Back to Work being pushed through, Questionable IME


#1

I had my LTIP denied on numerous occasions by the insurer. As 21 months approached, I was sent to two IME assessments per a request by the insurer to the joint committee they and my union rep were finally part of. The psychiatric exam stated there was no mental illness at hand and I was trustworthy. The physical exam noted mechanically, I was limited and could not perform my own occupation. It also stated several biased opinions regarding observations of my pain, my interpretation of my own pain, and that I should be able to perform accommodated workplace jobs (ie mechanically the test shows I am limited in bending and in a great deal of pain from it, but recommendation I should be able to lift 25 lbs from the ground). My credibility is questioned throughout the report and I made detailed notes on the examiners reaction to something that is prohibited according to the Ontario Human Rights Code and was unsettling to me.
Ultimately, the fact the report states the agreement in inability to perform my own occupation (which had been stated by numerous providers beforehand), means the insurer paid out my overdue benefits finally.
However, they have stated I can perform accommodated job functions and immediately scheduled a return to work meeting with human resources and the insurer present. My function has not changed, my injury has not changed - I am more than two years with this chronic pain. I am confused and concerned regarding my options. I saw a preview of a schedule they are presenting at this meeting which involves an immediate return to work (in one week) of 3 days a week, a few hours per week, full return in two months or less. The insurer has stated I don’t meet qualifications for not being able to perform any job and they will close my file in a few months. I have seen various specialists, undergone several treatments, etc , with no relief and no change to my situation. I have always continued to follow up on my own, seek additional referrals, etc. I am feeling railroaded, incredibly overwhelmed and at a loss as to what else I can do to help myself face this situation.


#2

My advise in these types of situations is aways the same. If any heath professional has given an opinion for return to work, then the insured person should go along with it and attempt the return to work in good faith. If it works out… great, if it doesn’t then they can’t say you didn’t try. “Didn’t even try” is perhaps the number one reason that an otherwise legitimate disability claim will be denied. Unfortunately, you have to try in situations like this, even if you thing there is no possibility of success with the return to work. Just go to the doctor and have you symptoms monitored during the return to work. If your doctor legitimately feels the return to work should end, after seeing you trying to do it, then that is ok.

Choosing not to do it will mean they can legitimately deny your claim for breach of contract. You can try to argue later that the return to work was inappropriate, but the reality is that it will be impossible for you to get over the “you didn’t even try” argument. Again, i need to stress that I am not accusing you of not wanting to get better or actually “not trying”, I am saying this is how the optics of the situation would be perceived by others who are decision-makers on whether your claim would be approved or denied.


David Brannen

Disability Lawyer with Resolute Legal

The response posted above is based on the limited factual information made available and is not intended as a full and complete response to the question. The only reliable manner to obtain complete and adequate legal advice is to consult with a lawyer, fully explain your situation, and allow the lawyer enough time to research the applicable law and facts required to give an adequate opinion. The basic information provided above is intended as a public service only, a full one-on-one discussion with a lawyer should be done before taking any any action. The information posted on this forum is available to the viewing public and is not intended to create a lawyer client relationship with any person. If you want one-on-one advice, please click here to request a free consultation or call toll free 1-877-282-5188 to speak with a member with our disability claim support team.


#3

Thank you for your advice. I think the fact the report being used is so flawed and biased and is being used to immediately resume workplace activities is concerning.
I have not given up seeking a solution to my condition so that is also frustrating. Nothing has changed, I am not improved and yet that is being ignored with no apparent repercussions for the report writer or insurer. I would like to ultimately find a solution to my pain and disability that allows me to function fully if at all possible. I have recently read up on “chronic pain centres” and see there appear to be several. My doctor has stated before my pain is now chronic due to time but had not mentioned one of these referrals - just individual doctors and treatments. I had never heard of these before and not been referred. Are these of any use? Has anyone had any success with pain management? Are there doctors on staff who understand chronic pain and its limiting aspects? I keep seeing commentary in reports referring to my “youth” regarding the pain and injury as though I should not have it. I’d like to pursue every avenue possible to improve my condition but I feel like I am being blocked by a faulty report and a workplace and insurer who have decided I am suddenly well enough to work. Thank you


#4

There are doctors who specialize in pain management.
There are dedicated pain clinics.
Talk to your doctor and get referred to a specialist.
Good luck.