My English is not very good. Sorry if there are confusions.
I’m very fortunate for have came cross this forum. I’m sorry that my questions might not related to LTD. but I found what you suffered and the battle with insurance company are so much similar with our case with car insurance company. I didn’t find a forum about ppl dealing with car insurance company , and I’m sorry that I have to bring my issues here, but I find here might be the only place I might found advices and more importantly, understanding.
21 months ago, our car was totaled during a highway rear ended by another car. Their fault. Since then my husband who were sitting in the rear during the accident experienced pain in neck and back. He vomited initially and could sleep well due to the pain. He will only sleep for 2-3hours and failed to go back sleep again. Someday he will sleep for 12-14 hours. He couldn’t continue his work. All of this made him very down and had thought about suicide. Our doctor prescript some medications but those made him diarrhea very badly. He had seen a physio and it worked to a limited extent. Now the chronic pain, diarrhea and suffering destroyed him. He either is very down or very irritated. He refused to see the physiatrist that been referred to, because that doctor makes him feel even worse every time he came back from seeing that doctor. I find my husband start to forget things, lack of logic and couldn’t have a normal conversation with him.
Meanwhile, We are in a no fault province, after the accident, I couldn’t find a lawyer to turn to help. I find it’s very hard to keep contact with insurance adjuster. And they changed several adjusterS in the first year and only reimbursed my husband 3 months of medications which excludes antidepressants. When I finally keep contact with our adjuster, she said she need doctors notes to prove those medications are related to the accident. And for income loss, after asking my husband’s income tax forms, the adjuster no longer reply our emails. And now she said she send some files to the insurance company’s PT to review. And the PT said my husband’s symptoms are not related to the accident.
But I find the files the adjuster sent for review is just a portion of my husband’s doctors visit. They didn’t include family doctor’s notes and other specialist’s note. Is this considered bad faith of the insurance company? It’s almost 2 years now, time to sue?
Sorry for my long rant. I couldn’t find understanding outside until I came across this forum and saw so many ppl has to deal with insurance while suffering health issues.
The answer to your question is very simple in my opinion - yes, you need to find a lawyer. Your husband sounds like he may have some brain damage if he is forgetting things, has a lack of logic and cannot hold a normal conversation. He needs proper treatment, a head scan and an appointment with a neurologist. It sounds like your language is a barrier for you too. It would be nice if you could find a lawyer who speaks your native language if possible. Do not wait, as there is a statute of limitations in some provinces I believe. Get a lawyer now.
Thank you so much for replying.
After 14 months of waiting, my husband did seen a neurologist, but the neurologist refused to order MRI scan. At that time, my husband hands is numb and tangling. And even went to emergency room one time, because on that day it was extremely pain and tangling for his hands and I couldn’t even touch him. They ordered EMT though for him, but find nothing.
In our place, just few doctors receiving new patients. When I found our 1st family doc not competent, we changed to a new family doctor. But the newer one seems not willing to listen my husband’s long history of pain. The doc just wanna talk about one issue at one appointment. Especially during covid time, the appointment was done by phone. But I’ll call to have another discussion.
My husband lost his confidence in seeing doctors. He said he gave up and these 2weeks. especially the medications makes him diarrhea. He stoped taking antidepressants. I found him very irritated and might have some sort of delusions. He send 2 emails to our adjuster mentioned about he’ll let them know how not to treat citizens like dogs, and also mentioned other stuff without logic. I’m quite worried that the adjuster will also use these to go against him.
I registered for him for a free online counselor course last week but because of his language barriers, he didn’t pass the phone screening.
It’s hard to find a lawyer speak same language in our province. I found a student lawyer works in non profit organization that might speak same language as us, I’ll try my best to find her contact then.
All in all, been tried 2 doctors now, and seen several specialist. I too lost my confidence in them.
As Adam suggested above, see a lawyer. Also very important to see a doctor who will understand the nature of your visit the first time and take you on. Get this commitment from the doctor beforehand as it can be very frustrating navigating the medical system let alone the insurance system. So in my opinion do the following: make 2 appointments one with lawyer and one with medical doctor. If neither one seems enthusiastic about your situation before you waste the time to see them, keep calling. Call the insurance company and ask for in writing what they are proposing to give you for benefits. Also, keep yourself calm and energized. Sometimes we run in circles before we see the clear path ahead of us. It’s equally important to have your husband get better. Antidepressants are not always the answer and doctors know this. Antidepressants don’t work for everyone or in every circumstance. His depression will get better once he knows he’ll be taken care of. Be aware though that most of these “accident” lawyers don’t charge fees unless they win for you, so you have to have a seemingly winnable case. Their fee is 30% but it’s better than nothing. The lawyer can negotiate more money, long term services and treatment etc. You can also advise the insurance agent that you will file a complaint against the insurance company: Auto Insurance . FSRA is Ontario’s auto insurance industry regulator. Our mandate is to protect Ontarians, each and every time they get behind the wheel. … FSRA is here to ensure that Ontario’s auto insurance companies operate with integrity, to ensure you’re protected on every front.
Good luck and keep strong!
Thank you so much Cherryl! for understanding and advices! And more valuable, encouragement! Thanks a lot for that!
We are in SK and I hope there is sth like FSRA here. I found one walk-in doctor to be willing to listening to my husband. So that’s a goos part.
For the lawyer part, I called several and left messages but receive no reply yet. But I’ll keep trying. In our province, I heard car incident lawyers won’t do the contingency fee thing. They’ll charge beforehand. But I’ll keep my hope.
I scheduled a meeting with the insurance adjuster but when I asked about the location for the meeting she doesn’t reply emails anymore. I then asked about online meeting due to covid 19 cases is surging in our place. The adjuster doesn’t apply either. I found dealing with insurance is like a black hole. I have to say some key words and then they might reply.
since last week, my husband’s mind was not stable and he sent 2 lengthy and illogic emails to the adjuster, in which my husband mentioned about his suicidal thought, and something like he wes treated like pigs and dogs. I’m worried that insurance company’s not replying email is because they are planning to go against my husband.
All in all, I will still keep looking for lawyers. And thanks so much for your words!
I have PTSD. I see doctors and specialists regularly. You need to keep pushing doctors, take charge of your personal health, keep pushing them.
Get a lawyer to handle all claims and discussions with adjusters. There are two parts to insurance. Adjusters jobs are to frustrate you until you quit.
Thank you so much for sharing your case and all the advice.
Today the insurance set me my husband’s medical records. Which lacks a whole part of his initial doctors visit. We went to a walk-in clinic after the accident, but they didn’t get this part of medical history. And also our first family doctor who knew my husband’ s suicidal thoughts, but didn’t send out our report.
Insurance company sent several letters to our fist family doctor. But the doctor never responded. My husband lost his trust on the medical system too. He is very angry whenever I talked about his case. He thinks there will be no cure for his pain, and he wants to disappear in this world.
For some reason doctors don’t take initiative to respond the requests from insurance companies. You have to talk to this doctor in person and make sure she will send whatever the insurance company needs from her. Another thing she may need an authorization from you to do so.
Yes, we made a specific appointment to tell the GP about insurance company’s request. The GP even scanned the letter from insurance company. But I don’t what happened to the GP. He just doesn’t response.
This GP also messed up several times about specialist refer and medication prescription.
That’s our first doctor in Canada, makes us frustrated about the medical system here.
Thank you so much for the advice.
I’ll go and get the medical history by myself then. It’s been 10is months the doctor just doesn’t provide what insurance company asks.
Just now my husband had this phone appointment with doctor. And doctor again ask him to get x ray. His pain is around his neck and headache. But the doctor didn’t ask too much and then ask him to do back x ray. On the x ray form, it indicates my husband has back pain. But it’s not accurate.
And then I need to talk to the doctor again to correct this.
Several times previous doctor referred a specialist, we waited and waited for months but get no one contacted us. We talked to GP, he said it because the wait time is long. But later on, we found that our reference didn’t get thru to reach to the specialist.
Or there are times, doctor said he faxed prescription to the pharmacy, when we go get the medication. The pharmacy said they didn’t receive anything. My husband have to wait in pain over the weekend and contacted with the doctor and to get his medication.
It is things like this, makes us lose confident here.
It is frustrating. Happens to me all the time. Just call them if you are not sure.
Depends on the system they use. My doctor sends his referrals while talking to me. He just fills out the form in his system and presses “Send” button. That’s all. Sometimes they mess up at the specialist’s office as well.
I find our marriage is going fall too. It’s very hard to communicate with my husband now.
The newest doctor messed up the x ray form. Neck pain and headache messed with back pain. My husband now doesn’t trust him any more. And he thinks the doctor doesn’t respect him, because the dr keeps ask me instead of asking my husband questions. Now my husband refuses to go to that X ray test and refuse to go to see this dr.
In our small place, there are very few GP to accept new patient. Among those who accept new patient, one was charged twice of sex harassment patients, and some have bad reviews online.
Among 3 GPs we have seen, only 1 is good but he retired. We’ve seen 3 walk-in doctors though, that are relatively better but they are walk in doctors. And in our province, there is no chronic pain clinic.
Whenever I talk to my husband about going to see a doctor, he’ll be angry and he’ll said something like the medical system is a failure, or he wants to bomb the system. Makes me really frustrated and hopeless
That sounds awful. I am just going to cut right to the chase here and say that there sounds like there is a huge language barrier. Your husband sounds like he does not speak very good English or communicate well in English and that may be a huge barrier to him getting help. If he does not trust you or does not trust the doctor to ask you questions, then he will have a lot of trouble finding help.
What you need is an advocate who speaks the same language as your husband. I know where I live, In Edmonton, you can search for doctors in your area who speak the same language as you. Here is my suggestion to you: Find a doctor that speaks the same native language as your husband and take your husband to see him. Even if you have to drive 2 or 3 hours, you must do something. Maybe you need to move closer??? A lot of people have to move for health reasons. Your situation sounds critical. If your husband is threatening to kill himself or others, and you are thinking of divorcing him, then maybe it is time to take a chance and move somewhere where you can find better resources and your husband can find a doctor he likes who will “respect him”.
Bottom line: You may need to move to a bigger city to get help.
In our area, there is no GP speaks the same languages accepting new patients. And before we moved here, my husband has no problem to study and live in the US. Sometimes he might not understand quite well, but he has no problem if the other people rephrase their sentence. That’s the main reason he feels the doctor doesn’t respect him.
The doctor only has 15mins for every patient as he described in his welcome letter. So he has no patience to hear my husband’s 20 months history, he said he wants to hear the main reason why my husband make appointment. But my husband wishes to talk about which medication doesn’t work, why he has several pain and why he’s here today. The doctor just stops him.
We had seen 3 walk-in doctors that are understanding and caring, but I don’t how we could see them regularly.
The problem you are facing is a systemic problem all throughout Canada. Doctors have really cracked down in the last few years. You get 15 minutes per visit, and can only bring up 1 issue. If you have multiple problems your doctor will ask you to book multiple appointments. It is because our public health system is at the brink of collapse and doctors cannot afford to spend hours with everyone.
The other suggestion I have for you is to look into “Concierge Medicine”. You pay a little bit extra (sometimes $99 a month) but you get a doctor that has LESS patients and will spend time with you. I dont know where you live so I cannot tell you the closest concierge medical doctor near you. Unfortunately there are not a lot in Canada, but it is growing. It is very popular in the USA.
Other than this, I have no suggestions for you. Unfortunately, your problem is NOT with the insurance company. They can only act on the medical information they recieve and your doctors sound like they are not sending the right information. Therefore you need to find a doctor who can help you and your husband or else you will be doomed to fail. Concierge medicine may be fit for you.
thank you so much Adam, It’s really an eye open for me to know there is service like concierge medicine although i doubt if we have it here in SK. But I’ll definitely check it out!
And also thank you for help clearing my mind that the doctors issues that doesn’t help to send medical records to insurance. Yes, I would say the issue is about doctors 70%+insurance 30%.
I really feel people in this forum helps us more than anyone since we have seen so many doctors. Thank you!
No problem One more suggestion for you - my wife is very smart and she is a nurse, and I told her about your problem and she said this to me. This is in regards to where you said above “We had seen 3 walk-in doctors that are understanding and caring, but I don’t how we could see them regularly.”
“Tell her that any walk-in-clinic will have a schedule of when each doctor works. Ask them for the schedule. Then, just go in on those days and try and request that doctor to see that day. If you do this often enough eventually you will built a repertoir. When you request diagnostics (e.g. blood, xrays, etc) make sure you tell them you dont have a family physician, and the doctor will use himself as your doctor. Then when you go back to the walk in clinic he will have your specialist reports. They may not like this but they legally have to do this if you don’t have a family doctor”.
Thank you soooo much for the insight! It’s people like your wife rebuild my faith in the system! I really appreciate her. And your input and sharing your experience where I can’t get nowhere!
I’ll read your words one by one to my husband!
You don’t know how helpful it is!
This is normal when you see a GP. My doctor has 30-minute appointments if there is more to talk about. I tend to talk too much so he asked his reception to only book 30-minute appointments for me LOL
You don’t need to tell your doctor all your husband’s medical history. You can say: “He had a car accident 20 month ago. Now he has a severe neck pain, headaches, delusions, suicidal thoughts, irritability and so on. The medications that he is taking are not helping”. The doctor will ask more questions and will decide what tests and medications are needed.
It is time to consult a lawyer. Every ethnic group I know has their lawyers, doctors and interpreters. You may need to connect to your community and find one. Maybe even in another province.
You should see for yourself if you need all this hassle with your insurance company. Is it worse it? I heard a lot of stories about ruined lives because of difficulty dealing with the insurers. Hope you’ll find some peace of mind soon.
One more suggestion for you - my wife is very smart and she is a nurse, and I told her about your problem and she said this to me. This is in regards to where you said above “We had seen 3 walk-in doctors that are understanding and caring, but I don’t how we could see them regularly.”