Do we have a say in 3rd party provider for rehab?


#1

Another issue I am dealing with. Hope you can help.

My wife is being recommended for a third party treatment plan that is not in our current city, but is within our province. I have looked at the reviews on this company, and they are not very good. The treatment recommended is basically ACT therapy and physical fitness for treatment of fibromyalgia/MTBI. She has been off work on LTD and CPP for several years with depression/anxiety caused by chronic pain and fatigue. I am assuming, since they are not nearby, that she would have to complete most of the programme on her own . We don’t see the benefit to self learning and its causing her increased anxiety and anger. I know there are companies in our city that provide these services - and are much better reviewed that the other company being forced on me by the LTD insurer.

Do we have any say in the programme provider? Someone closer, that could provide daily/weekly supervised treatment?
Can the insurer force her to travel 5 hours to attend monthly meetings? I can’t attend with her due to work.
Do we have to allow their employee into our home to provide services?

Thanks
Steve


#2

My husband went through rehab hell and if he was better he would (and still might) file a claim against his Insurer and the providers.
Your insurer can likely request that she be assessed. Any treatment providers funded by your Insurer are her treatment providers. They are ethically and legally bound to her best interests-they likely will try to have her sign very sketchy forms to attempt to wiggle out of that fact.
I would wait for others to comment.
My advice is never allow them into your home, politely let them know it is your private space and you will meet them elsewhere ( coffee shop, library, office and such)
Request in writing why they have chosen this company to do the assessment given the location. Let them know how hard it will be for your wife to manage that.
Ask for the credentials and CV for each provider prior to any appointments so you can review with your wife’s doctor and the proposed treatment. They must have outstanding CV’s to warrant a 5 hour commute.
Ask for all authorization and other patient forms that the rehab providers will require to be filled out. You may need to review those forms with a lawyer.
Ask for a copy of the referral provider agreement between your Insurer and the providers.
Wait for them to respond and go from there.
Also ask for the Master Policy as your obligations are spelled out in the contract.
Ask for this information to be sent quickly so as not to cause any delays.
Ask for a copy of the claim file

You are not powerless but must must always be polite, respectful and honest.

Given the fitbit garbage and a 5 hour drive for treatment-you have a right to think somethings up.
No matter what your wife can not attend these appointments alone. Friend, family-someone must go.

Anyone providing medical treatment has entered a provider-patient relationship and are bound by that. ( They like you to think otherwise)


#3

She must cooperate and participate in getting better so it is again so important that she does nothing that looks like she is refusing a recommended treatment. Is her doctor supportive, who has medically cleared it.
Ask her doctor if the 5 hour commute would be harmful or not recommended for her.
Take it to her doctor and if the end of the day she has to participate, have her doctor clear her for like two weeks and then see how she is doing.
She has a right to any treatment providers reports and her medical charts/clinical notes.
Surveillance is common around rehab time too.
Not sure if your wife has benefits but maybe she could get “her own physio and psychologist” Therefore she is trying their recommendations. Also you can request to video tape the appointments for everyone’s mutual benefit.


#4

Sorry to hear about your situation - we see this all the time.

The rules regarding “who chooses” the rehabilition providers are set out in each insurance policy. The rules for your wife will be different than others because no two insurance policies or disability plans are exactly alike.

That being said, most LTD plans and policies are worded in a way that allows the insurance company to choose the rehabilition providers. So in answer to your questions:

  1. No, you really don’t have a say in the rehabilition providers. If you want to keep disability payments, you need to go to the providers they choose.

  2. Yes, you can be made to travel up to 5 hours in some circumstances. They would need to pay her mileage and hotel stay. You would need to consider all options to get a friend or family member to go with her if necessary.

  3. You don’t have to allow their employee in your home. Offer to meet them elsewhere.

It is critical that you go above and beyond to follow all the recommendations and treatment laid out by the insurance company. You don’t want to give them the opening to terminate the disability payments because you are “not cooperating”. Better for you to jump through all their hoops and if they then choose to cut off payments, you will be in a very strong position to appeal your claim.

You always want to be able to tell the judge that you did everything asked of you and still they wrongfully cut off your payments.


#5

Please request the providers forms ahead of the appointment. My husband was presented with a statement of indemnification and Waiver and Release for physiotherapy. They wanted him to surrender all defenses if the physiotherapist and clinic decided to sue him. It also waived all responsibility for all clinic and staffs gross negligence, up to and including death. He still participated and cooperated with all other requests. His Insurer had joint planning meetings and lots of reviews on how he was not cooperating and were preparing to cut off his benefits.All because he would not sign the waiver.
Physiotherapist also wrote a false report and made accusatory statements.
We recorded everything and his benefits at this time are still ongoing.
We openly recorded the physio, but secretly recorded the rest. If we had not done so he most likely would have been cut off. Lawyers, including Mr. Brannen strongly advise against recording. I feel the other way.
Go with your gut.


#6

Yes, you should absolutely never sign a waiver against negligence for any treatment. I question whether it was a violation of the physiotherapists’ professional responsibilities and ethics to even present your husband with such a waiver.


#7

My husband was suppose to be there for post-op treatment ( he was six weeks out of surgery) but from the report it was a functional assessment and treatment. Then to move to work conditioning and finally to work hardening.

If he signed the waiver and the clinic was negligent and harmed him, in signing the waiver his disability insurer could also cancel benefits as he has a duty not to waive subrogation.

He plans to file a claim, but his health may not make it possible.

To Steve, these are not 3rd party treatment providers. Where an insured is referred to a treatment provider, the providers primary duty is to the insured. That is so even though the provider is paid by the insurer.
I would also print off and send the negative reviews on the proposed clinic so you can show why your wife has concerns.
Also you can ask for all of the forms, and other info on my previous post and honestly say someone who is also on claim suggested to do so.
Stay humble and cooperative. Good luck


#8

Thanks for the information David. This forum is excellent.

My wife had her first rehab appointment on Friday. They essentially gave her an ACT book to read on her own and have given her two daily logs to fill out to track her daily activities (exercise, sleep, reading, etc). They expect her do perform the same activities every day at the same time. They are very secretive on the plan going forward. The time logs has made my wife very anxious and I think it will set her back. She functions OK on her own schedule but sleeps a lot due to chronic fatigue and pain. They backed off the Fitbit request but want to attend the gym with her once a week to watch her exercise.

We have a followup with her psychiatrist this week to get his feedback on the treatment. From a legal standpoint, is this type of time tracking actually considered rehab or therapy? I think they are just gathering evidence against her to cut her off. My wife is too trusting and thinks its OK but at the same time she’s become very anxious about being on a schedule.

Your thoughts are greatly appreciated.

Steve


#9

My advice is to be as cooperative as possible. Do what is asked unless your own doctors take issue with the treatment. Don’t try to sabotage the treatment program even tough you may not believe in it. You don’t want your benefits terminated on grounds that you didn’t cooperate. This approach is even more important if you think they may terminate benefits after the treatment is completed.


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 reliabile 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.


#10

During rehab there are three main ways Insurers look to cut you off benefits: 1. failure to cooperate/participate
2. failure to comply with medical treatment ( hence the same day/same time workbook) 3. Not consistent information provided by the claimant ( each provider will be shocked that your wife said something to them and something different to another provider-they are trained to look for inconsistencies and if not found the truly unethical will just be inventive)

How can your wife give informed consent if everything is secretive?

They misinformed her about the master policy. They are secretive. Why would you trust that?
Make sure she discusses the stress and impact this is having on her to her psychiatrist.

David is right that she has to be as cooperative, polite and honest throughout.
As her treatment providers they have legal and professional obligations to her. Including giving her directly copies of the medical reports and all clinic notes/charts on her.

In a few weeks she should ask for her claim file. Bring the schedule to show her psychiatrist. Maybe see if there is some extra anxiety meds to help her get through this time.
She should not go alone, Document everything.

It is treatment/therapy–who are the providers? i.e. psychologist, occupational therapist, physio? Look up there codes of conduct/regulations?
Did they have her sign a waiver promising not to hold them responsible for negligence?


#11

Steve ask the psychiatrist or her doctor to refer your wife to a pain clinic and a pain psychologist. Through the public system there is usually a long wait. Maybe a physiotherapist too.
She has to cooperate as fully as she can but they have obligations also.
If it is Odessey Health then google Dr. Richard Marlin on RateMD.


#12

How is your wife and the rehabilitation going?