After COD insurance company demands


#1

Thanks for the replies.


#2

Your policy is a contract that outlines what insurance company can or cannot do. It clearly states that they can send you to any doctor or a program that they think is necessary. As long as they pay, you are obliged to follow the terms of the policy otherwise they have the right to stop the payments. Of course, it doesn’t mean you have no rights. You do.They should play nice and treat you fairly.

I think you should use discretion when you either speak out loud or post anything online. It all can be used against you.

As I noticed most of the post here are about how it is hard to be disabled and not to be able to function as a normal healthy person :slightly_smiling_face: Nobody posted anything fraudulent so far. Not sure what kind of information an insurance company can dig out of this forum and use against you.


#3

Not all policies say the above. That is why my spouse is suing. It comes down to is it reasonable what they are requesting.

You always have to cooperate within reason. Any time an Insurer is looking to spend money it is to save money

You do have rights. I will post later tonight on what is reasonable when they request an IME


#4

I believe the same but my posts would clearly identify me. However I am the spouse and not the disabled. That said I believe you should not be scared of posting or sharing the truth.


#5

Those tests are useless, they only show one day.

You have to do what the insurance company asks but contest it later if needed.

Yes, that is very likely.

Yes, there is an edit button at the bottom of your post (it looks like a pencil).


#6

It doesn’t delete messages.


#7

I too am past the Change of Definition date. For 2 years they have denied me treatment. Now Manulife is reconsidering. But right now say treatment doesn’t always work. (Mental Health)
I recently started medical marijuana for symptomatic relief. Works great. My partner can tolerate me now.
The only demand is they’ve asked my doc for an update and he and I meet next Wednesday.
The big issue for me is lack of treatment. Why now after 2 years of saying no?


#8

What do you mean by denied treatment?


#9

Group policy has zero mental health coverage and I had a breakdown or breakthrough May 2015. Won’t even cover counselling beyond 2 sessions. So they denied treatment. PTSD, bi polar II, intermittent explosive disorder, GAD and more. I am in receipt of CPP -D since last January.


#10

For those you need an OHIP covered psychiatrist. Find one in your area


#11

Thanks to all that commented.


#12

BIG TIP–always request any intake forms to be provided to you before going into see any IME or rehab provider!!!
In writing-with proof of request

  1. Prepare for the evaluation in advance. Know your medical history and be consistent
    when telling your history to the IME physician.
  2. Make an appointment to discuss your medical history with your attorney. Let your
    physician know you have been asked to submit to an IME, and make an appointment to
    be examined by him/her on the same day.
  3. Take someone with you to the exam who can speak for you and take accurate notes of
    the procedures. Take pictures of any swelling or obvious physical marks in the IME
    physician’s office.
  4. Do not attempt to exaggerate symptoms or over react when touched or prodded.
  5. Be cognizant of the fact the IME physician is neither your advocate or medical doctor.
    Do not ask medical questions about your treatment, and answer only the questions you
    are asked. Do not contribute information beyond the scope of the examination. In other
    words, during the IME exam, don’t discuss the problems of your life.
  6. Send the insurance company a request for credentials and other information about the
    IME physician. Also, request a copy of the report be sent to you at the same time it is sent to the Insurance Company-offer to pay for postage and copying fees–do this in advance of the appt.
  7. Be mindful you may be surveilled by an insurance investigator. Wear braces, use canes,
    or other therapeutic devices as instructed by your physician. Limit your activities on the
    day before, the day of and the day after your IME examination. Look for strangers on
    your street, or neighborhood.
  8. Ask for a copy of the in-house physician’s report on the IME. The insurance company
    may or may not give it to you, but ask anyway.
  9. Stay calm, and if the IME physician hurts you, say so. No physician likes to have a
    patient carried out of his office on a stretcher. If the IME physician manipulates you, or
    physically hurts you to the point of pain, ask for an ambulance to be called.

#13

What if IME doctor hurts you mentally? Can you call an ambulance? :slightly_smiling_face:


#14

You get a lawyer and sue!


#15

Can’t you just backspace everything and save it?


#16

The waiting list around here is years.
I would suggest getting checked in to a mental hospital.