Can an insurer force you to take anti-depressants or anti-anxiety medication when you're on stress leave?


#1

I now know of two people who have been told that they must take some form of anti-depressant or anti-anxiety medication or they will be terminated from their long term disability and stop receiving benefits. They have both been approved for long term disability/stress leave and the insurance is through their workplace with the premiums being paid by the company. Both are located in Ontario and this is supplementary health insurance through a private provider that pays them a portion of their salary, not OHIP or some other government program.

They are making good faith efforts to get better but have basically been told they have to have a prescription from a doctor for some type medication for mental illness or they loose their coverage. This means they basically have to ask a doctor to prescribe something they don’t want or probably even need. In both cases a multiple doctors, including psychiatrists, agreed that they required stress leave. The doctors only prescribed medications after being asked to do so by their patients. Both requested some sort of counselling and doctors once again agreed that would be a prudent course of action but these requests were denied in favor of drugs by the insurance company.

They’ve been allowed to choose to change drugs but neither feel any have helped their symptoms and yet still must request some other drug from their physician or lose their coverage. They were also threatened with potentially providing urine samples to prove they were taking these drugs, are insurance companies allowed to force you to submit a urine sample as a condition of continued coverage?

It seems like the insurance company simply doesn’t want to pay for therapy and is essentially forcing people to take drugs they don’t want or need, is it legal for them to essentially force you to take medication?

Even if legal I feel it is a despicable practice and is something that bears further scrutiny. I find it wrong that an insurer is allowed to manipulate someone into requesting drugs they don’t want from their doctor under the threat of losing their benefits.


#2

Insurance company wants to make sure they try all sorts of treatmens to get better.

I am surprized that they were approved for LTD without doing any major therapy or taking meds.


#3

I really don’t think this is coming from an interest in having anyone get better.

Both doctors and the patient want to pursue counselling but the insurance companies response is that drugs are the answer and are basically forcing them to take medication. Both had a few sessions psychiatrist approved and then were told that no more therapy would be funded, only drugs, even when doctors said they should continue therapy. It’s no coincidence that drugs are far cheaper, this not only saves the insurance company money but since they know the patient/client don’t want to take drugs an easy way to force some people off of coverage.

In any case my main questions are if they are allowed to do this and whether people can be forced to take urine test to continue on long term stress/disability leave.


#4

I’ve found insurance companies can request whatever they want if it’s written in their master insurance policy. My lawyer had to request them for mine and it’s 1300 pages long! The insurer usually states that you must be receiving constant medical treatment for your disability and when it comes to mental illnesses it must be bad enough to be “treated” which usually means meds and therapy. Personally I currently have a huge hate-on for insurers. Most companies (like mine) don’t even approve a leave for “stress”.


#5

My spouse was urine tested at random to prove he was taking morphine—they also checked to see if he was taking his anti-depressants.


#6

Whaaaat? :astonished:


#7

It was at the Pain Clinic. I always pay every so often for medical files and understood the testing to ensure he was not selling his morphine but was surprised that he was also checked to see if he was taking all his anti depressants.


#8

Complain that you are having adverse reactions to the meds. I could never take antidepressants as they made me worse. It was prescribed for nerve pain but still…it was horrible.


#9

My understanding is yes. Because we need to be doing everything we can to get better and go back to work. My understanding from my GP if we can find a professional who had a better solution to improving my situation with depression, cptsd, anxiety and blood pressure issues. Then we would have to document what and why we are doing something. I’ve had a very long healing journey 12 years - I want to get better. At the top of my game I was in Major Account Sales now I’m uncomfortable paying bills or dealing with my bank or small stresses. My experience is get a very supportive GP to take control of your healing. Well wishes all!!!


#10

Do you know what qualifies and “constant medical care”?


#11

My interpretation is it depends on your medical condition.
Whenever the doctor wants to see you.
My condition is physical but the standard treatment is drugs that cause other problems.
I see my neurologist once a year.
If there is a new miracle cure treatment then I might I might pursue that but if it has a risk of death or something, I don’t see how I can be forced to do it.
I am obligated to follow conventional treatments.


#12

Most policies require that you be under the constant care of a physician. Essentially seeing a Doctor on a regular basis applicable to your condition.


#13

Normally it is worded as “continuous” or “regular”, not constant. However, the idea is that you are receiving appropriate treatment for your diagnosis and condition. The words regular, constant or continuous are all relative to your medical condition and what the generally accepted frequency and type of medical treatment would be.


David Brannen

Disability Lawyer with Resolute Legal

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#14

Are you still receiving LTD? If so, what do they require and how often after 5 years?