December 18, 2012
Lincoln Financial Group
8801 Indian Hills Drive
Omaha, NE 68114-4066
RE: Policy Number: 00040012471100000
Claim Number: 1120009027
Ladies and Gentlemen:
Subject: Appeal of Decision to Deny Long Term Disability
I, Steven ****, am advising your company at this time that I am appealing your decision to deny my Long Term Disability based on facts, including but not limited to, the following; Lincoln Financial claims that my condition is pre-existing based on all the findings that the insurance company reviewed of my medical records ranging from 9/1/2010 to 9/1/2011.
However, it is my claim that the records were not interpreted properly by your office and I dispute their findings, to wit;
1. I did stop working on January 13, 2012 due to the fact that Dr. Safar found that upon his examination in December of 2011, there had been rectum left from a surgery that happened 34 years earlier and that it needed to be removed as it come to the point that it had become infected in November 2011. Mr. Dixon was diagnosed with Crohns Disease 34 years ago and has had an anal drainage for that whole 34 years, and it had not become infected or create any kind of life threatening problem for Mr. Dixon until November of 2011.
2. Medical records do indicate that I have a long standing history of Crohns Disease, but they also indicate that my Crohns Disease has not and was not active during any treatment that I received in the year prior to this current condition. In fact my Crohns Disease has not been active since 1991. I have always had some anal drainage for the past 34 years, which was always referred to as sinus track drainage, and was normal with a little discomfort, but never a problem. I did discuss the drainage with prior physicians and they have always told me that I would always have the drainage and there was nothing that could ever be done about it. I just lived with it until, in November 2011, IT BECAME INFECTED!!
3. In March of 2011 I was admitted to Highland Hospital in Highland, IL. I was not admitted for Crohns Disease or any other thing that had to do with Crohns Disease. I was admitted for Pneumonia with Plurisy and was treated at that hospital for that condition ONLY. However, as I was being treated for the pneumonia, I developed a small bowel obstruction and was transferred to Barnes Jewish Hospital. While I was at Highland Hospital I was given Flagyl and Cipro for my COPD. Thus meaning, I was not put on these antibiotics for the drainage coming from my perianal area, BECAUSE IT WAS NOT INFECTED. Now, its very imperative that your company read the statement made by Dr. Gutierrez in that she states in her finding on May 5, 2011 that the antibiotics that I was given for the COPD were helping with the drainage, but I was not put on the antibiotics for the drainage. The drainage continued and there were no concerns of this drainage from any doctors, or myself, until November of 2011 when I was diagnosed with an infection, and the infection occurred NOT from the drainage, but it was found that for 34 years part of my rectum had been left in my anus.
4. When Mr. Dixon saw Dr. Lester Crancer on 4/7/2011 his notes clearly state that I was seeing him after my hospital stay for a follow up and that I was being treated for a blockage and had been being treated with Flagyl and Cipro. (THE ANTIBIOTICS WERE FOR THE PNEUMONIA, NOT ANAL DRAINAGE) Dr. Crancers assessment at that visit was that I had Crohns Disease and that Barnes Hospital was following me after having a bowel obstruction.
5. I was seen by Dr. Lin while I was at Barnes Hospital for a small bowel obstruction and I did indicate to her that since they put me on the Flagyl and Cipro for my COPD with pneumonia and Plurisy, I was amazed that it was slowing my drainage, but the antibiotics were not continued for the drainage. As your company states itself in the findings in paragraph 5 of the denial letter, the antibiotics were stopped as instructed for the pneumonia with Plurisy and COPD, and the drainage continued, but I was not instructed to stay on the Flagyl and Cipro due to any infection of the drainage. In fact, at my visit with Dr. Alexandria Gutierrez on May 5, 2011, Dr. Alexandria stated that no more medications were needed and she did not put me on any antibiotics, I was instructed to stay on my current medications at that time which consisted of; calcium 600 mg one tablet twice a day, citalopram 40 mg one tablet a day, Imodium 2 mg one tablet a day, Vicodin, vitamin B12, and Xanax .5 mg 2 times a day. So if my drainage was infected at that time, dont you think Dr. Gutierrez would have insisted I stay on the antibiotics? However, she did not because the drainage was not, at that time an infection, or life threatening.
6. Dr. Alexandria Gutierrez also stated in her report for my visit on April 27, 2011, the patient does have active perianal disease, but it is NOT active draining fistulas. So in the proof of Dr. Gutierrezs own notes, there were no active infected fistulas, and the INFECTED fistula did not appear until November 2011.
7. On 12/07/2011 when I saw Dr. Gutierrez because blood starting coming from my rectum, it does state that I was on Flagyl and Cipro. That is because when I saw Dr. Lester Crancer in November of 2011 he suggested that I take them until I get an appointment with Dr. Alexandria Gutierrez. Dr. Crancer suggested that because the Flagyl and Cipro that I was taking for the COPD and pneumonia in April of 2011, seemed to have an effect on the drainage. It was only prescribed at that time by him to see if I got some relief while waiting to see Gutierrez.
In Summary; my claim was not filed to receive Long Term Disability due to Crohns Disease or bowel obstructions. My claim for Long Term Disability was filed due to the fact that it was discovered in November 2011 that I had an infected fistula that needed to be removed because it had NOW BECOME INFECTED, and upon examination by Dr. Bashar Safar in December 2011, it was found that part of my rectum was left inside me to rot for 34 years which should never have happened. I was never put on Flagyl and Cipro by any doctor for perianal drainage until November 2011, and that was because it was found that when I was being treated for COPD and Pneumonia with pleurisy, these antibiotics had an effect on the normal sinus track drainage earlier in the year, (just an effect, not a positive or negative or diagnosis or treatment, just an effect.)
Furthermore, your company cannot deny my claim based on the finding that I have Crohns Disease with fistulas, because all Drs notes from Gutierrez, Crancer, Safar, and Dr. Lin clearly state that my Crohns Disease and fistulas are not, and were not, active, nor were they showing any signs of being infected.
Lastly, and most important to this appeal is that when Dr. Safar set up the surgery for Mr. Dixon, based on the first findings in his office in December 2011, the surgery was to be very short with a return to work within six to eight weeks. However, when pretesting was done in January 2012 for the surgery, it was found that an infection had formed several inches in and around the kidneys and that a more intense surgery procedure was to be done. Mr. Dixon did not know until the day of the surgery, January 24, 2012, that Dr. Sarfar had changed everything that he intended to do, that it was going to take several more hours for the surgery and there were very high risks of kidney failure.
So, the diagnosis changed during the pretesting stage for the surgery in January 2012, based on the CT Scan that was performed in January 2012.
Furthermore, the Short Term Disability nurses review completely understood the situation and determined this was not a pre-existing condition, and Mr. Dixon received his benefits deservingly for the whole 13 weeks. Once this claim was turned over to Long Term Disability, the determination that I had received from the short term claim should not have changed.
Lastly, since Lincoln Financial denied the Long Term Disability claim Mr. Dixon has suffered tremendous financial hardship. He did attempt to return to work on August 9, 2012 with an OPEN WOUND, DISCONTINUED TAKING ALL HIS MEDICATIONS, AND HIS HEALTH SUFFERED BECAUSE OF IT!! Mr. Dixon was only able to work for about eight weeks and now his health has suffered because of it. Mr. Dixon went back to Dr. Gutierrez in October 2012 and has been put on Mercaptipurine and steroids. He has to have blood drawn once a week to follow his white cell count as these drugs can cause Lukemia.
Mr Dixon should have been able to continue his recovery and healing process from this dire condition which occurred in November 2011, without any worry from finances, and Lincoln Financial should have gave him what he was entitled to on his Long Term Disability.
Fieldon, IL 62031
**** homeP. You also have my express written consent to discuss this claim with my wife, Julia A.CLICK here to see why Rip-off Report, as a matter of policy, deleted either a phone number, link or e-mail address from this Report.