Disability Claims for Idiopathic Hypersomnia – Part II

Disability Claims for Idiopathic Hypersomnia - Part II

If you haven’t already read Part I of my saga (i.e. trying to get my disability claims approved for my Idiopathic Hypersomnia), head on over here first: Disability Claims for Idiopathic Hypersomnia – Part I

Related:

We left off Part I with my Case Manager denying my Short-Term Disability claim because the “Medical documentation does not support total disability from the job demands”. This seemed a little silly to me – how does someone continue to work in a fast-paced, high pressure work environment when you are suffering from both insomnia and idiopathic hypersomnia concurrently for an extended period of time?!

In any case, the Case Manager’s last email to me on December 23, 2013 allowed me to file an appeal, due by January 22, 2014.

Disability Claims for Idiopathic Hypersomnia – Part II


Appeal email to Case Manager

January 3, 2014

Hi [Case Manager],

As mentioned in my previous email, attached is the detailed letter from my doctor. Please advise if any other information would be required for the appeal.

Thanks,

[Ulyana]


Second letter from my family physician

January 2, 2014

To Whom it May Concern:

Re: [Ulyana Frank, Date of Birth, Age: 25]

Please find below a summary of the symptoms that [Ulyana Frank] experienced during April 2013 – November 2013 relating to her work and family stress.

  • Patient noted that when she had new boss in April 2013 was when stress started to occur
  • Weight dropped from 120 lbs to 102 lbs around summer over the four months, now eating better and weight has stabilized around 106 lbs
  • Stress worsened in June 2013 when she and colleague had to support another department in addition to the one she supported in the past
  • Was working long hours, leaving house around 7 am and only returning home around 7-8 pm
  • In addition to hypersomnolence, was having more fatigue and difficulty remembering tasks and concentrating
  • Stress worsened in October/November when personal stressors also started to escalate – wedding planning, communication issues with fiance and family
  • in early November, started to have insomnia, only sleeping 3-5 hours daily despite not having naps during day
  • Lack of sleep worsened concentration difficulty and appetite; felt nauseous and vomited few times
  • Extreme daytime fatigue and restlessness worsened consequently
  • Was crying at times without obvious triggers, getting frustrated at fiance and family, also having frustrations at work with boss
  • Found low energy level affecting even simple tasks at work and at home, + psychomotor retardation “everything was moving fast while I was slow”
  • Found difficulty coping with tasks at work, which involved +concentration for writing articles; low motivation in general
  • Now, feeling better after having stress leave over past few weeks; sleeping better, energy level improved significantly
  • Concentration at work and at home also improved

If you have any further questions or concerns, I would be glad to offer assistance.

Yours truly,

[Family Doctor]


Reply from Case Manager

January 6, 2014

Hello [Ulyana],

This information has been received and I will update you further once your file has been reviewed by our appeal team.

Thank you.

[Case Manager]


Reply to Case Manager

January 6, 2014

Thank you [Case Manager]. I hope you had a great Christmas and New Year!

[Ulyana]


Second Short-Term Disability Decision: Denied

January 9, 2014

Good afternoon [Ulyana],

As discussed, attached is a letter regarding the status of your appeal.

Thank you,

[Case Manager]

Attached letter of denial:

09 January 2014

Dear Ms. [Frank]:

Re: Your Short Term Disability Benefit Claim Appeal

[Employer] has engaged [Benefits Provider] to review employee absences to determine eligibility for income replacement through Short Term Disability (STD) benefits. In order to be eligible for STD benefits, [Benefits Provider] must receive information that demonstrates your total inability to work as per [Employer] STD Policy.

[Benefits Provider] has received your request to appeal the original non-support decision of your STD benefits. After reviewing all of the information provided for your appeal the non-support decision for STD benefits has been maintained. As a result, your STD benefits will not be re-instated.

We have received and reviewed the following documentation:

1. Letter from [Family Doctor] dated 02Jan2014

The medical information did not support your absence from work from 28Nov2013 for the following reasons:

  • The medical information does not support the severity of symptoms and/or a diagnosis that are preventing you from performing your job duties
  • Although some symptoms were reported the medical information does not outline any severity or frequency of symptoms or restrictions or limitations that would have prevented you from continuing to performing your full duties. There is no information to indication [sic] you had a severe and persistent psychiatric disability [emphasis added – I never claimed to have a psychiatric disability!] that prevented you from working.

We are aware that [Employer] endeavours to provide a safe and supportive work environment. As such, your Manager and/or your Return to Work Advisor remain available to to discuss your return to work options. If you have any questions about the impact of the non-support decision on your pay, please contact the HR Support Centre at [telephone number].

Your Case Manager remains your primary point of contact with respect to your STD claim. If you have any questions or concerns, please do not hesitate to contact your Case Manager, at [telephone number] or by email at [email address].

Sincerely,

[Disability Specialist]

[Benefits Provider] Appeal Team


Email to Case Manager

January 14, 2014

Hi [Case Manager],

As mentioned during our conversation, I plan to re-appeal the decision.

Thanks,

[Ulyana]


Email from Case Manager

January 15, 2014

Hello [Ulyana],

Thank you for this confirmation. We will await the additional medical information for your second level appeal by the due date of February 8.

Thank you.

[Case Manager]


Email to Case Manager

January 27, 2014

Hi [Case Manager],

Is it possible to request an extension of the due date? I have a condo closing next week and was also in a car accident on Friday, so we’re trying to deal with the insurance companies now.

Thanks,

[Ulyana]


Email from Case Manager

January 28, 2014

Hello [Ulyana]

Although I understand your situation noted below, I would still strongly encourage you to provide the additional medical information for your second appeal by the due date of February 8. Your file will remain closed until this information is received.

Thank you.

[Case Manager]


Venting email to high school girlfriends

(This isn’t part of the appeal process, but it’s a raw look into the emotions and challenges I was experiencing at the time, how devastating the entire process had been and how one simple denial sent me spiraling down into a deep depression.)

I am so beyond exhausted. [Mr. Unchained – then fiance] literally has to catch me from falling over when we’re out.
I’m not sure if I told you girls but in nov/dec, my dr. ordered a 3 week medical leave. Complicated, but mainly it was I was so stressed at work + with the wedding that I was getting super anxious to the point of insomnia. Insomnia is bad enough as it is, but give that to someone who’s narcoleptic [I call it narcolepsy for simplicity’s sake] and you’ve got yourself a foolproof recipe for disaster!
After my leave I returned to work (oh and my amazing boss gave me my annual review and rated me low on accountability and communication because I should have communicated that I was overwhelmed because those were the most stressful weeks of her entire career. Keep in mind all my dr’s note said was leave for medical reasons and she so kindly presumed I did it because I was overwhelmed with work!!! Then when I mentioned it to her she pretends she has no idea what I’m talking about and says “I’m in my 40’s and have been here for 17 yrs! I’m smarter than that to make assumptions like that! What you’re feeling is just guilt for leaving work.” …. right.) I submitted my medical papers for my leave and shortly after I get a call saying it’s been DECLINED because the medical evidence doesn’t support that I needed to be off!!
So my dr is like WTF and writes a TWO PAGE REPORT and we submit it.
Then I get another call saying it’s still denied because some BS about it not showing the severity of my symptoms and no proof of psychiatric disability.
Ugh, if you knew anything about ANYTHING, you’d know a) it wasn’t a psychiatric disability I was claiming and b) how debilitating narcolepsy is c) how debilitating insomnia is and d) how much worse they must be if you have BOTH SIMULTANEOUSLY.
I was pretty upset when she called to let me know and it really hit me so hard that day that this is my condition, this is never going to get better, I’m not only going to have to live with this for the rest of my life but I’m also going to have to face this discrimination and ignorance for the rest of my life!!! It was pretty freaking depressing and I literally spent the entire weekend in bed which kinda scared the hell out of [Mr. Unchained] because I don’t think he’s ever seen me that depressed and also because I was saying things like if this is how it’s going to be for the rest of my life, what the hell IS THE POINT OF LIFE!!! All I can think about all day is how freaking exhausted I am and how badly I want to just sleep and if that’s all that makes me feel better I might as well be dead.
I’ve had my battles with mental health in the past and I knew I was starting to slip down a very slippery slope but when you’re in that state, who really cares? I willed and forced myself to stop thinking like that eventually and it was okay after the weekend but even now that I’m writing this I’m totally fighting back tears. Ugh. I’m not emotional, so if I’m crying it’s probably cuz I’m too tired lol
Anyway, the condo is closing on Tuesday which is headache enough as it is. Add in the fact that my stupid-as-hell brokers can’t figure out HOW to insure it, add in that work is still ridiculous, add in that we’re STILL not done the major wedding planning pieces and then put the icing on top of all that (i.e. Car accident last week – still waiting to hear if it’s written off) and I’m really like 1 rain drop away from drowning.
(yeah I’m dramatic. Sue me lol)
So I email the case manager asking for an extension on the re-appeal (due next Saturday) in light of the condo+accident and you know what the [profanity] says?! “I understand your situation however I would strongly encourage you to send in your paperwork for the original due date.”
Anyway, because I’m convinced that they denied it because they have no idea WTF idiopathic hypersomnolence is (a variant of narcolepsy that I apparently have) ‎and they DON’T have specialized dr’s making the decisions (so how the hell they think they know better than my dr, I don’t know) I was told I can provide more info on the condition if I choose. (Isn’t that their job if they don’t know what a condition is? It’s called google … Don’t deny a claim because you don’t know wtf the condition is and how it impacts someone.)
Sooooo I have from now til Saturday to write a research paper on idiopathic hypersomnolence/narcolepsy, insomnia, the dangers of sleep deprivation, how it prevents me from being able to do my job and hope that this time they get it. If not, they’re taking back 3 full weeks of pay. Which, of course, I cannot afford (now of all times!) and will give me major anxiety if there’s financial issues to add in to the pot.
Since it IS a disability and I AM entitled to disability benefits, I do think that this is nothing short of ignorant discrimination (which would give me a legal case if so.)
So… if they deny my claim AGAIN I will speak to a lawyer and pursue this further. I do NOT want an unsupported leave on my record (think of how bad that looks!!) and so I’m going to fight this until I exhaust all options.
It’s been an exceptionally tough time the last few months so thanks for your support and reading through my very raw emotions/enraged rant.
xoxo‎,
The Debbie Downer

Mrs. Unchained 55

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