CFSAC summarizes the various testimonies that it heard

CFSAC summarizes the testimonies and stories that it heard from patients.
Typical issues that patient face are:
"

1. Deny, Deny, Deny -- Not paying claims, regardless of merit, no matter what proof is provided. It forces the claimant to action when they are too ill to launch an appeal, especially one deliberately undefined.
2. Delay, Delay, Delay -- Holding off payment of claims, partial claims, or legally directed settlements is another strategic tactic
3. Drop, Drop, Drop -- Terminate claims arbitrarily, which forces patients to seek expensive legal counsel and medical documentation for appeal.
4. NOT providing the RULES or governing 'Plan Document', or at least not the appropriate ‘version.’ ERISA levels fines of $100 per day to insurers that delay in providing this basic document, but advocates say that $100 per day is not a sufficient deterrent. They recommend large automatic fines for not complying, and fines should be directed to the claimant (separate from and regardless of the success of the claim).
5. The ‘standard of proof’ is deliberately obfuscated. “Not delineating upfront what DOES constitute proof of disability allows for more abuse of PWC claimants, ‘spin’ placed on facts, and creates an easily manipulatible ‘moving target’, to render claim success impossible.”
6. Habitually ignoring pertinent, objective medical evidence.
7. Paupering the claimant -- (This is a major and frequent complaint of patients and advocacy groups) The LTD Carriers’ MO is to pauper PWC so they don't have the resources to obtain a proper medical diagnosis or medical care. Being impoverished by not receiving LTD, many claimants have to choose between paying for legal representation or paying for medication and medical care.
   
   Paupering the PWC also thwarts retaining legal counsel. Very few lawyers are willing to take on contingency a case where the compensation is minimal yet the effort and time will be made deliberately intensive by the carrier’s vast and well oiled legal machine.
8. Delaying a lawsuit filing can further pauper the claimant. “In one case, even when lawsuit was won by claimant, Carrier appealed, successfully delaying payment.”"

More details here

A patient's story on dealing with ERISA disability issues - testimony before CFSAC

Marly Silverman presents her experience as a part of her testimony before CFSAC .  This is a typical story experienced by various patients.
"The regulations of ERISA are excessive and extremely bureaucratic. They are part of an “administrative process” that uses language or legalese, which is often contradictory and counter-productive to the well being of the claimant, i.e. the individual who is sick or injured.  This administrative process is long, and tiring. One must exhaust all of the steps in the administrative process, before one is allowed to file a suit against the employer/insurance company. By the time one is actually able to do this, personal savings are gone, and a financial crisis of long-term proportion sets in"


It is high time we work together to alter ERISA to create  a win win situation for all sides.

Legislators and government employees are exempt from ERISA

Interesting to know that Legislators and government employees are exempt from the 'protection' offered by ERISA. This way they don't get to know what the private sector workers go through in an unfortunate case of disability. More info here