My insurance company hired a RTW Company months ago. My doctor said that part seemed fine to see how I did she didn’t want to argue. Then we get into the program and it’s making me actively worse. I have mental health issues and can’t do basic tasks some days and suddenly they’re treating me like I should be doing hours of housework a week, which is just one example of the activities they require, but I’m struggling. I’ve struggled sectoral times in program, but anytime I participate less than their required amount they said it’s noncompliance. So when I participate the right amount, which is the absolute limit for me, and has been to the detriment of my own health, pushing me past what I can handle, they say I’m doing fine.
Now they’re giving me work related tasks, telling me to look at resumes and start doing more cognitive tests, but the issue is I’m not functioning well at all. I am unable to do basic tasks. I told them this week I was in distress, which my doctor can confirm, and they were pushed more activities at me. It feels like they’re trying to break me or drag me through their system at my expense to say I passed their program, at which point they cut my benefits off.
I’ve been in distress several times during the program and being in it has literally caused some of my symptoms to worsen significantly, which my doctor can attest to.
I have not been on a RTW program, but earlier on my LTD, my insurer enrolled me in a rehab program because my family doctor checked off a question on a form stating that rehab would be beneficial. It made me worse and when I talked to my specialist (not family doc) about it, my specialist said the program was a bad idea. I told my case manager that my specialist did not agree to the rehab, and I was immediately removed from the program. I think you need to have your family doctor or psychiatrist write a letter to your insurer stating that you must be removed from the RTW program asap.
It seems to me that you may be required to try, but you cannot be required to succeed. You try your best and document your failure. Is there some kind of log or dated notes you can keep documenting what’s gone wrong? Then take that to your medical carer and have them document it too. And if it’s making you worse instead of better then document that and inform them of the failure.
Document your status/symptoms pre and post each session and share with your insurance, program contact and family physician.
Ask the program how they assessed your baseline and what indicators they are using to evaluate your progress and determine you are ready to increase intensity. Ask in writing and require they respond in writing. Share with insurance and physician.
At a minimum, your physician should be able to write a letter confirming that your condition symptoms become worse following the sessions and this is delaying your progress.
I would also ask if the program has evidence to support its use for your condition. Is it evidence-based using quality research?
Remind them that insurance payments are not a handout! You or your employer paid premiums to support you in these situations and you should not be forced to do activities that is harmful/negatively affecting your condition.
I would ask them to share the benefits and risks of the treatment plan for your specific condition and share you are hesitant (not non-compliant) to participate in the plan because it is worsening your symptoms. Put this in writing.
Ask that they modify the plan to reduce the worsening of symptoms and ask what alternative programs/activities
may be better suited to your unique experience - everyone responds differently.
They should be able to modify the program in response to your outcomes. Treatment plans often need to be adjusted - they should be evaluating how you responded to the last session prior to moving forward.
Document everything! Sorry you’re going through this.
I will second Caro’s comments below. The key is for you to participate in good faith and stick with the program as long as possible - but not to the point of having a mental breakdown. So, check in frequently with your doctor so you progress and current condition can be documented. If you are going to say you have gotten worse, it has to be documented over time by your doctor. You should err on the side of trying to stay in the program as long as possible, rather than convincing your doctor to agree to pull you out of it. It is a fine line, but it is easier to deal with a bad report upon completing a program like this, than itis to deal with them saying you quit the program early.
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 1-877-917-7050 to speak with a member with our disability claim support team.
Please reach out to your medical team as soon as possible, especially since you’re having thoughts of harming yourself. That’s the number one priority, everything else can wait. You matter most right now.
It sounds like the return-to-work program is pushing you beyond your limits. If I were in your position, I’d consider sending a short message to your claims handler such as:
“I need to take an immediate break from the return-to-work activities required to maintain my LTD benefits. Your current demands have become overwhelming, and I’m experiencing severe distress (thoughts of self harm) as a result. I will be contacting my healthcare providers as soon as possible for help.”
When yu are ready again, don’t worry about hitting their 80% target, just do what you can. If 20% is your maximum right now, then that’s where things stand. Keep communicating that clearly and consistently, and that you’re doing your absolute best within your current medical limitations.
If your LTD benefits are stopped even though you’re genuinely trying within your medical limits, a qualified LTD lawyer can challenge that decision (aka mop the floor with them in litigation). You don’t have to face this alone.
If you ever feel unsafe or close to harming yourself, please call or text 988 (the Suicide Crisis Helpline in Canada and the U.S.) they’re available 24/7.
I’ve been in touch with my medical doctor and therapist I haven’t seen in a while so that part is covered and I’m not in immediate danger. That said, I’ve been like this for a while and am not getting better.
I’m not fully sure how to approach telling them what you’re saying, even though I agree with you, because my situation is this: they set up meetings for me with the insurance company and the third party company together, in what always feels like ganging up on me. Video meetings where they’re both there. It’s so intimidating and terrible.
I’d just send them an email and copy a family member or just yourself. That way your email becomes part of your claim file, that a lawyer can use if needed.
Their tone will likely change once you go on formal record (with an email) that their demands are causing you severe stress and thoughts of self harm.
Hi Cornflakes I’ve been thinking about how to handle your situation for a couple of weeks and I think I have figured out the approach that I would use. In addition to ensuring that my doctor is documenting reports about the failure, I would start getting my attempts at compliance and the failure due to disability on the written record. I would confirm in writing (email or posted, keep a copy) that you are trying your best to complete the program but are having increasing symptoms and your disability is preventing you from participating to the full level that the program is requesting. I would also put in writing that the program has been suggesting to you that if you are unable to complete the program that you would be cut off from your disability benefits. I would remind them that terminating your benefits because you are too disabled to complete their rehabilitation program would be a breach of the insurance contract and ask them to confirm in writing their continued intention to abide by their obligations under the insurance contract.
I just received a letter 2.5 months ago saying that as of a date like 2 yrs ago as of Dec 31,25 I am being cut off for medical dental all of it and I assume most of us on LTD require medication of some kind and I have 1 that is $1500.00 + month and they give me 2.5 months and are going to just dump you high and dry. I feel like it is a threat as they state they only way to get them back is to go back to work immediately. They think I’m bonkers now?
@Cassmack5022 your provincial government may have a program to cover the costs of high-cost drugs if you don’t have any insurance coverage. In Ontario, it is the Trillium Drug Program. Drug manufacturers will also cover the cost until you can transfer from your current insurer to a provincial program. Doctors may also provide “sample” bottles while you are waiting for approval for coverage.
Any update? I would talk to my doctor to about reassessing your current health status and if they agree that the RTW is now harmful to your health to write that. For me my insurance asked my doctor for consent before any programs like this and if this was given they can say an updated opinion. Ask the insurance company questions of if they are asking you to do this with your doctor saying not to. Have you been seeing your therapist again? An idea is to discuss with them and your doctor to advocate that you need to get better first with therapy. For RTW discuss if your therapist or get someone who can support RTW instead of the RTW company your insurance company hired. These are ideas.