Pharmacogenetics and LTD form

I am on STD but may have to transition to LTD soon. My insurance company has offered to pay for pharmacogenetic testing in order to find out which medications may work better for me because I don’t usually tolerate them well. It sounded like this may be something they just started offering, or they don’t offer it that often, as my case manager admitted she did not know much about it. It was explained to me that I don’t have to disclose my results to the insurance company (Bill S-201 prohibits mandatory genetic testing and disclosure of test results). I understand the potential benefits but I am not absolutely comfortable with providing my DNA for any reason.

I have some questions:

  1. Is there an increase in insurance companies paying for genetic testing or do they offer it only to a select few people?
  2. Do you think it will affect approval of LTD or have any negative impact on my case?
  3. What is the best way to decline the offer (what reason should I give)?
  4. My case manager sent my doctor some forms to fill out so that she (my case manage) can get all the info needed in the event I transition to LTD.
    I am not sure if they are the actual LTD application forms or preliminary forms to get an idea of my medical status. Should I talk to my doctor before the forms are filled out to make sure they are filled out accurately or just request a copy afterwards? Any recommendations on how to go about it?

Thanks in advance

Whatever you do, make sure that the company that does the genetic testing signs an agreement that they will only provide the results to you. Also make sure there is wording th in any authorizations that will not allow the testing company to provide the info to any third party.

Don’t just accept their policies stating that they protect your privacy, get them to sign something that they do protect your information. Make sure it’s signed by someone by a manager at the testing company

Finally keep copies of all of this.

Forgot to add.

Yes have your doctor look at the forms. The only reason I would do any of this testing t is if your doctor has a drug they want your to try, but are concerned you would have a bad reaction to it. If there is currently no recommended drug by your medical team that warrants this test then there is no reason to have the test done.

Thanks Buckets365. I think I’ve already decided I don’t want to do the test. Firstly, I’ve already just started a medication that my doctor suggested so like you said I’m not sure that I need the test, secondly, my case manager said that the results would go to my doctor (on the website for the company that does the test it says that results only go to the person taking the test unless consent is given to share with another medical practitioner). I’m not comfortable with results automatically going to my doctor (after I give consent) as then those results end up in my medical file and even if I didn’t consent, my insurer would know I took the test as they are paying for it and they may wonder why I didn’t share results with my doctor.

So I guess what I wanted to know was how do I decline the offer (for what reason) and would there be any negative impact?

I suggest that you have your doctor put in your file that this test is not required for your treatment (if they agree that it is not required). That way your insurance company can’t say your not getting appropriate treatment (even if it is just a test).

If it were me and the doctor said the test provides no benefit to me I’d just say the following…

“Since my attending physician sees no need to have this test done to appropriately treat my (fill in ailment/diagnosis), I kindly decline this test as it won’t help in my recovery. If you believe this test is required to meet the eligibility for LTD please provide the part of my LTD policy that states this.”

Honestly, your inurance company can cut you off at any time for the silliest of reasons that are a breach of contract. If they ever decline or cut you off DO NOT follow their appeal process, but go directly to a reputable specialized LTD lawyer.

Forgot to mention…do all this communication with your insurance company via email. Any verbal conversation you absolutely must followup immediately with a a summary email stating what was discussed.

Your case manager is not your friend. Some of them will just lie directly to you over the phone even though they seem nice and genuine.

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Thanks Buckets365 for those tips. You mentioned some good points I will keep in mind.

This is a complicated area of the law. We are researching this issue and will be publishing a blog article and also presenting on this in our Weekly Disability Claim Answers Show in the future.

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.

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Here is the link to the blog article we published on the topic: Long-Term Disability and Pharmacogenomic Testing - Resolute Legal Disability Lawyers



Just wanted to share my experience.

I ended up deciding to do it after initially saying no. The insurance company didn’t get a copy of the results and I was the only one who went over the report with the provider (a pharmacist, if I remember correctly).

In the end, I found it to be useful as I changed to a new medication and I know which medication from different categories is going to be effective and which one is not and I have proof. The report doesn’t really have more information than how you’re likely to respond to various medications. The insurance company doesn’t get any of it. I’m glad I got it done.

It actually did provide benefits and probably will be useful in the future as well. I gave a copy of the report to my pharmacist and my gp. If anyone wants to see what it looks like, let me know, I’ll blank out some info on mine and share. It’s really interesting actually.

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This is very interesting. Thank you for sharing!