Can Anyone Help Me?
Martha kissed her two small children goodbye and watched them closely as they ran toward the school bus, lunch boxes flailing, backpacks slipping off their small shoulders. It was a beautiful day in rural Maine. The sun glistened through the kitchen door and onto Martha’s small kitchen where she kept her collection of crystal figurines. Evidences of an early morning rain on the windows reflected spectrums of prism light from the small statues, an array light show which Martha loved to wake up to in the morning.
While sipping her coffee, she watched as her son, Mathew 7, and daughter Chantal 9 ran to find their favorite seats on the bus next to their “best friends” from the neighborhood. Most mornings, Martha’s children, like all others, were so engrossed with the start of their day, they almost never looked back to the mother waiting in the open door, waving goodbye. But, today, it was different. Unexpectedly, Mat and Tellie looked toward their mother and gave a quick wave. Martha smiled and waved back as she watched the yellow bus move slowly down the street to the next stop, where more children got on the bus and began their day.
Martha closed the kitchen door and quickly wiped the tears from her cheeks. Noticing her coffee was now cold, she refilled her cup with her favorite flavored coffee and asked out loud, “Now where did I hide those cigarettes?” She hadn’t smoked in, let’s see, how many years? Must be twenty-five years, at least, she thought.
Finding a crumpled package of old Marlboro’s in the back of one of her kitchen drawers, Martha sat down at the kitchen table, lit her unslightly bent cigarette and inhaled deeply. It tasted good. After another good puff on her Marlboro, Martha picked up the letter from the insurance company and read it for what seemed like the hundredth time. “We regret to inform you we are no longer able to approve any future benefits. Since you no longer meet the definition of disability contained in your policy, you have received your last check……..”
It was no use. Things started to go downhill about a year ago when Dr. Weinhaus, a Rheumatologist, diagnosed her with fibromyalgia. The pain was almost impossible to bear at times, and her employer, grew increasingly concerned as she began to take more and more time off. Finally, her supervisor caught her in tears in the ladies room and suggested she apply for disability, which she did a week later.
Martha’s employer, a local drug and pharmacy chain, paid the premiums on a group short-term and long-term disability policy, which she regarded as part of her meager benefit package offered to her at the time she was hired. Making application for the 26-weeks of short-term disability seemed easy enough, and within 5 days, Martha was being paid weekly short-term disability benefits. Times were tough, but her employer continued to keep her as a legal employee and, thank goodness, her heath benefits were paid for. Unfortunately, despite Martha’s attempts to do everything possible to get back to work, her health did not improve and she was forced to continue her disability longterm.
That’s when the trouble started. Her disability insurer, Unum Group, began to send her letters asking for more and more medical information. She already provided her claims specialist with all the information she had, plus, she knew Dr. Weinhaus supported her disability and sent in his office treatment notes on a regular basis. Despite an overwhelming amount of physical therapy notes, office visit notes, and lab reports, provided by her doctors and specialists, UNUMProvident eventually denied her claim. “Based on the medical information you provided, our in-house Board Certified medical consultants have determined there is no objective medical evidence to preclude you from performing your own occupation.”
“Who the hell are these in-house consultants, anyway?” Martha remembered thinking, “they haven’t examined me, and they know nothing about me at all.” “It is our determination that fibromyalgia is a syndrome, not a disease, and as such, you are able to perform the material and substantial duties of your own occupation. Therefore, we cannot approve any future benefits.” The news was devastating. Of course, she appealed the denial decision, but UNUM only said the same thing, “we don’t believe you can’t do your job.”
Without her monthly disability benefits, Martha had been unable to pay her mortgage and now faced the loss of her home. Although her supervisor initially supported her long-term disability leave of absence, the drug store chain terminated her employment after a year, leaving her without health insurance or resources to buy the pain medication she needed in order to function on a daily basis. COBRA payments were out of the question. Recently, she stopped seeing her doctors because she just couldn’t afford the specialist fees, and besides Mat and Tellie needed new shoes, and Mat wanted a Cub Scout uniform so he could attend meetings.
Unum Group had even taken her Social Security Disability Income lump sum check for both herself and her children. She depended on that money to bring the mortgage up to date, but UNUM said they would keep her monthly benefit if she didn’t pay them back. Reluctantly, she wrote the check for $16,543.00 and sent it to the insurance company. That’s when she could no longer afford her much needed medical treatment, and try as she might, she just didn’t seem to get any better.
Martha rubbed her shoulders, and then winced in pain. She hurt. “Isn’t there anyone out there who can help me?” she cried out loud in frustration. But, Martha knew the answer and her decision was clear. She just couldn’t take it anymore. Walking to the curio cabinet in the corner of the kitchen, she admired her crystal figurines for a few moments and then removed her favorite– a butterfly. It was beautifully made and was given to her by her mother just before she passed away a few months ago.
Back at the kitchen table Martha put her face in her hands and sobbed. “Can’t anyone help me? I just don’t know what to do now.”
Although Martha knew she and her kids were in trouble, she bravely picked up her cold cup of coffee, and calmly lit the last cigarette, gratis of the Marlboro Man.”Life goes on”, she thought,”I don’t know just how right now, but life goes on.”
Martha is one of the many thousands of working class Americans and other working professionals who receive disability benefit denial letters every day from dishonest disability insurers. Although not always as tragic as Martha, facing a long-term disability without income replacement is equally devastating to a family with financial responsibilities.
When there is a loss of income because someone in the household cannot work due to sickness or injury, bills do not get paid, health insurance may be lost and treatment stopped, foreclosure or eviction places the family on the street, or places the insured as an additional burden on other family members. Individuals who are ill suffer the defeat of continued financial ruin, and some, like Martha, cannot find relief to the physical long-suffering and emotional humiliation.
As Americans we have access to some of the best known medical science in the world. Unfortunately, our government and its leaders have not placed a premium on providing medical health care to all its citizens. In fact, one might say that access to the best medical treatment in our country is limited to those who can pay the high cost of medical insurance, or absorb the costs of medical treatment on their own. Most middle class working Americans depend on health insurance benefits provided by their employers. Not too many working families can pay the alternative high COBRA premiums either and have to do without medical insurance when jobs are lost. FMLA leave is also limited in scope and time.
Therefore, when one is deprived of access to health care because of a job termination, particularly for disabled persons, the means to receive treatment, care and necessary medicines is also denied. In the absence of a country wide medical care system, disability income protection is essential to middle class working Americans. And, it is precisely for this reason the working American is often left without financial support in a time of need.
This is a story I wrote maybe ten years ago when I was asked to write articles and stories for various health magazines. I rarely get this emotional in my writing, but it was a very popular article at the time.
