Difficulty with Case Manager

Hello everyone

I have been on LTD with Manulife for just over a year and a half. I work with my GP, Psychiatrist, and a therapist. The therapy is a year long program and I have been connected for a little under two months. I am still trying to figure out the best medication, my psychiatrist is changing all of medications at our next appointment. I was contacted by my case manager who stated that I will not meet the change of definition this January. She believes I had been on the same medication for two years which is not true, she told me I was wrong three time’s when I told her that she was incorrect. As a result of this phone call she requested an update from my therapist which was provided as well a a report from my pharmacy for the past year. I received a letter soon after from Manulife which stated they were unable to determine at this point if I meet the change of definition. After this my Case Manager called me again and stated that I was to be given OT Reactivation therapy. I am not ready for this as I am still in therapy and I am still not on the right medication. My psychiatrist is very supportive and agrees that my symptoms have not been addressed that would allow me to take part in rehab at this point.

Sorry for the long novel but any advice/feedback would be appreciated. My case manager is very aggressive and I feel that she is not listening.

Sean

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Case managers will try and frustrate you until you give up at this stage. They pick cases for ‘frustration’.

You need to get a lawyer to handle your claim from here.

The case manager is playing this game, https://www.amazon.com/Delay-Deny-Defend-Insurance-Companies/dp/1591843154

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Thanks for the reply. Even though my change of definition is six months away you think I should connect with a lawyer!

I would try the free consult. You may need them later. Have you asked for a full and complete copy of your claim file yet?

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Well, it depends on what your condition is, do you plan on fighting for continued LTD?

If it is anxiety/depression you need to see a lawyer and have them handle from here. Go for continued LTD, and keep working on approving.

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I am off for Clinical Depression, Social and Generalized anxiety, and unspecified trauma disorder. I do plan on fighting for continued LtD past the two year mark

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I have not. I think I will

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First, I am going to reiterate what I have said before: This is why I do NOT talk to my case manager over the phone. I have too much anxiety and it puts them in a position of power over you. They know all the questions they are going to ask ahead of time and you don’t. It’s an unfair advantange, sort of like being interviewed by the police without having a lawyer present. They expect you to answer their questions immediately but sometimes my brain doesn’t work that way and I need some time to think about what I want to say. Also, via phone does not leave a paper trail but email does. You have proof of everything that was said. By requesting communication only via email or postal mail, you put the ball back in your court. I highly recommend doing this. Do not let them tell you that you can’t do this, you very much can. They might not like it, but tough luck for them.

Second, the 2 year deadline for mental health is a tough one and is often contested by these insurance corporations. There’s two reasons for this: #1) Mental illness is not something that can be “seen” and therefore it is easy to frustrate the situation by requesting objective evidence when it is hard to get, and #2) People with mental illness are far more likely to be in a fragile state and give up their claim or become overwhelemed (or kill themselves even). It’s sad but true but this is what the LTD company hopes for. If you have resolve you WILL win. Period. Your doctor, psychiatrist and therapist are what matters. The LTD company can say whatever they want but it is just jibber jabber. Document everything. If they are asking you to begin return to work or occupational therapy and you are NOT medically cleared to do it, then you need to get that in writing. Have your doctor, therapist and psychaitrist write a short letter saying that you are not medically cleared for OT and send your case manager this.

Coming back to what I said in #1… always remember that the case manager is not your friend. And you are not theirs. Do not be nice to them or mean, just be firm and respectful. Let them know you will not be itimidated or messed with. Eventually they will go on and find an easier target to pick on and you’ll be left alone.

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It’s a good idea. You can tell your case manager that you are not feeling well to talk over the phone and ask her to email you her questions. This is what I started doing after my case manager twisted my words. Now at least I have time to think about the answers and also my anxiety went down.

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Yes it is the best thing I ever did. At first there was resistance, they would say “We really need to do this over the phone, don’t worry, it will only take 30 minutes and they are just standard questions” but I refused. I told them there wasn’t any reason they couldn’t send the questions via email or post mail and accommodate me. It has resulted in a reduced contact level with my case manager. Whereas they used to phone maybe 5-6 times a year I now hear from them twice a year if that. I can take 1 or 2 days to respond and even have my wife proof read my email for me to make sure I am saying what I mean to say. It is the best thing I ever did. I think @David_Brannen could do an article on it. Of course some people (older generation especially) probably find phone much better and email to be uncomfortable, so in that case stay the course

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Yes, I think this is is a great article topic Adam and we will feature this topic next week on our weekly Q&A call.


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.

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Hi Sean, I encourage you to get a consultation with a disability either with us or another firm. The key thing to understand is that the insurance company has a process or formula they follow as people approach the change of definition. It is like a train that does not leave the track no matter what you or your doctors say.

They best thing you can do is to handle it in a way that maintains your credibility because in situations like this a denial at the change of definition may be inevitable. However, this does not mean it cannot be reversed and your benefits approved soon thereafter.

Hang in there. this is a common situation but you can overcome it.

David


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.

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Sean, I am a big advocate of people educating themselves and getting advice as early as possible. Contact a law firm that will focus on educating you about ALL options, not just selling you on hiring the firm. Also, some lawyers will offer to help at the internal appeals stage (where you are now) rather than only waiting ot get involved if a lawsuit is filed. It is not common for lawyers to get involved at this stage but we are strong advocates of it because it will cost you less in the long run, and we have had good success in helping people win internal appeals (before lawsuit).


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.

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Thank you everyone for your feedback and advice. Unfortunately because my job is unionized, I have to receive support from my union and can’t receive support from a lawyer.

I definitely see the game my case manager is playing and will have all further communication through email or mail so that I have a paper trail. Thank you, Adam and Elaine, for pointing me in this direction.

Thank you David for your advice and insight. It really heps

Sean

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Hi Sean,

We recommend that you have all your interaction with Manulife in writing instead of phone calls. Their case manager has been known to document your conversation and use as written evidence of your progress. Whether the report support or disapproves your claim, it is not up to your discretion, and you may find discrepancy between what your said (memory) vs what the case manager actually types out.

We have been doing all interaction thru written means (ie emails or mails) and we have declined to speak to any non-medical personal for whatsoever reason just so they cannot type up some report based on that case manager’s impression (ie non medical expert).

Vocal interaction without consented recording can lead to a lot of mis-communication, manipulation, or mis-remembering things. If you plan to take legal action eventually, it is the best you have every thing written & recorded.

Good luck…!!

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I have sent an email stating that all further communication be in writing.

I do intend to challenge the change of definition.

Thank you everyone for your support

So I sent an email requesting communication through email or mail. My case manager replied through email stating she was acknowledging my request but stated that my rehab worker would still need to communicate through telephone.

I replied stating that I can provide information through written communication to her.

I do not understand my case managers rationale. She can communicate as per my request but not my rehab specialist? She can get all information/updates through email.

Any feedback or others experience would really help

Do you have the rehab person’s email? I would email the rehab and request she/he contact you through email.

My advice is to record any meetings or conversations so you can make accurate notes later on.

I don’t have an email, only a phone number.

In my original email to my case manager I was specific saying all staff from the insurance company.

I don’t think it’s hard for her to send an FYI to my rehab worker.

I never thought about recording my phone calls. I have never done it on any phone call in My life but I am sure there are apps to do so.