LTD cut off due to "Non Adherence"


#1

I would like to share my story with LTD Carrier, just in case someone might find it useful in the long run.
I have been on approved LTD claim for mental disorder since September of 2016.
As I was nearing my 2 year mark (10 months to go) I was referred for Cognitive Behavioral Therapy through the carrier Rehabilitation Specialist (Vocational Training Program).
I had few sessions and I could sense it was becoming harder and harder as each session went by. Therapists are not independent as they claim. I know this has been mentioned in this forum numerous times but it doesn’t hurt to reinstate that.

I participated, never missed a session or homework. The issue was I was unable to reach 80 % or higher functionality in activities listed. So they cut me off claiming that I was non compliant with the program.

Just like that.
I am of an opinion that once you are referred to Rehab Specialist for Vocational Training Program that either you get cut off because you can reach 80 % of functionality hence you are able to work or you get cut off because you cant reach that and they will fancy it with Non Compliance/Adherence wording. Either way, if you are nearing your 2 year mark like me and are part of Vocational Training program you will get cut off at some point.
I have no intention in appealing their decision through the Carrier as it is waste of time and efficient weapon to further discourage us along the way.

Instead I am shopping for a disability lawyer near my area (Southwestern Ontario) and will be serving them with statement of claim shortly (hopefully in the next 2 weeks). I will also claim punitive damages, mental distress on top of asking for reinstatement and interest.
I am disappointed that David does not service our region directly otherwise given the wealth of advise and information he would have been my number one choice.

I hope you find this useful. My piece of advise, once or if you are asked to enroll in rehabilitation, please remind yourself that they are not there to help you or be the person you lean on rather dishonest bunch of people waiting to get something out of you to reason their ill fated decision.

I wanted to share this story as appreciation for the forum, David and active members.


Medical Coordination Benefits
#2

Thanks for sharing this, This is exactly what my husbands statement of claim is addressing. He claims that Great West utilized a claim management system and procedures with respect to disability intervention services which was intended to wear down the plaintiff into a position of vulnerability for manipulative purposes.
He is also claiming against the psychologist, physiotherapist and OT.

When an Insurer refers you to any health care provider --these providers are not to put their professional and financial interests ahead of you, their patient. They can not abuse their inherent power over you as a patient.

I agree with you that there is systematic bad faith that when you are referred to health providers it is all about wearing or breaking down an Insured so they would rather just go back to work than face abuse…and for those that can not return to work to set up false or biased reports to support an allegation of non compliance.

Wish you luck…at some point we may go public as so many claimants have been set up and abused through these rehabilitation schemes that I believe there maybe a media opening to stop this abuse or alert others of this practice in claims.


#3

Well said and wearing and breaking down is great way to put it. It is highly unethical approach withholding information that shows the true reflection of patients and attempting to corner you on something that they can use as escape goat.
Good luck to you as well. Anything but silence will raise up the awareness of this nonsense and hopefully after billions of dollars in courts they too will learn the lesson at some point.I am also suing the rehab center for handling the case in a bad faith


#4

If you want I can send you my court filings. They are trying to strike a part of my husbands claim against the physio.
Going for a motion to strike is highly common against self-reps. Its all about delay-so he has filed to amend.

Not sure if you got your claim file or master policy yet. My husband was scared the health care providers might lie, he was equally as hopeful that they might help him. It was so dehumanizing for him.

He did digitally record everything. So he can prove the truth. Aggravated and punitive damages IF awarded are not that high–our motivation is accountability and to help the next person. How health care professionals can exploit an individual when they are physically and mentally at their lowest is so unbelievable and harmful.


#5

I hope it all goes well. I did the same with recording. I sensed where it was headed with vocational rehab specialist and decided to record sessions. During sessions she mentions that I always complete all the homework and do well with reading CBT book that she assigned (better than other patients she had) but on her letter to carrier (make no mistake this was coordinated between the two) she purposefully left out progression parts and included none of it.


#6

The psychologist they sent him too told my spouse that he lost his fundamental/human rights by default when the Insurer is paying for treatment. If that is the mindset of a healthcare provider—well, blew my mind. ie: don’t have to ask for consent, don’t do what I demand or answer my questions-non compliance–want access to your medical records and reports–well you can’t because I might not get paid if I respect your right to access.


#7

Best of luck with the lawsuit.
That is a big area and I’m sure there are good lawyers nearby.


#8

Hi Jam,

I do work in Ontario, in fact it is where most of Resolute Legal’s clients are located when you count LTD and CPP cases we handle. I am licensed as a lawyer in Ontario. Contact me for a confidential chat if you want to learn more.


David Brannen

Disability Lawyer with Resolute Legal

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