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Legalease
Legalease, Lawyer
Category: Legal
Satisfied Customers: 14573
Experience:  15 years exp all aspects of general law
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I am really upset and cannot fall asleep due to an issue that

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I am really upset and cannot fall asleep due to an issue that I am having a really hard time with. I work for a large bank that employs tens of thousands of people. I have a great reputation at work and I have never been reprimanded whatsoever. In the last three weeks, my life has been a mess because I was relying on my company to support me in my time of need and that is not happening. I have bipolar disorder and have been taking medications for many years for it. I have never taken disability for it however. I have been going to the same psychiatrist for almost a decade now. I just experienced my father going through chemotherapy for advanced cancer. I really have experienced a wave of depression like no other in the past three weeks. I foled for short term disability with Aetna. My doctor submitted paperwork to them, literally the day after I filed. The Aetna rep stated that my disability is not severe enough to warrant being on disability for a month so I can seek out therapy and get some much needed rest. I called them on multiple occasions, to see if there was anything I could provide them with and they stated that there was not. Now, today, finally after two weeks of receiving no phone calls from them, even after I practically called them daily...they leave me a voicemail stating that they are declining my claim. I was absolutely distressed and worried. What am I going to tell my boss? I requested an appeal today, went back to the doctor, and he filled out another round of paperwork for Aetna. I am really afraid that I am basically going to be turned down again. My husband is an attorney, but he handles a completely different type of law. He is really upset that I have been treated this way when I am legitimately ill and going through a very hard time. We talked about it tonight, and I am not sure at what point do I bring an attorney into this. I can promise you that I did everything by the book and I am really a wreck right now because I cannot believe this is happening. I pay the maximums out monthly for the best insurance from my work, including long term disability, and I feel like I cannot even depend on my own company to take care of me. What do I do???
Submitted: 2 years ago.
Category: Legal
Expert:  Legalease replied 2 years ago.

Hello there

 

While I am sorry to hear about this, I am not surprised. You see, all insurance companies, whether they are worker's compensation insurers or short or long-term disability insurers fight claims of workers who are taken out of work due to mental health issues tooth and nail. Your case is not unusual and you can find volumes of information on line about these issues. Unlike physical injuries where the insurance companies can monitor and gage the condition of the employee and work on getting them back to work as soon as possible, mental health conditions are much more difficult for them to keep track of and determine when an employee should return to work -- so they pretty much deny 99% of mental health claims that come across their desks because they maintain the attitudes that anyone who is pulled from work should not be doing the job if it stresses them out so badly OR you are faking it to get yourself a vacation (I do not feel this way so I don't want you to get angry at me for telling you this -- but I am just imparting to you the prevailing thinking of these insurers when it comes to mental health disability claims). If you do nothing about this and return to work after a few weeks, they will most likely start treating you differently at work also and you will suddenly start getting passed over for the good shifts and for bonuses and promotions. I do not know what your husband does as a lawyer but I am surprised that he was not more aware of this prevailing thinking when it comes to insurers and mental health disability claims. In any event, to continue going through the company and appealing this will be completely fruitless and this is the time that you go and speak with a lawyer who specializes in disability insurance claims -- the lawyer can pursue the insurance company on a bad faith failure to pay benefits that you legitimately paid for and in the face of a lawsuit from you the company will most likely pay the claim for the month or two that you are out of work. However, if you go back to work after hiring an attorney and suing them, your life will be worse and they will run you out of the company so subtly that you will not have much to pursue them for on a wrongful termination claim if/when it happens. My suggestion is that you speak with a local lawyer who specializes in disability insurance claims -- if your husband does not know anyone then you can contact your local county bar association and ask for a referral and they will be able to give you several names of lawyers to speak with. Even if you decide not to pursue this with a lawyer you can still speak with one and get some insights into your treatment by the insurer and the company and you can have the lawyer on notice in the event that you want to pursue this matter into the courts. I wish I had better news for you, but unless you are a member of a union or have a written employment contract with a company then you are an employee "at will" which means that an employer can hire, fire, promote, demote, etc at their own whim or "at will" and unless you can prove that the company or the insurance company is discriminating against you due to race, gender, age (over 40), disabiity, religion or sexual orientation then there is very little you can do about the way that you are treated by an employer. You also need to be careful not to stay out of work too long if you do not want to lose your job -- under the Family Medical Leave Act (FMLA) any employee who has been with an employer for a year or more can take up to 12 weeks off in a calendar year (either in one block or in intermittent days and weeks), but when the 12 weeks is up the employer can terminate the employee and that is whether the employee is out of work on a work related injury or a outside injury or illness -- it includes all types of absences and unless the company has a different policy that it has voluntarily adopted, the employees sick time and personal days can be included in this 12 weeks by the employer (so you do not get additional time above the 12 weeks using sick or personal time -- all of it is rolled into the 12 weeks so that the max in a one year period is 12 weeks). Once the 12 weeks is over, it is up to the employer whether to terminate you or demote you to another position with different pay or to keep your job open. The employment and disability insurance laws are simply brutal to the employee. So, you should speak with a local attorney and then proceed with caution from there. You will have to decide what you want to do here in consultation with a lawyer.

 

--MARY

 

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--MARY

 

Legalease, Lawyer
Category: Legal
Satisfied Customers: 14573
Experience: 15 years exp all aspects of general law
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