I have been off of work once 2015 due to right side hip/leg/pelvis/flank and liver pain and nausea and vomiting (amongst other symptoms). As a result of ongoing symptoms and very little help medically (I live in northern Canada where everything seems to work a bit slower here) I ended up in the hospital last July for mental illness symptoms. I am constantly in so much pain and distress physically that I get depressed and anxious more than I normally would.
Long story short, recently a medical consultant from my insurance company contacted my psychiatrist to discuss a diagnosis of Somatization and returning back to work. She did not consult my family doctor or specialist or even therapist to discuss. Not one of them agree with her and think that something is going on medically. I want to know who is the person that has the say to clear me back to work? Is it my family doctor? There are things going on with my hormones (possibly PCOS which if I have could have caused my anxiety and depression ) as well as my liver. All medical has not been ruled out. If I originally went on disability due to physical symptoms can they just slap this diagnosis on me and close my claim or does my family doctor have to be consulted?
I should also note that I’m still waiting to get with a liver specialist and neurologist but in my community they only come up here a couple times a year and wait lists are long. I did reach out to my disability manager asking if there was anything that they could do to help me - I asked last year but nothing.
Somatoform Disorders can lead and can qualify for long term disability. They can not just disqualify you because the Insurer believes your physical symptoms are psychiatric. I mean what came first-the physical symptoms or the psychiatric symptoms? No one knows yet-so anything is really just an opinion.
I suggest you make a list of all the objective tests that you have done and what the proven history is.
Also make a list of all your subjective symptoms. Make a list of upcoming medical specialist appts. and such.
When you look at both lists what prevents you from working-now make that list.
Talk with your therapist about how to cope with the stigmatization and having to prove yourself-ways to cope with that added anxiety.
Did your psychiatrist say you can work? The Insurer is looking for a way out of your claim. Good documentation will be your best defense.
Thank you for the response. I was diagnosed with depression and anxiety in my 20s and have been on meds for that since. When I started getting sick at the end of 2014 I thought I had the flu. I couldn’t keep anything down and had no appetite. This along with a bunch of other symptoms is why I was put on the disability claim in the first place. The doctors have yet to figure out why I’m vomiting and having such nausea but I have tests that say I have fatty liver and capsular distentsion which could contribute. Also my diabetes has been out of whack since being sick and vomiting doesn’t help. I can’t work or do much due to the fact that my nausea and vomiting is sporadic and out of control, I have bladder issues, the right sided pain that is under my breast which goes to the back and down my flank (I haven’t been able to wear a bra in over a year), I also have osteoarthritis in the hip and the list goes on. I filled out all of this information in the CPP papers this spring - they have that information on my limitations.
So in more detail my psychiatrist got a call from the medical consultant and he discussed diagnosing me with somatization - which she agreed with without consulting my doctor or specialist. Because of this diagnosis he wants me to start an activation plan to get back to work. I forgot to mention that this year I was diagnosed with Borderline Personality Disorder in the spring and then about 2 months ago with Bipolar Disorder. So for the BPD I was waiting to take a DBT course which started this month. DBT is a 7 month course. According to the letter I received my psychiatrist assured my insurer that I can complete the course and start the activation program. She deemed it feasible. I barely leave the house now with my symptoms because I have no control over what’s happening health wise at this point. I have mobility issues. I’m still adjusting to the meds for my new diagnosis and still adjusting to the diagnosis.
She also apparently recommended alcohol and drug services for my Marijuana use. I started using Marijuana in 2015 after there was nothing that would work for my nausea and vomiting. I tried different pills for it - still do - but Marijuana was the thing that worked most consistently. I have been open about it with every medical professional that I see. I have enquired both from my family doctor and my psychiatrist as to how to get my medical license but they just referred me to each other. As for my usage it is less than last year and at no point did I know I was at risk for having to go to alcohol and drug services. They want me to do a 30 day inpatient treatment which my family doctor, specialist and therapist think is ridiculous and grasping at straws.
I have been doing everything I can do to advocate for myself and get help. I feel like I’ve fallen through the cracks of the system. I also had to change my doctor recently because the last one I had kept cancelling and rescheduling appointments, did not fill out the referrals discussed amongst other things. So my new doctor has only seen me a few times but he does not agree with somatization either but he doesn’t want to step on any toes and doesn’t think he can be of much help with my insurer. Is he the one that’s supposed to clear me to go back ?
I would also like to say that my mental illness wasn’t a part of my claim until I admitted myself to the hospital last year for safety. I wasn’t getting much help and I just kept getting worse. Mentally it broke me down- made me more depressed but I think it was a reasonable response considering what I have been through. I feel like they’re just trying to end my claim and my psychiatrist didn’t help - was she allowed to do what she did without consulting the rest of my medical team?
Surveillance is when the insurance company video tapes you so they can “catch” you doing something that they think you shouldn’t be able to do.
It just means they are preparing for a lawsuit.
What your doctor says is the ONLY thing that matters.
Are you positive that your Psychiatrist advised you could do an activation program-this is usually exercise and cognitive psychology or PGAP. Or it could all be included in the 30 day treatment.
Make an appointment with your Psychiatrist to get the details. Request your complete claim file from your Insurer.
I understand the pot use-but without a medical license you are on shaky ground by using it.
If your psych agrees with the plan-that means you likely will have to give it a try-unless your psych did not agree and the Insurer is fudging facts. Which can happen.
When and how is this all to begin? Have you looked up the treatment center?
Yes it says it in the letter and she told me that she agreed with the consultant. She basically said "you’ve had a lot of tests that’s have come back normal right? " when I questioned everything. The letter said that she agreed that it was feasible for me to do the DBT program, the inpatient program and this activation program. I was actually going to the hospital 2 times a week for IV fluid and gravel because I am throwing up so much and it was causing dehydration. I started last October and I had to stop a couple of months ago because I got phlebitis and the doctor in the er said if I continued the treatment I would probably die because my body can’t handle it. That was the only treatment I was getting and it was helping a bit so now I haven’t had any treatment in a few months so I’m having a lot of flare ups.
At the point I’m unable to do any sort of exercise. I’m mostly at home and in bed in pain or dealing with my other symptoms. When I do try and push myself I’m out for days so my doctor was advising to take rest and try walking for 5 or 10 minutes a day but not to push myself so hard. It’s hard for me to do much when I can’t eat or my sugars are unstable etc. So for my psychiatrist to say that this is all feasible is very wrong. My other care providers agree.
I want to go back to work and be healthy but I need treatment of some sort to at least minimize my symptoms to the point that I’m able to do things . Mental health agreed and assigned me a nuse advocate. Mental health is questioning my diagnosis of depression and anxiety because PCOS as well as other medical conditions can cause this and not everything has been investigated. The nurse advocate has put together a package with their concerns as well as a list of my symptoms and CPP application etc. They have sent this to my psychiatrist, doctor and specialist . With everything that is going on they do not think that what my psychiatrist has recommended and agreed to is not feasible at this point. They also think that a treatment plan has to be put together for me to help me to get to a point where I can start recovery. So of there are conflicting opinions will the opinion of my doctor over rule that of my psychiatrist?
Also according to mental health since I’m a client with them if there were drug and alcohol serices needed I would do it through them and not through the rehab Centre. Also it is conflicting for me to be able to do DBT and an inpatient treatment program since I wouldn’t be able to attend DBT.
I’m super overwhelmed with everything and reached out to try and understand where I stand and what to do. Thanks for all of the replies; it’s much appreciated.
This is supposed to happen beginning of October and which treatment centre? The one for drug and alcohol or? I’m not very familiar with the activation program and no one has really explained it to me.
Kudos on having a nurse advocate! If you have documentation that goes against what is being proposed then you are in a much better position. However the Insurer, even with all your proof, may view any refusal to participate in their plan as unreasonable and terminate benefits.
Is it possible for you to be referred to a new psychiatrist? I would also advise getting a notebook or you can google pain diary and there are sheets you can print off to daily track your activity and symptoms. Use a scale of 1-10 to track pain and fatigue -and just note any activity or non activity by the hour.
The diary is not only good proof-it is an excellent source of information for your health providers. It also helps you to learn how to manage and pace yourself so you can limit the flare up.
Do you have any coverage for physiotherapy through health benefits or through the hospital. It would be in your interest to give physio a try–before the Insurer assigns an activation program!
You say you are not doing any treatment.
Treatment is taking medications, seeing a mental health professional, regular Doctor appointments and such. Let the nurse advocate and your Doctors send in their opinions. Watch what you say right now to your Insurer as you don’t want them to say your are refusing help.
Generally, the court will weigh the risk to the plaintiff in participating in such a
program with the potential benefits, and require evidence that the proposed
rehabilitation program has a good chance of success. Therefore, the related
provisions of the long term disability policy and the factual basis prompting the
insurer’s request should be carefully reviewed.
Some policies afford unilateral discretion to the insurer to determine the
appropriateness of a rehabilitation program. This does not
mean that the insurer can act unreasonably when exercising its discretion, and in
fact to do so could arguably provide a basis for a bad faith claim.
Because your psychiatrist agrees with the Insuer—you will need strong documentation from your other providers on why the proposed plan is not feasible–or you can offer to try for 2 weeks and then have the plan and your health in relation to the program reviewed.
Personally I feel that the majority of time the Insurer is using these programs as a way to stack the claim file against the Insured. Especially when there is a high chance of a very long term claim and the claimant is under 50
I guess I’m doing treatment then because since I’ve been sick I’ve seen a doctor at least once a month (sometimes more), I’m doing counselling and seeing my psychiatrist. I’m going for all of the tests and following through with referrals. I also did an anxiety course through mental health and I’m doing DBT now.
I wish the insurer would see that I’m not refusing to do treatment it’s that I’m not physically able to complete what they’re asking of me right now. Not until my symptoms are better managed. It’s super frustrating to say the least.
They have said in the letter that I am to let them know where and when I will be taking the alcohol and drug rehab and they have not said anything more about the activation plan like where it is or even what it is fully.
Not sure if you read this article but I think it is relevant to your situation and what your Insurer may be up too
Quote: When all else fails, insurance companies will seek to blame a person’s disability on mental or psychiatric problems, even if the person has no history of mental illness or psychological problems. What happens is that the psychiatrist agrees that the person is disabled, but that he or she will be able to achieve a full recovery with the right psychiatric or psychological treatment. If the claimant and his or her doctor disagree with this assessment, then the insurance company can argue that the claimant is failing to seek the appropriate medical care,