It’s the game they are playing. What we did was just to refuse to take or return any calls, send them official written documentation requesting ALL communication to be done via written means (we sent both emails and also mails with tracking & signature confirmation). At the time, we consulted a few attorneys and was preparing for serious legal actions if it becomes inevitable. Luckily, with the proper preparation as well medical expertise on our side, we were approved of LTD. The key to win these battles is to prepare it like a legal case. ie you need to do your part (protect yourself from getting “set-up” by them for fraudulent evidence) as well have the proper medical professionals (ie ur GP & specialist) indicating the reason to continue to support your on-going disability as well as compliance of the treatment.
In record your rehab program. Could you be more specific? is this a real “medical rehab”? like psychotherapy? physical therapy? Are they been referred by your GP or Specialist?
if yes, then continue therapy as guided by the medical team.
if no, (ie this is a “manulife” rehab), then you need to request approval from your primary treatment team as well proper medical “credential” of these manulife programs.
In regarding to your case manager’s “hassle” on insisting verbal communication & update, you certainly have the right to “refuse.” You have to remember, insurance companies are not your “Ally.” These case worker’s primary job is to find a way to “remove” or “wean” you off from their cost as a profiting company.
find support from your medical team and have them document the stress from dealing these insurance companies and your reason for written communication as a better & more effective mean.
consult attorney for assessment; that way, you get a feel which legal would you prefer if you really need one, and get a general understanding what you would go thru. (but again, legal sharks are not compassionate beings as well… their main interest is to profit from your case; ie pay up front or split part of your settlement)
** key point is to build your case like preparing it for court. do anything & everything that will help you. (eg we find talking to the case manager is like digging your own grave; case manager wrote her first report making up whole bunch of things claiming the client is actually recovering & doing well). after all, you are on your own, and all we can do here is to support you and provide our experience.
in addition, as the case manager spent more time with you, more reports can be constructed by them. so when all these reports add up over time (months, years) its weight gets heavier and can be reasonable documentation to discrete your claim.
we just end up not returning any calls, so they send us papers to fill (some for the docs; some for the client). phone conversation is just a trap for you to say the wrong things, and once you have said it, it has been recorded, and you cannot deny what you said in court. Unless you are 110% confident, you won’t make a mistake and will say things you “meant” to say, I would suggest to play it safe than sorry.
Thank you for your response Yumyum00. My case manager acknowledged the request for written communication but stated that the rehab specialist has to speak on the phone with me as a part of the rehab process. I replied saying that’s my rehab specialist can community through email or letters but again the CM stayed it is a requirement to speak over the phone.
I have spoken with a lawyer but because of my unionized position I have to receive support from the union which to be honest had not been helpful. I believe that my Insurance provider is counting on this.
My psychiatrist is telling me to take part in the Occupational Therapy as they will see I am not ready. He will not provide any documentation against it. My only concern with him.
I am currently in a support program through CAMH which has a weekly support group and individual therapy sessions.
I feel that the addition therapy my insurance provider is wants fine but not now. I am at my limit of what I can take and on top of that all of my medications have been switched. My therapist wants to see exactly what the Occupational therapy looks like and will follow up as both of us expressed concern as I see it as a duplication of support.
My insurance is simply pushing the return to work.
I am also looking into applying for Omers disability pension as I anticipate being cut off from LTD in January. I have been approved for their disability waiver until June/21. I believe any appeal with my Insurance company will take very long.
just record the phonecall. When the OT calls you could also rquest to meet in person…just not at your home. You do need to go through this process. The OT will discuss your meds, sleep and stuff. They will then decide if they think they can save money by offering you a rehab program.
If they do a rehab offer then take it to your therapist to review. If your therapist feels it is worth a try, then make sure he puts down as a trial and follow up in 2 weeks.
Hi Sean, your case is quite different from ours due to the differences in the nature of the illness. We were never introduced to go thru a 3rd party therapy program. But allyoops seems to have good suggestions. My general impression is that you have to follow your doctor’s treatment and guidance. If your psychiatrist believes OT can benefit you, it may not be a bad idea to understand what’s it about. Personally, with mental health illness, we find that medication can only help so much in the way to “numb” some of the symptoms, but the main treatment still comes from inside (ie strength and more strength). We practice meditation daily (1.5-2hr) and been to weekly long intense retreats. It is like a mental exercise that, thru our will & effort, we train to keep the mind focused on a good balance or energy (hence, train the mind not to follow negativity). CBT provides suggestion & group support, but strength & change can only come from within. Keep fighting…!! a path will be revealed for you.
So the OT from the Return to Work Program contacted me to begin the Program. I voiced my concern regarding the program. I did not refuse I simply stated that due to my medical conditions I am not ready for the program. I also emailed her supervisor the same information. I spent 45 mins detailing my current situation. The OT stated that she did not believe I was ready as well to begin the program and advocated this to her supervisor.
This was on a Friday evening and on Monday I spoke with the Treatment manager, OT manager, and I agreed to complete the first two sessions as they assess my functionality. The treatment manager stated that this could support my concern to the insurance company.
The next day I received a letter from my insurance provider that I was refusing to take part In treatment and as such I would lose my Ltd at the end of the month.
I attempted to contact my rehab worker, on vacation, so I called my case manager who stated that it was a fact I had refused the program as she had received an email from the rtw treatment manager who stated that I did not feel ready for the program and did not want to proceed.what the case manager left out was that in the same email the treatment manager stated that she would connect with her to discuss my concern. I contested this and she asked why I did not feel ready. I again stated what I had done previously that I was not on the right medication and was still experiencing symptoms of my disability. The case manager told me that people work who are not on the right medication. I was very upset and told her that this statement was a deflection and that no one else had any bearing on my health and ability to work. At this point I ended the call and contacted the treatment manager who followed up with my case manager. The treatment manager as amazing and stated that I was not a candidate for the program and never refused treatment and also indicated to my insurance that their program was almost a complete duplication of service to the one I am already receiving support from, CAMH, and that she believed I was still not on the right medication.
I contacted my case managers Suoervisr who apologized profusely for what had happens and put it in writing that I would not be cut off from Ltd at the end of the month that and that I would be assigned a new case manager. Suffice it to say I was shocked that she apologized for her staffs conduct. I am also following up with a formal complaint against the case manager and have requested a copy of my file to support the complaint. My psychiatrist has also provided documentation that stayes that I am not ready for a rtw program and this also included a depression and anxiety function assessment.
The manager asked that I complete the functionality portion of the rtw program. I agreed.
The OT completed the assessment and stated that her recommendation is that I be referred to the rtw program in 6 months to a year as I am not ready due to the symptoms my disability
This whole process really took a toll on my mental health and all happened as all of my medications were switched.
My change of definition is this January. I feel that it will be approved based on the whole situation and documents on form the rehabilitation program and my psychiatrist.
I would appreciate any feedback/advice and thank you fell reading my novel
I am glad to hear you got an apology. We are seeing this more often now in cases like yours where there as bad misconduct. We once were successful in a bad faith lawsuit for a very similar situation. I can’t discuss any details, but it is these situations where the claim manager takes an unreasonable view that the person “refused” the recommended treatment. I am glad to hear there was a happy ending for you in all this.
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.
So I was assigned a new case manager who, within two weeks, approved my change of definition. Thank you to everyone for your feedback and support. It made a real difference for me.
