Laid-off workers and aging baby boomers are flooding Social Security’s disability program with benefit claims, pushing the financially strapped system toward the brink of insolvency.
Applications are up nearly 50 percent over a decade ago as people with disabilities lose their jobs and can’t find new ones in an economy that has shed nearly 7 million jobs.
The article goes on to state that Social Security disability may run out by 2017.
Why the Social Security Disability Trust may run out
What the article’s author, Stephen Ohlemacher, left out (due to any number of reasons) is that Social Security disability trust has always been ravaged by claims forced upon it by the private health insurance industry.
We speak from first-hand knowledge.
CIGNA forced Paul to apply for Social Security disability, even though he had a paid policy with CIGNA through his former employer, Fidelity Investments.
If you have disability insurance through your employer and you are forced by illness or accident into the long-term disability program, the very first thing your plan does is FORCE you to go and apply for Social Security benefits.
We then had to send CIGNA proof of our Social Security application or his CIGNA disability would be denied. That’s what CIGNA told my husband in a phone conversation back in 2008. (Little did we know CIGNA had planned on denying his benefits already.)
And if Paul was turned down for Social Security benefits, CIGNA would help him find an attorney who would appeal the case. CIGNA states this (however coyly) on their website, although the use of the word, “guide” needs to be replaced with “forced” and “threatened:”
We’ll guide you through the Social Security claims process. Our Claim Managers will review your claim to determine if you may have the potential to receive Social Security Disability Income benefits. If so, they will refer you to an external company specializing in obtaining Social Security benefits.
Health insurers gaming the system
What we have here are innumerable cases of for-profit corporations gaming the system for their own benefit or their bottom-line.
The reason CIGNA, and others, force their disability claimants to go through the Social Security application process is so they can reduce the benefit amount to the claimant by the amount the federal government will give.
In fact, CIGNA produces this slick bulletin for their brokers outlining all the benefits that Social Security and Medicare will provide to those with debilitating diseases, just so CIGNA won’t have to fulfill their contractual agreement. After all, you did pay them premiums.
Crashing the system and fattening their bottom line with Federal dollars
In the process of forcing people who don’t need Social Security disability to apply, (please see the article from the New York Times below) these behemoth insurance companies are purposely crashing our system to the point where people who do need and do qualify may be left without.
The health insurance industry fought a big battle back in 2009 to prevent all Americans from enjoying a public option; one where they would actually have some competition from a government style health insurance plan, like Medicare.
Corporations like United Health Care, WellPoint, CIGNA, Aetna, and others, used all their lobbying power to prevent YOU, the consumer, from enjoying the benefits of your freely-elected government giving you access to affordable health insurance.
BUT when it comes to their ability to enjoy the benefits of our government, well, that’s just fine and dandy. Actually, it’s the purest form of hypocrisy.
From the New York Times, Insurers Faulted as Overloading Social Security:
The insurers are forcing many people who file disability claims with them to also apply to Social Security — even people who clearly do not qualify for the government program.
The Social Security Administration defines “disabled” much more stringently than the insurers generally do, so it rejects most of the applications, at least initially.
The insurers say that requiring a Social Security assessment is a standard practice and that there is nothing wrong with it.
The policies they sell allow them to coordinate their benefit payments with others to make sure no one is paid twice. Thus, if a disabled person can get benefits from somewhere else — like workers’ compensation, a disability pension or Social Security — the insurance company can reduce the benefit check by that amount.
Call to action
Write your Congressional representatives and let them know you know what is going on with health insurers abusing and gaming our system.
YOU paid into Social Security all your working lives and it’s YOUR money and it’s not for companies like CIGNA, United Health, WellPoint and others to use to reduce your benefits. They take in your dollars for health plans but want you to use Federal dollars when it benefits them. Those Federal dollars are your dollars.
And please write to Congressman Paul Ryan specifically since he knows how Social Security helped him through a difficult time in his life yet he wants to hand our money over to private corporations.
The American Conference Institute assembles a yearly “defending against ERISA claims” conference usually held in New York City. This year’s conference is at the New York Marriott Downtown.
If you have Multiple Sclerosis or any other disease that forced you to fight for your benefits because companies like CIGNA denied (lied about) your illness, then you know all about ERISA or the Employment and Retirement Income Security Act of 1974. Unfortunately, ERISA has had negative consequences. A full explanation, written by an ERISA expert, can be found here.
But you may not know that the very same federal judges who may hear your case attend these conferences where they help coach insurance companies, plan providers and other attorneys on how to defend against ERISA claims. In other words, how to make sure a company like CIGNA doesn’t have to fulfill their contractual obligations and pay your claim. From the conference brochure:
An ERISA Moot Court: Featuring top defense attorneys arguing some of the hottest andmost common issues facing ERISA practitioners today, panels of renowned ERISA juristswill critique arguments, question our litigators and help all attendees understand how tosuccessfully convey their positions to the court.
The federal judges are going to going to participate in a moot court? That’s rich. And our favorite here at the MS Activism Foundation:
Breaking Up Is Hard to Do: A Focus on Severance Plan Litigation including Triggering Events,COBRA Hang-Ups, and the Other Litigation Issues that Arise in Separation Situations.
CIGNA had a big loss this year in CIGNA v. Amara, even though they are spinning it otherwise, so of course, CIGNA’s senior counsel, Christina McNally will be in attendance at the conference.
Fidelity Investments, my husband’s former employer, is listed on the last page as being in attendance as well. I could not find a name though. Last year it was their very own senior counsel, (and Paul’s fellow Boston College alum) Laura Tholen.
Here are the names and districts of all the federal judges who are attending this year’s conference. And here is a link to the PDF of the 2011 conference. If you are fighting for your claim, and see your judge, send them a letter. Tell them that you know what they’re doing and that it certainly does not appear impartial.
Here are the Codes of Conduct for United States Judges and be sure to ask about CANON 3: A JUDGE SHOULD PERFORM THE DUTIES OF THE OFFICE FAIRLY,IMPARTIALLY AND DILIGENTLY.
Hon. Daniel E. Knowles, III U.S. Dist. Ct., E.D. La.
Hon. Morton Denlow U.S. Dist. Ct., N.D. Ill.
Hon. Matthew Kennelly U.S. Dist. Ct., N.D. Ill.
Hon. William S. Duffey, Jr. U.S. Dist. Ct., N.D. Ga.
Hon. Viktor Pohorelsky U.S. Dist. Ct., E.D.N.Y.
Fernando J. Gaitan, Jr. U.S. Dist. Ct., W.D. Mo.
Hon. Timothy C. Batten, Sr.U.S. Dist. Ct., N.D. Ga.
Hon. Robert Jonker U.S. Dist. Ct., W.D. Mo. (I think the American Conference Institute meant MI not MO.)
Hon. Richard G. Stearns U.S. Dist. Ct., D. Mass.
Hon. John Coughenour U.S. Dist. Ct., W.D. Wash.
Hon. Robert B. Collings U.S. Dist. Ct., D. Mass.
Associated Press, 07.11.11, 11:29 AM EDT 
NEW YORK — French drugmaker Sanofi said Monday that its multiple sclerosis drug candidate Lemtrada did not achieve one of its goals in a late-stage clinical trial.
Sanofi said Lemtrada worked better than an older drug, Rebif, in preventing relapses, as patients treated with Lemtrada were 55 percent less likely to experience a relapse in symptoms. However, the drug did not prevent their multiple sclerosis from becoming disabling, as it had in previous studies.
Sanofi also listed the side-effects as headache, rash, fever, nausea, flushing, hives, and chills, leaving out the deaths reported in the clinical trials.
I also was very wary when I read the study and they were touting the drug as being able to prevent disability outright. It was even reported that it may reverse brain damage from MS. Nothing short of a miracle, right? Or a selling point worthy of $20.1 billion?
If you have been following this blog because you or a family member has Multiple Sclerosis you may know about the Sanofi takeover of Genzyme. Alternately, if you are one the many pharmaceuticals or investors or PR and advertising firms that visit us, you already do know that Sanofi completed the $20.1 billion buyout of Genzyme.
Which brings us to Campath (acquired from Bayer by Genzyme) now known, or trying to be known, as Lemtrada. We have written about it here because of the shameful desire to increase the price of a relatively inexpensive cancer treatment to $60,000 per year for Multiple Sclerosis treatment.
And no, it is NOT YET APPROVED for use by the FDA. Campath/Lemtrada is still in clinical trials. Here is a link to the latest in their Clinical Trials.
At one point, Genzyme was giving Campath away for compassionate use in cancer patients. This was done by Genzyme to erase the yearly sales figures so that when the same drug rolls out (when approved) the $60,000 per year price sticker for Multiple Sclerosis won’t have a sales comparison number–of something much, much cheaper. Redefines the whole meaning of compassion, doesn’t it?
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Health Care Reform:
While the Affordable Care Act (that’s Obamacare to all you Fox News viewers) is not yet a law–we still have until 2014 for the whole thing to go
into effect–the GOP is back to using their favorite catch phrase, “death panels.”
Here is a link to an article in Talking Points Memo about Rep. Phil Gingrey (R-GA) raising the dirty specter of death panels and rationing yet again. Just an FYI, Rep. Gingrey voted to abolish Medicare. I think the good doctor should know better than to espouse what he does, but politics is a dirty game. Here’s the quote:
“[U]nder this IPAB we described that the Democrats put in Obamacare, where a bunch of bureaucrats decide whether you get care, such as continuing on dialysis or cancer chemotherapy, I guarantee you when you withdraw that the patient is going to die,” Gingrey said. “It’s rationing.”
Dr. Gingrey, the rationing and the bureaucrats are already here but they work in the health insurance industry and they deny claims (rationing), deny Multiple Sclerosis patients their long term disability benefits (more rationing) and they do not fulfill their contractual obligations when they take your premium dollars every month.
We’re the only democratic and industrialized nation in the world without a universal plan; a plan where anyone can buy into a risk pool and get themselves covered no matter what. We all get sick, it’s part of the human condition. It’s how we treat ourselves that defines our society.
My husband now, having been without insurance for 6 months, can finally apply to the new high risk pool–thanks to the Affordable Care Act. What should we do Dr. Gingrey, repeal the health care law like you and every member of the GOP want to do so that my husband (and all other Americans like him) will go without health insurance and health care?
Crying tort reform over and over, as Dr. Gingrey does, isn’t going to fix the system, but considering that the good doctor has himself been sued for malpractice several times, it becomes obvious why he repeats this so often. And why he’s introduced legislation into Congress that would limit damages for pain and suffering from malpractice cases. See H.R. 5 of the 112th Congress.
Dr. Gingrey has this to say about health care reform:
“Just one year has elapsed since the government takeover of our healthcare system and Obamacare has done nothing but create hardships for Americans and place burdens on businesses,” said Congressman Phil Gingrey. “Since its passage, state budgets have been crushed by rising Medicaid costs, businesses have struggled to keep their doors open due to onerous new administrative and tax burdens, and American citizens are being threatened with rising costs and less access to quality care. As we move forward in pursuit of a full repeal of Obamacare, we must stay committed to replacing it with meaningful, cost-cutting reforms that will improve health care, lower costs, and put Americans back to work.”
Government takeover of health care? Seriously, Dr. Gingrey, do you think those phrases like “death panels” still work when the law hasn’t even been fully enacted which then begs the question, what government take over? A proven lie.
If government is so bad, why does Dr. Gingrey want to use government to sharply cut medical malpractice awards? Won’t the free market just sort things out on its own?
But if Dr. Gingrey is speaking about the government creation of a high risk pool to help my husband and all Americans with pre-existing conditions get access to health care by purchasing insurance that will cover them, then I suggest he re-read his Hippocratic Oath.
As for tax burdens and small businesses, small businesses love the Affordable Care Act because they get tax breaks. And read more here, from Fox itself!
Are we being threatened by rising costs? Yes. Why? Because Dr. Gingrey and his GOP ilk refuse to expand Medicare to Everyone. A national health plan that would compete for customers may inspire the private health insurers to actually produce a good product. Competition does that. As it is now, the private health insurers have zero competition.
And as for jobs–you guys have the House. Do something useful.
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Now onto the National Multiple Sclerosis Society:
We got a flyer from the National MS Society the other day about their teleconference series that, “is designed to support individuals with MS through the continuum of their work experiences; from staying employed, to retraining and on to post-employment options. Understanding how to access vital resources will help individuals make the best choices through any stage of their workforce journey.”
With all the money the National MS Society takes in (and spends), this piece of writing just sent me over the edge as it purports to say
something without saying anything at all. They paid for that with your donation dollars. And it gets worse:
Applying Through Your Employer’s Long Term Disability Benefits When MS Progresses
Featured speaker Lisa Kantor, LLP from Kantor and Kantor will share her expertise as an advocate who has successfully represented people in Employment Retirement Income Security Act (ERISA) benefit claims for over 18 years. If you have MS and Long Term Disability Insurance through your employer, you will want to know how to apply for and access these vital benefits.
Let me just begin by saying that the whole reason I’m here writing this, the whole reason this Foundation exists is because of the way my husband was treated both by his Long Term Disability insurance carrier, CIGNA, and his former employer, Fidelity Investments.
He was denied his benefits by CIGNA. Twice.
He was told by Fidelity, after having completed 6 months of chemotherapy while working at the same time, that he wasn’t performing as well as his fellow workers who were not going through chemotherapy–even though he led his group in activity. We had no where to turn for help.
This sort of teleconference series makes the National MS Society look good, but doesn’t really help. And with all the money they have, imagine what they could do. They could start by lobbying Congress to fix ERISA–that would go a long way in helping not just those with MS but all who have been denied their benefits or who have been mistreated by their health insurer.
Listening to Ms. Kantor may be helpful, she may even gain a few clients from this teleconference, but she can’t help you “apply for and access these vital benefits.” She simply cannot.
See, one cannot actually access their long term disability benefits. I wrote extensively about that over at Illness and Insurance Hell.
Your insurance carrier starts the process while you are still on short-term disability; they force you to apply for Social Security benefits and prove that you have been through that process or else they’ll deny your claim. And lastly, they lie.
They lie in the face of medical evidence, they make things up and when they are threatened with legal action, they send photographers (bad ones I’d like to add) to your house to photograph you and your family. My husband has lesions on his brain and spinal cord, could the guy with the camera, snapping away at us, somehow disprove that?
Then, after all of that, they all attend conferences with federal judges (among others) to figure out how to defend against ERISA claims. Anything not to pay a claim.
Which brings me back to the Affordable Care Act, the Ryan plan to abolish Medicare and the GOP still trying to get rid of health care reform, like Dr. Gingrey above.
I ask this: If the GOP succeeds in repealing health care (doubtful) but say they do, then the provisions in the law that help people, that stop lifetime caps, give seniors free preventative care, that fill the Medicare donut hole, that stops insurers from retroactively cancelling your plan, that gives Medicare drug discounts–if the GOP stops all this then what good is that little $8,000 Ryan Voucher? Rep Ryan won’t be using one, not with his retirement plan, thanks to you, Joe and Jane Taxpayer.
We are glad to report some good and sane news today.
The pre-existing insurance plan created as part of The Affordable Care Act has always been a sore point with this Foundation and with many health care activists and with good reason. The eligibility rules surrounding the plan were written with political motivation behind them.
For example, my husband has Multiple Sclerosis and to apply for the high risk pool, he had to go and apply for coverage with a private insurance company and furnish a letter of denial. Not hard to do when one has Progressive-Relapsing Multiple Sclerosis. But think about the ridiculousness of this exercise in futility.
Thankfully, things have changed for the better and certain restrictions are gone.
But there is still one sticking point and that’s the rule stating that a person with a pre-existing condition must be WITHOUT insurance for six months prior to applying to the high risk pool still stands. Progress is slow.
More information can be found from PCIP.gov.
From the LA Times:
The Obama administration, expanding a program created by the new healthcare law, moved Tuesday to make health insurance more affordable and accessible for Americans who have been denied coverage because they are sick.
Across the country, the federal government is reducing premiums on special coverage available to uninsured people with preexisting conditions such as cancer or diabetes.
And the administration is loosening restrictions on who can sign up for so-called preexisting condition insurance plans.
These plans were created by the health overhaul that President Obama signed last year. They are meant to provide temporary aid to sick Americans until 2014, when insurance companies will no longer be allowed deny coverage to people who are sick.
But the number of people signing up for these plans has lagged, in part because of high premiums and stringent eligibility guidelines.
Now, federal officials estimate, premiums in some states could come down as much as 40%, thanks to a more refined analysis of what the plans should charge.
The administration is directly slashing premiums in the District of Columbia and most of the 23 states that have elected to have the federal government run their health plans. The remaining 27 states, which each run their own plans, will be able to reduce premiums, as well.
At the same time, the administration will no longer require applicants for these plans to furnish a letter from an insurance company showing they had been denied coverage. Instead, applicants will need only a letter from a doctor, nurse or physician’s assistant stating they have a medical condition.
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