Day: 01/16/2015

My mental illness

Activity (log)

Created By: Beaudette, Donald
Created Date: 09/09/2014

Response: Doyle, James 09/11/2014

We do not dispute that she remains impaired at this time due to her mental illness.

And what proof does Unum have of my mental illness?  Or that I remain impaired by it?

In the absence of this information, reasonable conclusions cannot be made at this time as to the insured’s continuing entitlement to benefits under the contract, and termination of further benefits on this basis is appropriate.

As noted above, we have previously paid the maximum 24 months of benefits for disabilities due to mental illness. We cannot approve further benefits for the insured’s Major Depressive Disorder and secondary diagnosis of Anxiety Related Disorders as they are considered mental illnesses. The SSA does not limit benefits based on this criterion.

If the claim is being denied for proof of continuing mental illness, then why isn’t Unum requiring that I see a psychiatrist? And why am I required to have an expensive functional (physical) capacity test to prove a mental disability?

I see what Unum has decided to do here… During the appeal process, if I provide their forms signed by a doctor that isn’t qualified to give a mental illness diagnosis, then I haven’t provided the “appropriate” information to reinstate my benefits. If I were to obtain an updated disability status for mental illness, then I can look forward to my benefits being terminated sometime in the future because of the 2-year limitation.

You know, I’m having a hard time following all of this insurance industry talk, besides the fact that every argument by Unum appears to be circular.  I’m sure other insureds have a hard time also. I don’t feel equipped to represent myself when I don’t even understand the language.

And it’s not fair that Unum has a huge corporation behind it to work on my claim, including medical, legal, and insurance experts, while I only have the internet and me.

I’m going to demand a free and impartial advocate, provided by Unum, to assist me in this appeal.  (Don’t laugh.)

Unum working hard to prove that I’m mentally disabled

Activity (log)

Created By: Beaudette, Donald
Created Date: 04/21/2014

Note: it was never communicated to you at the time of re-open liability acceptance in 2007 that benefits due to behavioral health conditions (depression/anxiety) are limited by your policy to 24 months of benefit payments. Physical impairment can run concurrently, which in your case it has, and such benefits are only limited by the maximum duration of your policy, which is age 65.

Physically, it appears you have had years of tx for physical conditions, most notable for pain — fibro, TMJ, neuropathy, etc., which has not been successful…

[Define “success” in treating intractable pain?  I’m still here, aren’t I?]

Advise insured that dependent on responses above—not sure what our next steps will be given no current providers. Policy does require being in reg and appropriate care… though that needs to be medically determined and give your length of tx w/no results, its not clear to me if such would be applicable.

Also–possible we could send you for an IME–that too would have to be determined by our medical staff.

7/18/2014

Based on last medical info received and/or the past medical info and reviews, medical comment is needed in order to determine the necessity for updated APS form and/or to clarify what regular and appropriate care would be for the insured based on her dx’s and cx’s, and what medical benefits would be anticipated from such if the insured were to pursue new/additional treatment.

I don’t find an answer to these questions in the copy of my file.

Self-reported condition limitations

Activity (log)

Notify Date: 06/12/2014

Request: Beaudette, Donald 05/2/2014

CONTRACTUAL OVERVIEW:

No Self Report limit.

http://www.diattorney.com/what-are-self-reported-condition-limitations-in-a-group-long-term-disability-insurance-policy/

What are self reported condition limitations in a group long term disability insurance policy?

A self-reported symptom condition limitation are unfortunately starting to become more prevalent in group disability policies. This limitation is aimed at directly trying to limit usually to a 24-month period certain conditions such as chronic pain, fibromyalgia, chronic fatigue syndrome, and in some policies, they even define to include headaches or migraines.

Stahl v. Unum

Activity (log)

Created by: Beaudette, Donald
Created Date: 07/16/2014

Own occ[upation] appears to be legal secretary which would require exertion of up to 10 lbs, constant sitting, occasional stand/walk and bilateral UE use for frequent reaching, handling, and fingering and constant keyboard use.

So, is that all there is to being a legal secretary? If so, I was overpaid.

1/15/2015, Roadside drug test for cocaine and cannabis given go-ahead

http://www.telegraph.co.uk/news/uknews/crime/11348109/Roadside-drug-test-for-cocaine-and-cannabis-given-go-ahead.html

If the test gives a positive reading officers will take the motorist to a police station for a blood test, which will be used in any prosecution. The Home Office estimates as many as 200 people a year are killed by drivers impaired by drugs.

A new drug driving offence comes into force in March which will introduce a penalty of up to six months’ imprisonment, 12 months’ disqualification and a fine up to £5,000. It sets limits at very low levels for eight illegal drugs – cannabis, cocaine, ecstasy, ketamine, heroin, lysergic acid diethylamide, methylamphetamine and MDMA. Under existing measures anyone suspected of driving under the influence of drugs has to undergo a “field impairment test” by the roadside…

Driving under the influence of cannabis is not anything like driving under the influence of any of these other drugs.  And no testing for prescription medications?  What, just because they’re legal?  If a driver is impaired, it shouldn’t matter which substance is causing the impairment.

In 2009-10 police carried out 223,423 breathalyser tests for alcohol but just 489 field impairment tests. The advent of new equipment to allow quicker and easier drug testing at the roadside is expected to lead to a significant rise in the number of tests carried out. Results are also likely to give for the first time a more accurate picture of the extent of drug driving.

An accurate picture?  Maybe of people driving under the influence of illegal drugs.  But even then, testing positive for a drug doesn’t mean your driving was impaired.

What, does the U.K. want to have a prison system as huge as the one in the U.S.?

1/15/2015, ‘I couldn’t stop’: About 9 percent of marijuana users risk addiction

http://www.thecannabist.co/2014/01/15/couldnt-stop-9-percent-marijuana-user-risk-addiction/26047/#disqus_thread

Under comments:

painkills2 • a few seconds ago

“Alcohol, I believe, is just above the 10 percent range, so of all the people you see who drink, one in 10 have a problem where they lose control or it hurts their lives.”

I find it hard to believe that the addiction risk for alcohol is only 1 percent above that for marijuana. That doesn’t even make sense.

Whenever I read a story about someone with a drug abuse problem, the real problems are usually found in why a person is using drugs, not about which drugs they are using. Self-medication is something you can find all over this country, more so than others because our health care system is so crappy.

The addiction industry can label a person’s drug abuse problems as addiction (more money for them), when in reality, addiction is just one of the symptoms — of whatever problems that person had before picking up a drug.

Why Maple Syrup Is So Damn Expensive (And So Delicious)

http://www.huffingtonpost.com/2015/01/15/intersting-maple-syrup-facts_n_6471346.html

Around 300 different natural flavor compounds have been found in pure maple syrup.  And that’s why imitations will never do. Not all 300 compounds are found in every batch of syrup — it varies in amount between producer and time of year — but nonetheless, maple syrup is one complex flavor.

You can pour maple syrup on snow and EAT IT.  It’s called maple taffy and it’s one of the best things that happens in the winter in the North East. Maple taffy is made by boiling maple sap past the point of syrup, but not so long that it becomes maple butter. Then, it’s poured onto snow where it hardens to be eaten.

The person who makes the maple syrup is called a sugarmaker.  Not a bad title if you ask us. Native Americans were the first sugarmakers and they taught Europeans the process.

Begin rant…

I hate it when a product I use every day changes — that’s because most changes are not for the better.  Case in point:  3M brand Scotch-Brite sponges.  When I opened a new 3-pack the other day, I noticed the sponges felt different.  And now, about 3 days later, my sponge is already starting to fall apart.

I search the packaging to see what the “new and improved” change might be… I mean, maybe it’s an environmental thing… but there’s nothing.  Just these cheap-ass products.

…End rant.

Child-resistant packaging

Although I haven’t researched this issue extensively, what I have read seems to show that using child-resistant packaging is a successful strategy to keep drugs away from young kids.  I’ve also read that strategies are being created to tackle the fact that older kids have no trouble opening a tamper-resistant package or a prescription bottle, illegally accessing drugs. I have a fear that pretty soon, pharmacies will require biometric information before patients can access certain prescription medications.

The New Mexico Department of Health wanted to require biometric information for the Medical Cannabis Program, but so far, that issue has been shelved.

And yet, I have no fear that the government or corporations will start requiring gun buyers to provide biometric information…

Don’t use generic Lyrica for pain, Pfizer warns U.K. providers–or else

http://www.fiercepharma.com/story/dont-use-generic-lyrica-pain-pfizer-warns-uk-providers-or-else/2015-01-15

“Pfizer believes the supply of generic pregabalin for use in the treatment of pain whilst the pain patent remains in force in the U.K. would infringe Pfizer’s patent rights,” the letter states, going on to urge addressees to make sure prescribers know about the pain patent and advise clinicians to prescribe Lyrica by brand when using the drug to treat neuropathic pain.

It’s not just friendly advice. The letter closes with a not-so-veiled threat of legal action. “[I]nstructing or encouraging the usage of generic pregabalin in pain would amount to procurement of patent infringement (an unlawful act),” the letter states. “Pfizer therefore reserves all of its legal rights in this regard.”