Insurance Denied For Man Living With Crohn’s Disease: Terry’s Story

Insurance Denied For Man Living With Crohn’s Disease: Terry’s Story

 

 

Terry, aged 41, suffers from Crohn’s disease. Although he was able to work for many years, his condition worsened and he couldn’t handle his position while trying to manage his disease anymore. After his insurance claim was denied, he came to Share Lawyers for help.

Terry was diagnosed with Crohn’s disease in his mid-20s after noticing severe digestive issues – namely weight loss and mouth sores. Through the advice of his doctor, he was able to manage his condition with nutrition and anti-inflammatory medications for many years without it interfering too much with his daily life and work.

Terry always loved computers and worked in tech support for a large media company in Toronto. There were some days where Terry felt better than others, but he tended not to complain and could work with few issues.

In December 2016, he began to experience more intense are ups with his symptoms. He was using the bathroom so many times during the day and feeling constant discomfort. This was frustrating and often embarrassing for him. His anxieties about his digestive distress seemed to worsen the condition for him and his mouth sores made it difficult to eat.

Terry’s co-workers noticed his weight loss and his general fatigue. Although their inquiries about his well-being were well-intentioned, it made him more self-conscious. He became inefficient with his work and had a difficult time coping.

He decided to go on short-term disability to gather his strength. Who knew, maybe the stress of working in these conditions was making his symptoms worse?

Terry decided to the take initiative. He became stricter about his diet and practised meditation and stretching to manage his anxiety. However, his claim was denied by the plan administrator. He then applied for E.I.-disability, which he received for 15 weeks.

After that time, he was not feeling any better and missed a trip to the West Coast with his wife to visit his daughter in university over the winter break. Feeling totally depleted and in constant pain, he applied for long-term disability through his insurance company.

The response from his insurance company was sceptical – they did not believe that Terry’s Crohn’s symptoms were disabling as he had coped with them for more than twenty years. They cited insufficient medical evidence and denied his claim. How could this be? He couldn’t understand why they wouldn’t believe the fact that his symptoms had worsened. He returned to a specialist and tried to appeal twice on his own, but to no avail. He was exhausted and had been so sick for so long. He felt ready to give up. But how was he going to support his family? The question kept him up at night.

Terry was watching TV when he saw an ad for Share Lawyers. He decided to try their services and see if anything could be done. Share Lawyers immediately began helping Terry by arranging a referral for him to see a gastroenterologist for a more comprehensive workup and assessment to substantiate the claims for the insurance company. The insurance company hit back hard, but Share Lawyers were in Terry’s corner and weren’t backing down. Share Lawyers worked to negotiate a settlement for all the back payments owed to Terry from when he stopped working and for future payments moving forward.

Terry’s not ready to go back to his job, but he has peace of mind without the added stress of feeling helpless, Terry is moving forward to work on his well- being. One of his doctors have suggested surgery if his symptoms do not start improving.

Share Lawyers is proud to have helped Terry through this stressful time in his life, and letting him know that he was not alone in his fight with the insurance company.

 

*All names and identifying details have been changed to protect the confidentiality of all involved.

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