I am diagnosed with agoraphobia, panic disorder, and CPTSD. My doctor suggested I go grocery shopping with my parents as a form of exposure therapy. A few months later I get a call from my insurance company saying they have video of my walking into a grocery store. They said it contradicts what I told my doctor and what I wrote on my ltd application form. Is there any way I can fight this ?
I’m sorry this has happened to you, it is hard to get this kind of communication from the insurer. However, I would think that you can nicely and calmly explain to them, perhaps in an email or letter, that the video information they possess does not actually contradict what has been documented about your illnesses. You do in fact have challenges going places and with your anxiety symptoms etc etc, and that you are monitored and treated by your medical doctor/team. Upon their recommendation to try shopping a bit with people you feel safe and/or familiar with (your parents), you went to the grocery store. Perhaps. you even try to go yourself, and slowly get this exposure per the medical doctor recommendation. Unless you have said that you never leave the house, and you will never again leave the house for the rest of your life, it is not a contradiction, it just needs to be explained to them. I hope that helps and perhaps others can make some suggestions for you as well.
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I did made in writing I never leave the house will that be an issue ?
Yup, get your doctor to write a note to them that you did it under her/his instructions and it’s part of your treatment plan.
I think case law shows that insurers using video surveillance just usually backfires on them.
I wonder if it was a trap from my doctors part. Since how would the insurance surveillance know when to follow me around.
That would cause your doctor to potentially lose their license to practice. I’d request your claim file from the insurer if I were you.
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@tylerunnsteins
If the insurance company is skeptical of what you’ve been telling them and decides to put you under surveillance, they can keep you under surveillance for several days, weeks or sometimes even a few months (according to one article I read by a law firm). I know someone in the insurance industry and that person told me that usually it’s for an entire week or two.
I agree with Buckets365. I would ask my doctor to write a note/letter explaining that they recommended that you go to the grocery store for exposure therapy, and also request a copy of your complete claim file.
Going forward, give your case manager updates whenever there’s a change in your functioning or your treatment plan.
Also avoid using absolute words such as “always”, “never” to your doctor or insurer. You may have good days and bad days so it’s ok that your symptoms fluctuate. On a good day, you could go to the grocery store but on a bad day, you may be unable to get out of bed.
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Good advice @sunrise.
When completing insurance assessment for Activities for Daily Living, I use generic statements, similar to:
I can, depending on mood and energy, walk, talk, eat, write, display emotion, shop, visit friends or family, cook, craft, garden, among other minor household tasks.
Hth
How does the insurance get skeptical of the patient? What triggers the surveillance?
What was the outcome of the therapy plan? I would also discuss how it (I presume) failed to desensitize you or how the treatment is progressing.
I still get panic attacks at the store
Insurance companies will be suspicious of any condition that has subjective symptoms, that cannot be proven with objective testing such as blood work, imaging (xrays, MRIs etc) . In particular, mental health claims for anxiety, depression etc without any other comorbidities will be seen with skepticism. They will also look at what psychiatric medications and treatments you’ve tried and whether you’ve had psychotherapy/counselling etc. Basically, they will look at what you’re doing to get better.
Usually before they conduct surveillance, they will send the insured an activity form where you have to fill out your daily activities for a week, and then they send an investigator to follow you around the following week.
However, in your case, since you had already told them you never leave home, your insurer sent an investigator to verify if that was true, without necessarily asking you to fill out an activity sheet.
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why did the insurer send an investigator without sending me a form to fill out ?
Just my guess but they didn’t need you to fill out the form as you already told them you never leave home. So they were basically checking if that was true and if not, where you go when you do leave home.
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My doctor wants me to get more exposure therapy and suggest I go shopping with my parents. Do I have a right to refuse ?
You need to follow your doctor’s advice for multiple reasons.
If you don’t follow your doctor’s advice the insurance company will have more cause to end your LTD payments.
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Why would the insurance have a reason to cut you off for not following treatment?
Because all LTDs policies are contracts. And every LTD contract says you must be getting reasonable treatment.
I pretty much guarantee your insurer will end your payments the moment they find out you have decided not to follow your doctor’s advice.
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What about pwd odsp or any provincial disability income assistance program ?
You would need to look up the requirements for those programs.