Insurance company denied me short term disability benefits

I’ve been dealing with depression and anxiety for most of my life.Ive been on meds for it from my doctor.Anxiety is a result from the job I’m at.Its a very large company,very fast paced work the company does not care about you,only how much money they make,they treat you like crap,it’s not unionized,it’s basically like a prison camp there.If you make any mistakes there at your job you will get written up,and corrective action.Its very stressful there.I get panic attacks there,I was on short term disability last year for my anxiety,and off work for the same reason again now.My insurance company denied my claim because the information they have does not support or explain why I would be totally disabled from performing the duties of my job.They said to be eligible for benefits under my plan,I must be considered totally disabled due to an illness or injury that prevents me from doing my job.
They said they don’t have enough clinical findings,symptoms or treatment that would support functional limitations of the severity that would prevent me from performing the essential duties of my job.
The insurance company also said the primary reason for my absence is due to work related issues rather than an illness.
The company would not let me go to a less stressful area,they would rather have you quit.
I can’t sleep at night,my doctor has helped me send reports to the insurance company,and they still want more documentation.Its stressful just dealing with the insurance company.
Any suggestions would be appreciated!

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I hope your doctor is a psychiatrist. A regular family doctor GP is not good enough. In addition, the psychiatrist should have some experience dealing with insurance companies.

It is a good idea to start seeing a psychologist as well. You may have to pay out of your own pocket.

The above should help your claim.

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Can the insurance company ask for detailed information about my counselling sessions?

Based on my experience they do ask but my therapist does not give up his notes without a court order. The insurance company can send a form directly to your therapist.

What form is this?The court order to my therapist?

I asked my social worker and she said she would only give a summary of notes to a court with a court order.

Insurance was paying for it (through my group plan from work) and it was unrelated to my disability claim.
If it was related to my claim then it would have been interesting.
Since they were paying, I would think they can get it (after going to court).

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You do not have to accept the insurance company’s conclusions in a case like this. If you have the support of your doctors you can appeal this decision. Sometimes all that is necessary is to have your doctors clarify things, but in other cases the insurance company will not accept your doctor’s opinion, and you may have to convert your appeal to be done by lawsuit if that is an option for you.


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.

I have appealed this…I asked the case manager of the insurance company for a copy of my file,she told me to fax a letter requesting it and I did.She told me it takes about a month to get it,which I think is a long time.
My psychologist is going to write a report,and if I get denied for benefits I’m seeing my lawyer.

Not sure how long you have been off but you could try filing for EI sickness benefits while on appeal.

They will most likely turn down your psychologists report.

I went through 3 submissions from my GP and 4 from my psychologist.

Then I decide to sue. I had an accident case open, so I am using the same lawyer.

I received a lot of good advice here.

Next is discovery. In a turn that they were not expecting, I asked to discover the case worker. I plan to grill her with questions on training related to claims. Who oversees her responses? Then discover that person(s). Then make complaints if they violated their professional code of conduct, i.e. Their psychologist refuting my psychologist for no legitimate reason.

Most people do not have the time, resources or inclination to go this far but I will.

I will refuse all settlements, pushing for trial. As in settlements they will try and beat you down more.

In a trial, all can be brought out and used against them by future claimants in other trials.

In trial, you may be able to ask for other damages as to how they treated you and managed your file. Keep evidence, have witnesses, record conversations if necessary.

Make sure your lawyer follows their code of conduct on service, timelyness and communication.

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What do you mean by discovering the case worker?What questions did you asked about training and who overseas her?I could use all the help I could get,the case manager is hard to deal with.

My social worker is overseen by a psychiatrist.

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I hope it goes well.
Best of luck.

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“Discovery” is the legal term for the right each side has to receive documents from the other side and do recorded interviews of certain people “under oath”. The insurance company has a right to interview you (the claimant) under oath and the you have the right to interview a representative of the insurance company under oath. This can be someone appointed by the insurance company, or in some cases the actual claims managers as indicated by the person above. It is always a strategic decision on whether to do discovery interviews with insurance reps, in some cases it is better to not do discovery and to save it all for trial. Sometimes a discovery just gives them a test run and they can then try to fix their answers for the trial. On the other hand, sometimes the interview is needed because you need certain admissions to prove the case. They key point is that you should always have a strategic reason to do the discovery interview.


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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Personally I would try one appeal and then get a lawyer.
Depending on the situation I might just get a lawyer on the first denial.

Insurers often force an appeal and will deny with an option to re-appeal again.
They do this to financially starve you, hope you trip up and exaggerate, or to run out the time limits to actually sue them.
If you have a denial and have medical support for being off work a lawyer brought in quickly can get you back on claim faster. It also sends a message to the Insurer that you will not give up.

Unless you really do your homeowrk and understand the claim game…a lawyer brought in earlier can save you in the end.

Best of luck!

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I am trying to appeal my claim.I saw my doctor and psychiatrist yesterday and they will be giving me letters for the case manager.Im getting EI in the meantime,but barely getting by.
What do you mean by trip up or exaggerate?
If these reports still deny me by my insurance company I will be getting my lawyer.
Thank you Ally&Jammer for your help,I appreciate this!

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I think trip up is saying you can’t lift something and then them having video of you lifting stuff.
Don’t use absolute wording, use “often”, “most of the time”, etc.

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Depending on the reasons for denial, it may make sense for you to appeal again on your own before getting a lawyer. It really depends on the context of your situation and the reasons for denial.


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.

Well, my lawyer will discover the case worker, during the discovery process of the case. This means we will load up on a lot of questions. When an appeal is turned down, there has to be documentation created by the insurance company as to why, I need to get this, then also, discover any psychologist on their side who refuted my psychologist. I will see if it is objective, and if not make a complaint to their professional association, in relation to their code of conduct on objectivity. Many of them are trained this way, I am hopeful to get training documentation that verifies that they must refute, refute!! Time to turn the tables!! I work closely with my lawyer as I am a knowledgeable person and professional. I take care to know as much as I can of my own issues to make sure they are handled properly.

They will try, but I know my psychologist would only send a report that did not include ‘her’ notes.

The insurance companies know this, that is why they ask, so they can then turn down an appeal because they will not give up their notes.

Now, when you case comes around, your lawyer would request these, and they would be available for court. That’s why I gave up dealing with them and sued!! They will keep screwing with you in many ways.