I am on LTD and my new case manager seems to be in a rush to close my case.
A few weeks ago he called me saying he will be closing my account because of a report he sent to my GI specialist to fill out. Then he said I had to start working ASAP and asked me when I will start working. I told him I can’t right now because I’m still sick and my doctor will help me with my return to work program when I’m better, so there must be some misunderstanding here. Shortly after I received a letter saying my claim was closed. I told my doctor what happened and he sent back my records to the insurance company and they reopened my case.
However, while it was closed I ordered my case notes from the insurance company and found out that my case manager sent an email to my company when he was closing my account stating that ‘She has no intention of returning to work’. This is a lie and may harm my reputation at work- especially because my company recently got bought and I don’t know the new HR or most of the new staff. Is there anything I can do about this? Isn’t this lie defamation of character?
Can I sue- if yes, how do I go about doing this?
If not, is there a way to get the insurance company to write to my company explaining that I never said that to my case manager? I just don’t want to be viewed that way at work while I’m genuinely sick and trying to get better to return to work.
Thanks, I just messaged my work benefits manager to see who I can talk to about the insurance guy behaviour. My doctor his working on helping me and I’m cautious on sending medical information to my company, i read somewhere where this can be harmful in the future.
So i’l just explain to her all these lies and assumptions the case manager is making, I hope this helps especially because he closed my case and had to reopen it.
There are many factors to consider in suing for defamation and this would most likely not reach the threshold. My entire file is filled with inconsistencies far, far worse and my lawyer says I can correct the file but with telephone conversations it’s them vs. you. (he said, she said basically)
I began to only communicate by print after that (email or snail mail) I do not speak on the telephone with any rep from my insurer. The insurance company most likely will not acknowledge the comment (s). He said, she said again.
What I did do, out of great frustration was send a letter to my caseworker documenting and citing my frustrations about his behaviour (calling me 3x per week after each intensive 5 hour therapy session just to ask if I was going to return to work yet), the inconsistencies of information (cherry picking on his part) and I also revoked consent to communicate with my employer citing misinformation and providing examples the communication in my file.
I cc’d the case manager, their ombudsman and several others/offices who had been involved in the conversations/communication with me. That letter stays in your file for anyone to read down the road.
Have you communicated to your employer that you are not medically approved to return to work? You can supply them a note from the doctor - it can be something simple like a prescription note saying “so and so is off work for medical reasons”.
My response was always, “when my doctor(s) give me the all clear to return to work I will” if they ask about the insurer’s comment, “they were wrong”
As long as you have medical documentation supporting the inability to work and can provide it each time the insurer requests it…you can toss the caseworker’s remarks in the toilet.
People are going to have their opinions of you regardless of how much effort you put in to convincing them you are ill. I have spent two and a half years of my illness fighting my insurance company (and employer) but never my doctors or people in my life who knew me. Why did I waste the energy and mental anguish on people who, in 2 minutes would be gossiping about someone else?
The best way to handle something like this is to file a complaint through the insurance companies formal complaint process. This is different than the appeal process and covers issues like this. Some insurers will have an ombudsman to handle issues like this. Often people can be successful in having the insurance company retract a statement like this. Lawsuits for things like this are problematic because they are expensive and you would have to prove that the statement caused losses and that is often hard to prove or the losses may not have happened or are just speculation for now.
If you don’t get anywhere with the insurance company’s complaints process, each province has a regulator for insurance companies and you could go there as well for this type of issue.
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.
The case workers are almost always working against you. They build a case for the insurance company. If your illness is very obvious and easily documented there are usually no issues.
If your illness is difficult to document, especially mental health issues such as anxiety and depression, you may have challenges with the insurer.
Your physician can write up as much as they can on an illness, but most times you really need a diagnosis and report from a specialist. These are not always easy to get.
If the insurance company is trying to hamper your efforts on payment or reports, then you need to consider engaging a lawyer if it makes financial sense.
Thanks everyone for taking the time out to respond.
I sent an email to my employer about my Case Manager’s behaviour. My employer reached out to our company’s Insurance Account Manager to let him know what was going on.
In the end my Case Manager apologized to me and my employer and said he is sorry his words were a bit harsh. His manager now knows so I guess he had to say that to make it look innocent. I’m just happy I got a chance to clear my name at work and at least now they know that what he wrote was not a true reflection of me. I really hope he does not do this to anyone else, because it’s very stressful being sick and then having to deal with this too.