I was the employee contact for the plan and processed initial applications. I knew procedure, obligations and participated in treatment until it became detrimental to my health, I regressed to a worse state without the proper psychological treatment methods recommended by my regular treating doctor. Through internal notes on my file, my case manager admits to “dropping the ball” on not requesting an update from my doctor for 5 months despite my documented bi-weekly emails asking if they needed one from her.
My claim has a twist as well. Although the insurer initially cited non-compliance for lack of participation in return to work vocational program, it was corrected by a higher department that my benefits were actually terminated over a financial/responsibility dispute between my insurer and former employer (who had terminated the contract with my insurer to change to a new, cheaper insurer) Each asserting the other is responsible for my claim payment. This is an ongoing legal issue between them, but has affected my mental state.
At this point, my insurer continues to pay my monthly benefit, but my treatment is now private and paid out of my own pocket. As @David_Brannen recommends, I receive regular and consistent medical care with supporting written documentation from all the doctors and specialists that I actively participate in a medical treatment plan.