Reporting Cynthia Demos
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MIAMI (CBS4) – Millions of Americans have disability insurance through their employers. But, even when doctors document disabilities many get turned down for the benefits. That is inspiring one cancer survivor to fight back against the system.
Susan Kristoff was a sales rep for a large company in 2006. But when her cancer returned, she was forced out of work and applied for disability benefits. Much to Susan’s surprise, her application was denied.
“There’s no way. I had two large holes in my hip how could I not be disabled,” Kristoff asked.
Instead of giving up, Susan decided to fight. Her lawyer explained to her that the problem was with the federal statute called ERISA which allows the insurance company to decide for itself who is and isn’t disabled.
“What that means is that this insurance company gives itself the discretion to determine who is eligible for benefits,” explained Kristoff’s lawyer, Alicia Paulino-Grisham.
Susan was unable to work and had no way to pay her expenses. Then, she learned that the statute has no penalty if a company wrongly denies you.
“If they deny a claim and a court tells them that they now have to pay it, there are no additional damages that they will ever have to pay,” Paulino-Grisham said. “There are no punitive damages if you lose your house because they denied your benefits. There is no incentive for the insurance company to do the right thing at the beginning.”
It took Susan and her lawyer two years before the insurance company finally paid her.
“Most people will go away; they’re too sick to handle their own claim,’ Paulino-Grisham said. “They’re too sick to put together an effective appeal.”
For Susan, it was the lack of penalties the company faced that really caused her to fight and ask for the law to be changed.
“They don’t have to pay any penalties. They don’t have to pay your family if you die during the process even though they denied you. That’s what needs to be changed with this law,” Susan said.