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
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