'GMA' Gets Answers: Man With MS Fights for Long-Term Disability Insurance
Critics say insurance company doctors pave the way for claim disputes.
Feb. 26, 2009 — -- Charles Tucker, a 48-year-old accountant from Titusville, Fla., began developing frightening physical symptoms about two years ago.
"I started getting tremors, shaking real bad in my hands and feet, making typing difficult or impossible at times, and writing getting worse under stressful conditions," Tucker said. "I started having numbness in the hands and feet, severe, severe headaches."
Tucker, who supports his wife, two daughters and baby grandson, was so tired he was falling asleep at work.
Soon, Tucker realized his fatigue and trembling were actually part of something much worse.
"He is suffering from multiple sclerosis, which has basically disabled him from performing his occupation," said Dr. Daniel Nieves Quinones, Tucker's neurologist.
Too sick to keep working, Tucker reluctantly left his accounting job.
"It was a very emotional, very difficult thing to do, to leave my job and wonder, you know, how I was going to support my family," he said.
Luckily, Tucker had been paying for long-term disability insurance with the Standard Insurance Company.
Last June, Tucker filed a claim with Standard. He did not receive a denial, but for months he could not get an answer. All he got were notices that the company needed more time and requests for more information.
Tucker was worried, so he hired an attorney and they obtained his records from Standard. Inside his file he discoved a surprising medical report from a doctor who works for Standard. That doctor had never met Tucker.
It was the expert opinion of 11 doctors that Tucker had MS, but the insurance company doctor said there wasn't enough evidence. In an official report, he said, "the diagnois of multiple sclerosis is not supported ... and the patient could return to a sedentary work activity."
Tucker said the report was devastating.
"I mean, it took me almost two years to really accept the fact that I did have this disease," Tucker said. "I had all these doctors telling me I did. And then this guy, who's never seen me -- from my understanding, he doesn't even see patients; he does reviews like this on a routine basis -- would say something like that."