front. And, I know, this isn't easy when you are just too sleepy to care.

Write again if I can be of assistance.
-sheep

[LexiFaye]

It's the meds on and off. I can't smile any more which they have told me is a huge problem. Everyone here is so damn concerened but they do nothing. I'm at the end of my rope. Itls the fibro the depression the anxiety the PTSD itls all spinning out of control and I fell like I am losing it competely. With no help. All alone... no friends. They seemed to have disappeared my family doesnlt want to understand.

[Countingsheep]

I get it. I had such a hard time with the meds, I'm now med-free. Of course, that means I sleep. A lot. But that beat my alternatives. Is your doc supporting you? If so, some time off work might be the best thing for you.