Denied and told to appeal-new LTD trick

I can give good advice, but did not follow my own wisdom!
So I was back on a gradual return to work and could not make it to full hours. So the Insurer denies my claim…and to boot…back dates the denial by a month.
So I have to appeal or sue. Did not follow my advice and in a full blown anxiety attack-sent few emails that I wish I had not. ie-claim file then accommodation request, then policy wording. Nothing rude–just scattered thoughts.

Reason for denial: Psychiatric diagnosis’s and ongoing treatment is not sufficient to show a disability to do your job.

The kicker. My Insurer knows I am being tested for and have a procedure in the next 6 weeks for potential cancer. During my appeal I am on an unauthorized absence and do not qualify for disability if I become sick with another condition.

UGGG

This is exactly why I am paying psychologists ten thousand dollars a year to help me. I also attend many programs on my own. It’s all about have tons of paper work to support my claim.

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How long were you on a gradual return to work before they cut you off? I have been on one for about 6 months and struggling to get to full time.

What would you have done differently?

I was over anxious to get back to work and over estimated my abilities. With Covid and only phone calls to my GP was not great. Although I did video with Psychiatrist and reg. see psychologist I thought I would be better faster than I am.
I have been trying to go back since May and could not manage. What caused issues is delays in getting tests for any underlying reasons for crushing fatigue.
The Insurer wants objective evidence on so far what is mainly a subjective claim. Which is a horrible game to play.
Basically they want me to appeal. The issue is I have upcoming tests and a procedure to see if I have cancer. When I am on appeal I do not have coverage for any new claims.

I will try and work it out. The whole world is crazy so I will see if an understanding can be made. I do have a great large employer.

Whaaaaat??? :astonished: :astonished: :astonished:

Did you know that a GP psychotherapist or a psychiatrist are covered by a provincial healthcare plan?

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Sorry to hear about the denial.

I would try to take medications and see a psychiatrist more often. Oh, they like when you take all the possible and impossible medications. Unless you look like a total drug addict it’s not going to cut it. You cannot enroll in a group therapy at this moment because of the lockdown restrictions unless they have something online.

Hopefully your test results will be negative.

Very clever of them to take away your coverage in case if you have a new condition. Didn’t know they can do that. It means it is better not to tell them about any potential new conditions, especially the ones that will take years of treatment.

Somebody I know told his boss about an upcoming test for cancer so next day they found some reason to let him go. Sometimes it is better to keep those things to yourself.

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Thanks for the feedback Elaine! I just wanted to share that telling your Insurer that you have upcoming tests for a potential seriousness diagnosis or longer claim may not be a great idea.

I do not see myself as not being able to go back to work unless something more is discovered that requires more time off. I just need support on a gradual return.

I am wired for hyper vigilance…I am hopeful there is just a miscommunication and confident I can work this out.

I’ve read your great advice on this forum and sorry to hear about the upcoming testing. Hopefully it’s all negative.
I understand the want to go back to work. Oh boy, I get it LOL but…what if you just are not ready or truly able to go back to work? It took me a damned long time to realize I was not ready (I’m 48 and have been working in some capacity since I was 11) I always thought I could get through this or get through that…turns out, I couldn’t.

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Thanks for the support Marilyn. I am a big advocate for tape recording all interactions with the Insurer. Did I do it…nope. Do I regret it…yup.

I did in writing ask for the policy wording/definition of disability and for their definition of objective evidence right at the beginning. I offered to go on EI Sickness at 55% rather than 100% STD salary coverage as I was going off due to a psychiatric disability. Mental health disability or any “invisible” disability is often more subjective than objective. But was not given that option as we get reduced EI premiums for having the short term plan. Of course the case manager is now saying I need objective evidence. Which I believe I have provided.

It is sometimes better to see a private psychiatrist, the wait can be long to see a public one.

I stopped telephone conversation with them after they attempted to terminate me the first time in 2018 AND I received a copy of my file the same week. I had kept my own notes, but reading theirs was 100% opposite of what I had actually said on the call. Plus, multiple reps would call me weekly and harass me about going back to work. They would document some calls but not others. I kept my phone bills showing the incoming calls.
It’s amazing what little they say when you have to put it in writing though. The harassment was a sharp decline.

They suck. You pay for a service in case the worst happens and then when it does you have to jump through hoops to get what you paid for. It isn’t right.

It’s true. Some areas don’t have many specialists. But it is changing now. Doctors are using OTN to see their patients online. My psychiatrist has started seeing her patients online since last year. I prefer to see her in person but when she was not able to come to the office we would meet on OTN. Of course, now we only meet online.

A lot of doctors are online now. Maybe it is one of the options for those who have limited access to the specialists.

I downloaded ACR phone calls application on my phone maybe 4-5 years ago. It’s been recording all my incoming and outcoming calls ever since. It works perfectly. You don’t even notice it.

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Hopefully the test results won’t show anything abnormal.

Hi Jammer, Good point. The wait can be long to see a publicly funded psychiatrist (i.e. a medical doctor/specialist funded by OHIP, for example). I know that medical doctors can either “opt in” to the public plan or they must “opt out” of the public plan. They are not allowed to work in the public system and the private system. They also must have a medical license to treat patients where the patient makes his permanent residence (for example, an Ontario medical doctor must have a license to practice medicine in Ontario and can only TREAT Ontario residents even via telemedicine - however, the Ontario resident can be temporarily out of the province and I believe the medical doctor can be temporarily out of the province or even LIVE outside the province as long as he has a license to practice medicine in Ontario).

I didn’t realize there were private psychiatrists in Canada or Ontario and that they are readily available. I know you live in Ontario and most of the forum readers live in Ontario. It’s a HUGE issue to find a psychiatrist and many people would be more than happy to pay for one privately and their doctors would refer them if they knew who to refer the patient to.

Are you able to point out any Psychiatrists who work privately in Ontario? That would be a great service!

https://www.mooddisorders.ca/guide/guide-to-finding-a-doctor

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Sorry, I just know they exist and were readily available.
I looked into getting a private one years ago.
There was no wait at the time.

ACR phone call application?!
I need more details please LOL

ACR is an app for a cell phone that records phone calls.

This is not necessarily true. This is definitely a grey area of the law, but as long as the overall from work is continuous, then new conditions that arise can be included as part of the overall disability, even if they happen after claim begins. You would need specific advice for your situation, but I wanted to let you know in general.


David Brannen

Disability Lawyer with Resolute Legal

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