Long term Disability Question

I am on approved long term disability claim for about 4 and half months ( mental illness) and during those months insurance company has caused more more than enough mental stress on me and they put me through a rehab program and it did n’t work and as per my physcologist I was not ready for CBT ( insurance hired psychologist) AND still they carried on CBT which actually caused me more stressed and there was a time when I was way lost and I was very susidal. Still I completed my rehab and was not ready to return to work. I got a new case manager and she told me that she sent some forms to be completed by my doctor and doctors receptionist called today and and she told me that they would like to get all clinical notes and a separate medical form to be completed by my physcaterist. receptionist also informed me that I have to pay $ 500 to have these forms completed and clinical notes. I am so stress because I have limited income and I can’t afford $500 to pay for forms. also she never mentioned about any cost about doctors forms before. please advise what can I do now?

any help will be appreciated!

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Also couple of months ago i requested my claim file and she called me to ask me that why do i need my complete claim file and i told for my own records and she siad they dont provide that info as it contains some confidential info.

what should i do?

btw i am still in my ouwn occupation

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In my case, the insurance paid for the doctor’s fee to complete forms — but my doctor only charges between $50-100 for the forms to be completed.

Maybe send an email to your insurance to inform them of the doctor’s fee and ask them to cover it?

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But they are asking for all my physcaterist notes plus personal forms to be completed
And which is costing me 500 dollars. They are causing me a lot of stress and anxiety.

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David what should I do ?

Did you send by email or fax the request for your claim file?
You need to send in a second request for a full and complete copy of your claim file. Send me a private message of whom your Insurer is and I will get the right email address to make the request.

Request from your Doctors if you can make a payment plan for the required records. Also request a cost estimate from the receptionist so you can provide to your Insurer.

You will want to send by fax or email that cost to your Insurer. Maybe they don’t know how pricey the records are. -Ask for help from them too. Explain how the cost will cause more hardship and stress.

You may wish to retain counsel or pay for a legal opinion.

Same for me.
My family doctor charges me $80 to fill out forms.
The insurer paid for reports from my GP Psychotherapist and Psychologist (The max I remember was $250).

$500 sounds really high to me but as Pme said try to get the insurer to pay if possible.

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It is probably a lot of notes for $500.
My family doctor works in a big clinic and the fee to get him to fill out my LTD forms was $500 (determined by the clinic) but when he was told that by the clinic, he reduced it to $50.
I think I read here that if the insurance company makes the request directly from the doctor, they will pay.
I suspect that is only some insurance companies.
My policy specifically says I am responsible to pay for all documentation from doctors to support my claim.

Yes I did request my case file through email and than my case manager called me and asked me why do I need my case file and I said for my own records and my doctor can see it and she said there is some information that they cannot provide to me so I said fine . And now they are bothering me and i guess i need to see what’s in my case file ? And i dont think she is giving me right info

I don’t think they can have stuff you’re not allowed to see but you may need a lawyer request your case file.
Get the free consult from Resolute and ask them what they think.

@allyoops, what is the purpose of having her claim file? Maybe it’ll show why the IME thought rehab would help?

You have a right to access see your claim file under PIPEDA or your provincial privacy act. Your insurer is the custodian of your information-you are the owner.

It is only helpful to obtain your file if your Insurer is being difficult, or asked to apply for CPP-D, or other claim issues.

Its a fun read

Thank you . I will again ask her to send me details so I can see what is in it and why are they so aggressive with us

My advice is just to send a short email/fax. Always be humble/polite.

May I have a full and complete copy of my claim file for my records and to help me understand.

Do not quote privacy or rights when requesting. If you have proof you asked and they refused…if you need a lawyer–they will get it for you and can ask why they refused you.

By staying humble or to the point you make yourself look good and the Insurer looks bad.

Unfortunately, it is the obligation of the insurance claimant to provide any documents to support the claim. You have no obligation to provide documents requested by the insurance company, but in a practical sense, if you don’t give the records they want, then it gives them a reason to deny the claim. It is common for them to make specific requests for medical records and reports, and that is usually a good sign. The more specific their requests, the more likely they are to approve a claim (in my experience).

In a situation like this you have to try and work something out with your doctor regarding the fee. However, if you can’t afford the fee, then you should put this in writing to the insurance company. You want it to be clear that you are unable to fulfill their request due to financial hardship.

You have a legal right to your claim file form the insurance company. You don’t have to give reasons. As long as you agree to pay a reasonable fee for them to print and mail it (usually $50-75), then they must send it to you. If they refuse get it put in writing and you can file complaints against them if necessary with the privacy commissioner or insurance regulator.

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 call toll free 1-877-282-5188 to speak with a member with our disability claim support team.**

hi bnn,
sorry to hear what you’re going through. I’ve read a lot of articles here that that people should be getting there claim file but allyoops answer below made good point to me.

it doesn’t make sense to me that you have to pay for records that insurance company is requesting from your doctor…wouldn’t those records belong to the doctor and if insurance wants them, wouldn’t they have to pay the doctor for them? At least that’s what happened in my case or maybe rules vary ifrom province to province. Im in (Ont.) & insurance co. paid my doc. for the records they wanted. Maybe a stupid question but what does the CBT rehab you went through mean?

It was going to be really expensive for my doctor to write the report (he works in a clinic and the clinic set the fee).
I think it was $200 but the doctor made it $50.
I lucked out.

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My policy specifically says I have to pay for any records to support my claim.
I am in Ont too, it depends on the policy?

CBT is Cognitive Behaviour Therapy (a psychological treatment).

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ok got it , thanks Jammer