Your case manager advises that someone will be contacting you to discuss rehabilitation. They don’t give any more details than that.
Rehab calls or visits (please don’t let them into your home offer to meet them anywhere but)
Your rehab consultant has professional and legal obligations to you-find out if they are professionally licensed-then look up their code of conduct, ethics and licensing requirements so you know the boundaries.
Rehab is going to try and find out how your illness or injury was caused-maybe they can shift the claim onto workers comp or elsewhere
Do you like your job because maybe you have a workplace issue not a disability claim. ( Note if it is a workplace issue that has caused or contributed to your disability-you have a legit claim-may need a lawyer)
Have you taken your children out of daycare or saving money by being at home-ie:motivation not to work
Is your spouse over protective and rewarding your illness by providing extra care (Used a lot)
Do you have any other life stressors-elderly or sick family (fishing to look for other reasons you might be off)
All questions will be asked in such a caring and supportive way-
If they can’t find an ulterior motive for you being off then it must be fear!
Enter The fear-avoidance model -for chronic fatigue, chronic pain, fibro and such. This psychiatric model is the hurt vs. harm theory-that it may hurt like hell but you are not harmed by the hurt so you should push on through the pain and fatigue. There is some validity to this but it is way over-used by insurer rehab and can cause much pain and psychological harm to the patient.Way over-used! Your rehab consultant though will find a Psych to say 6-12 treatments and they can cure your mal-adaptive thinking through EVIDENCE-BASED CBT!
Essentially the rehab professional will send you to their cherry=picked treatment providers (who might forget their professional and legal obligations to you-the patient)
If they can’t get you healthy enough to get back to work, or break you so that you are found non-compliant-then they have reports that can help to support a future denial and lower the litigation risk.
Am I cynical-maybe jaded by a traumatic experience-but just go ahead and do the following-which is all reasonable:
Ask for any patient intake forms prior to any appts. with a provider-Don’t sign a waiver
Politely make it clear that you personally are to receive any reports at the same time they are released to your Insurer (offer to pay for photo-copying)
Ask your rehab consultant for copies of their file on you too-regularly-as well as all clinical and chart notes while going through treatment, You just want to make sure everything is accurate.
Ask your rehab/Insurer for a complete copy of the terms and agreement for referral sent to each provider
Never go to any appt. alone
Always ask to hold off on the rehab plan so you can show your Doctor-make an appt with your Doctor about 2 weeks after rehab starts so you can discuss the effects with your Dr. Or it is possible your Doctor may nix the rehab and offer other treatments,
If the rehab consultant is working for the Insurance company and they are a licensed health professional they have legal and ethical obligations that must be disclosed and adhered too. ( But likely will not)
They must disclose any conflicts of interest as part of informed consent to providing services to you.
(likely will not be done)
This is where the Insurer may have moved in above the utmost duty of good faith and into a fiduciary obligation.
You would need a legal opinion but this is part of my husbands lawsuit-so if we get a court opinion I will share.
In my husband’s case GWL sent a terms of agreement and referral contract to the physio and psychologists that they agreed to notify GWL immediately if an insured requested a copy of “the report” and must give GWL a copy prior to releasing to an insured. GWL could laso order its destruction or try to get a protective order on the report.
We are suing as that breaches all privacy law. Privacy belongs to the individual. My husband would never have consented to any treatment or assessment under that secret contract. There were other stipulations too-that the provider must notify of any non-compliance or change of appointment times (hmmmm) and such.
GWL and a Psychologist or other treatment provider can not contract out my husbands right to privacy and what is disclosed. He has first right to refuse-he may get cut off benefits-but it is his right to choose.
So due to lack of informed consent he is claiming physical and psychological battery—until you experience being duped into bogus medical and psych testing -its hard to explain the impact. My husband almost took his life because of being treated like a lab rat.
Great West I believe years ago took over a few rehabilitation organizations and brought it under GWL Disability Intervention Services, I know from the claim file the rehab/OT was billing hourly. So likely one arm of the business pays for the next-each on their own metrics.
The cost benefit analysis she wrote up had my husband estimated for a year on claim and she had him back to work in 5 months. However due to the costs of all providers and herself the company would only save 1 month in claim payments.
So GWL makes money on the Intervention services to its own employee and department-because that amount paid goes to the claim experience and rate setting-and saves money by terminating the claim early.
Then why do people apply for both WSIB and LTD at the same time?
What if they push you to go back to work and you comply and go back to work. When at work you feel sick again and go to see your doctor who recommends you to stay off work. What is going to happen then?
Many times in Workers Compensation claims, employees also have coverage under short-term disability and long-term disability insurance policies through the employer. Some people may apply for both to protect both claims as there are
time limits to filing. -would actually need a longer answer or new topic heading-many variables.
This psychiatric model is the hurt vs. harm theory-that it may hurt like hell but you are not harmed by the hurt so you should push on through the pain and fatigue.
You should be able to go back on disability-if you are on a RTW plan or within the time frame of recurrence as defined by your policy. Just make sure you see your Doctor regularly and if you can’t manage it-then make sure you let your employer know and go back on claim. You want your employer in the loop of how you are managing to protect your job.
Don’t return to work against your Doctors advice. Again another topic unto itself.
Don’t sign a waiver.
Don’t sign a waiver for any treatment provider that requires you to give up your rights to hold them accountable for their gross negligence, malpractice and such. This is why it is important to request all patient intake forms prior to seeing your Insurance Companies referred providers.
At the physio my spouse was sent to he declined signing the waiver releasing the clinic and all staff for their gross negligence as well as it included an indemnity agreement which he agreed to waive all defenses to any claims brought against him, In the claim file GWL was seeing this as non compliance-with serious ramifications. LOL! They called it a standard waiver. I think it is so outrageous that I wonder if it is a set up by Insurers and the chosen clinics.
You should never sign such a waiver!
We did not ask for the intake forms because we did not know to do so. We should have! Also ask for photocopies of anything you sign for treatment on the day you sign them. We should have but did not think too.
There are other questionable forms-ask before you go.
Be prepared to hear that the forms are all standard–maybe if you are going skydiving but not for a medical appt.
If you signed such a waiver and were hurt-if you have a subrogation clause in your LTD policy-you waived that right in signing-you could also affect your home Insurance liability protection. Crazy Insurers!
You have to apply for both because there the same insurance can qualify you for both WSIB and LTD payments. Both WSIB and LTD Insurance have deadlines to file a claim that you don’t wan to miss. Very important to apply for both at same time to make sure you meet the deadline requirements.
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.
I just had a phone meeting with the assigned rehab specialist. For 2 years they have denied me treatment. And now she suggests the treatment their IMO and my doctors have been recommending that they denied for the past 2 years. I have been asking and we have 0 mental health group coverage I was denied at every turn. Now they say they want to help. Please. In our conversation she said “you have a pretty good grasp on the situation”. Meaning medications etc… I said I have had to be my own advocate. I better have.
We’ll see what they come up with. In the meantime smile and be polite.
I hope this goes well for you. Is she going to meet you in person or is she just sending you a plan? Hope for the best but also watch out for the worst.
Bet your claim file comments on your good grasp of what is needed showing that you may be less disabled due to your self awareness.
Denied treatment under the rehabilitation/vocational clauses in most policies. Not all are mandatory and you have a right to participate in the process and not be rail-roaded into their plan
Phone conversation went ok I think. I questioned why after 2 years of denied requests for treatment. They are now considering treatment options.
Not much of an answer. They want a new medical report to review and go from there.
I said that makes sense but please do not make monthly benefits conditional on receipt of a doctor’s report. “I am not playing that game”. I said the report may not come till late August or early September since my MD is new and my psychiatrist has had a family emergency and has cancelled my appointment for July.
She acknowledged that “they won’t play that game”.
It went well.
Question… What credentials are rehab specialists supposed to have?
The rehab consultant will also be a registered health provider either occupational therapist or nurse.
They are bound legally and professionally by their regulatory college and applicable codes of conduct.
They also are required to disclose any conflicts as part of informed consent and their role in providing services to you and what their role is with respect to rehab
The rehab specialist in question with my file has no professional affiliation. She is neither a nurse, nor counsellor. And claims education is her qualification. I said be that as it may remember you work for the policy holders and not the shareholders.
