In the animal world the Omega Pup is the one which gets picked-on and abused by all the other dogs in the pack. If you don't want your insurance company to treat you like an omega pup, then start acting like the alpha dog in the pack. Snarl and snap and let the company know that if they decide to pick on you they will get a vicious fight.
There are two times to snarl. The first is after you are approved for LTD and begin to get payments. Begin snarling when you receive your first notice that you are going to be sent on an IME. Snarling here might keep you from having to snarl because your payments were cut, which is the second snarl point. Some snapping and biting isn't out of order at this stage. Maybe give 'em the old Tyson love bite. Note: if your original claim was denied, use the same strategy as you would for an approved claim which was terminated.
Why do you have to do this? Because under the Employee Retirement and Income Security Act of 1974 (ERISA) the game is rigged by Congress and the Courts and the rules are strongly biased toward your disability insurance company. So, you must level the playing field, and you have to do it before the overtime period, which is the lawsuit.
It is our contention that if you take steps to ERISA-Proof your insurance claim before you must file a lawsuit for commencement or restoration of your benefits, you'll be treated fairly by the company and you won't have a need to sue. However, if you are compliant and quiet, the odds are you will get the Omega Pup treatment, and when you finally decide to fight you'll have no chance to win because of the screwy ERISA case law.
So how do you snarl?
First remember that EVERY document you send to your insurance company should be sent "Certified Mail, return receipt." When the receipt comes back, secure it to the document (or letter of transmittal) which was sent. Always keep copies of everything you send in, and written notes (or a tape recording if allowable in your state) of every conversation you have with your insurer. Date your record and log it into your calendar on that date. Remember, they don't play fair and can be EXPECTED to lose documents, forget conversations, lie, etc. "Oh come on" you say. Well, hey, maybe your insurer will play fair with you. Do you want to bet your future on it?
Get EVIDENCE into your files. You basically have to "investigate" your own claim. Your insurer WILL NOT -- it will only pretend to do so, acquiring the minimum amount of information it thinks it needs to justify denying your claim.
Get copies of YOUR ENTIRE MEDICAL RECORDS FROM ALL OF YOUR DOCTORS WHO SUPPORT YOUR CLAIM AND SEND THEM IN. In case after case, the insurer hasn't even bothered to get the complete medical records prior to either paying OR DENYING a claim.
Ask EACH OF YOUR DOCTORS TO WRITE A COMPREHENSIVE LETTER OUTLINING your diagnosis, YOUR LIMITATIONS, why it is disabling. Avoid absolutes, like saying you can only sit for "20 minutes" without getting dizzy. The doctors reports must be truthful (i.e. your symptoms are HIGHLY VARIABLE - some days you can sit or stand for several hours, some days you can't get out of bed without getting dizzy). This will avoid the problem of having private investigators (PI's) videotape you for 30 minutes and claim you were exaggerating.
Make lists of your symptoms and submit them on a periodic basis to your insurer. GIVE THEM INFORMATION, FORCE THEM TO TAKE IT, DOCUMENT that you tried to get them to put it in your files and consider it.
Make sure you see a doctor regularly, about 3-4 times per year. IF YOU HAVE A CHRONIC DISABLING CONDITION, THIS IS CERTAINLY REASONABLE. Your "Physician" could include a chiropractor (D.C.), Naturopathic Physician (N.P.), and even a doctor of Chinese Medicine, if properly credentialled in your state. If you go for regular massage therapy, take vitamins and herbs recommended by your members of your medical support team and/or your CFS/FMS support group, etc. then tell your primary care physician what you are taking. Also, try to get your primary care physician, often an internist or endocrinologist but possibly a rheumotologist if you have FMS, to be your "medical support team coordinator" and refer you to these other folks just mentioned, if possible. Otherwise, just tell him/her who you are seeing, what they are asking you to do or to take, and what the results have been.
Get statements from people who know you, coworkers, spouses, friends that you've been sick, that they knew you when you were well, that you have been having to cancel your social life. If you wait to get these statements into your records until after you are denied or terminated, the COURT MAY NOT HAVE TO CONSIDER THEM. Plus it will be more difficult to get them. (A disabled doctor's former employer's lawyer has told her she can't talk to her former co-workers because she filed a complaint against the hospital for discrimination.) Get these statements ASAP, notarized if possible. Then SEND THEM TO YOUR INSURER TO PUT INTO YOUR FILES. Will your insurer harass the people you use as witnesses? Maybe. But more likely they will LEAVE YOU ALONE, PAY YOUR CLAIM, and go on to more vulnerable, less astute claimants (omega pups) who haven't ERISA-PROOFED their records.
Here's a sample letter to send in with your copious submissions:
Your Address
The Date
Your Disability Income Insurer (Whoever handles your claim)
Your insurer's address
RE: ERISA Rights Submission, Claim Number xxxxxxxxxxx
Dear Insurer,
The implications of ERISA regarding my rights if you should breach your contract with me have come to my attention. You have failed in your fiduciary duty to inform me that if my claim for benefits is wrongly terminated or denied, only records in the possession of the insurer might be able to be admitted to court. This information is not in the Summary Plan Description provided by my employer, nor was it provided to me at or since the time I became disabled and filed my claim for disability benefits under the terms of the welfare benefit plan offered by my employer.
Therefore, for my own self-protection, I INSIST that you place ALL OF THE FOLLOWING MATERIAL INTO my CLAIMS FILE, ADMINISTRATIVE RECORDS, or whatever you call the record that would be submitted to the court should you terminate or deny my benefits. Even though much of this information is not about ME specifically, it points to a clear pattern and practice by insurance companies against claimants, and if you use these same tactics against me it would pertain to me. I have no way of know if you will or will not use these tactics against me, therefore I have no choice but to assume you might and protect myself by insisting you place this information into my permanent record.
Enclosed in this package are: (Then list what you are submitting):
Please understand that I am not accusing you of anything improper, I am just protecting myself as I must under the current ERISA litigation climate.
Sincerely,
Your Name
cc: Your former employer's legal department (with the notation "without enclosures")