My advice is to first say from my notes we spoke on this day and you advised…
Only if challenged then due to your injury/illness you were taping just to be sure your notes were correct.
Try to hold off on the fact you were recording unless you are pushed into a corner.
Absolutely, I would never disclose that I’ve recorded a conversation unless as you’ve stated they attempt to challenge what was said. My understanding is that they also record the conversation so would I be ask for copies of that in the event there is a discrepancy?
They might not be recording. Have you received any benefits or have they just been giving you grief? To get a clear idea for the denial I would ask for a copy of the complete claim file to review.
I would also send in the medical information/claim form for your surgery to get some funds coming in. Politely request your claim file and then you can see what they have received and compare to what you have and sent.
You should also request if they could provide in writing the reasons for your claim so far not being approved. Let them know how much you are struggling and if it is make your health worse, make sure you make your Insurer aware.
I haven’t received any benefits yet, they’ve pretty much been stonewalling the entire time (going on 4 months) despite all the information I’ve sent. They claim to not be in receipt of document, however when I mailed them they were sent registered mail and I have a notice of each one received and signed for. I did request a detailed outline for the denial following my conversation last Friday. My concern is that the case manager has been quite slow to respond in sending out letters. I never intended to get to the point where I would even need to apply for LTD, I initially was signed off using my own sick time (I had 5 months worth as I rarely used any) with the intention of returning. It wouldn’t be a stretch stating that I’m struggling a great deal since the denial as it’s created a great deal of stress and anxiety not knowing how to move on this. I will take your advice and request the file they have so that I am better able to ascertain what they actually have. Thanks for the suggestions.
If I am reading this correctly, 4 months is a long time for them to leave you in limbo waiting for a decision. If you are in an appeal situation, check our our resources on how to do your own appeal. We have videos and articles and I cover this in a chapter in my book. Be aware of deadlines for lawsuits if your appeals while go beyond one year from date payments stopped or the first denial date.
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 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. Answers from lawyer moderators are provided for informational purposes only, you should consult with your own legal counsel before taking any action that could affect your rights or legal obligations.
Have you received benefits yet Kevin?
I’ve been denied for the usual reasons (lack of medical evidence) and the case manager was attempting to indicate that my doctor had not sent in forms she requested. One of them being a surgical report from the orthopedic surgeon and the prognosis. I stated that I could send them to her immediately as I had copies, however this seemed to catch her off guard and she replied that my doctor needs to send them. The rest of the conversation made no sense especially when I played it back and transcribed it verbatim ( I record all calls as my recall of conversations is compromised due to my PTSD, depression and anxiety) I spent over 29 years working in a unpredictable violent environment where I’ve been assaulted numerous times resulting in broken bones, lacerations and even been stabbed once. I’ve witnessed suicide attempts and multiple violent acts perpetrated agains others. I was so annoyed with the case manager, firstly for the outright denial followed by intimations that I was not struggling as much as is suggested. This despite a psychologists, psychiatrist, mental health counselor and my doctor all in agreement to the diagnosis. .I haven’t posted much on her however I check in once or so per day as I find it extremely informative and want to thank you for sharing all the information.
I’m sorry that your Insurer is still not cooperating. Not sure where you are at in your claim but often filing an application in court claiming a declaration that you are totally disabled as per the policy and a claim for benefits is a simplified route and you can look at options such as legal aid, free law clinics and such.
In Manitoba for $5 you can request anyone’s court files-then you can see an application similar to yours so you can prepare and try going on your own into court.
My husband is suing as self represented under our simplified procedures (claims under 100K) but we have a fantastic lawyer (but not cheap) on speed dial if it gets out of our league.
I will let you know how recording calls and “the treatment providers” goes. We recorded because we were scared they might lie,
And wow did they lie!
I requested and received a copy of my file by email, it was full of inaccurate information (thankfully I recorded calls) with wrong dates such as July 2017 and on. I was frustrated to the point of giving up but have since hired a lawyer to assist. I’ll keep you posted.
2 Likes
That’s why I always say get the claim file. A good case manager documents fairly but ones that likes to close claims quickly to demonstrate productivity always have BS and inaccuracies. For those who do not record their calls and find inaccuracies (BS) in the claim file-you can send in corrections.
If anyone does not like recording then you can email or fax a letter documenting the call and what was discussed so you know it is accurate.
Hope all is well Kevin! The legal process takes time but so many give up! Hang in there!
Thanks, it’s hard to remain positive especially when expenses keep piling up. I did have a visit with my Doc today and while supportive she asked me what my plans were regarding work (I’m still considered and employee) and my future with my employer. She did provide me with another note, however stated that we would have to explore another game plan as I’ve been off since July of 2016. I’m not sure if I should just bite the bullet and attempt a return or not but I know that if I did I’d just be back at the same place I was when I left. Other option is to resign…will this affect my LTD claim is not clear.
Kevin, I urge you to seek confidential legal advice before making any decisions around your employment. If your disability claim has not been paid, you need to think about options for suing them or other appeal mechanisms. You really need to have a specific game plan when leaving work or resigning etc to avoid any surprises or mistakes.
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.
2 Likes
Another game plan could involve referral to specialists or maybe your psychiatrist could try new medications.
I know my husband saw his psych and is being weened off certain medications and then they are going to start trying a new pharma plan.
Do not resign and only attempt a return to work if you think you can manage it. Are your symptoms chronic? I would request more help from your health providers-or try different treatments? You want to try to improve and if not then being active in seeking help and options supports your claim.
Thanks for your reply David, I have sought legal advice and I’m having buyers remorse at this point. The lawyer has had my case since June of this year, however the last time I checked I was told they were still waiting on the file from the insurance company. When I was denied I immediately requested my file be sent via email which I received within 2 days. I offered to send this to the lawyer but was told it would not be of much use. I was also told that there would be up to one year time frame to settle and the clock would begin approximately 2 months after they receive the file. Is this normal practice?
I can’t really speak to your specific situation, but there can be delays that are entirely caused by the other side. Some delays can certainly caused by lawyers who represent a person in a claim like this. The file the insurance company sends the lawyer will be more comprehensive than the one you received (in my experience) they don’t send you everything. That may be what your lawyer is referring to. Often your lawyer or law firm may be dong things you are unaware of so communications with them is very important.
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.
Thanks for that, it puts me a little at ease as I do understand there are likely many pieces of information that they would need in order to move forward. The difficult part for me is seeking professional help ( I have been diagnosed with PTSD, anxiety, panic and depression by a psychologist and psychiatrist) as I am unable to afford the cost. I am still able to access counselling through my employers EAP, however they are unable to provide any third party information for my doctor. I’m sure your aware of how difficult it is to self refer to the mental health community through the public system.
You can request a copy of your complete file -they will charge a fee for photocopying. With your written consent you can authorize the file to be sent to your Doctor-I Think. You are entitled to review your file with them as well to see if you want to pay to have it copied. The Doctor/therapist owns the records but you own the information–you can ask to review-politely of course.
Allyoops, I have had consultation with a psychiatrist twice (that’s one more than usual) and she did report to my doctor that she was in agreement with the psychologists diagnosis (PTSD, depression, anxiety and panic). My medication was changed about 1 month ago with a new one added. I have requested to be referred to a psychiatrist or psychologist by my doctor through the regional health care system as I cannot afford the fees my psychologist charges ($190 per hour) as I have zero income.
As for the work issue, they continue to request a doctors note however my doctor gave me the impression that she felt that they may begin to ask questions. I just feel a lot of pressure from all sides, spouse/friends are adamant that I do not return, while my employer is being a little pushy about my date of return.
1 Like
Keep up with the referrals, even if it is taking a long time it shows you are trying to move forward. Have you ever had a MRI of your brain to see if there is any abnormalities?
How is your sleep–maybe be referred to a sleep study.
Buyers remorse for a lawyer–did you not enter a contingency agreement? Lawyers -often it takes a long time. Go with your gut and follow up on any concerns. But two months is so long for us but that is like only 2 weeks in lawyers time 
Hang in there…its always the hardest struggles that get you to the better times ahead!
1 Like