Proving to Insurance company I was unfit to work


#1

I was on mat leave when diagnosed with breast cancer. When chemo and radiation ended a rehabiliation consultant came to visit me and they wanted me to start a rehab program. My doctors did not agree with this and my family doctor wrote them a letter saying that i should follow their medical plan and not participate in the rehab program at that time as it would over exert me. 3 months later my LtD was terminated as they said I didnt have medical reason to prove i was unfit for work and that it was a breach of contract that i didnt participate in their rehab program. Both my family doctor and oncologist have written letters prior to the termination plus I had a psychological evaluation and the insurance company still declined my appeal. I am going to appeal again but i don’t know what else i can give them i feel like its a play on words what does my doctor have to state more clearly??? I have chemo-brain, am depressed and have anxiety, i have major fatigue.
Thank you


#2

Try the free consult. The longer your Insurer can delay and make you financially suffer they win. If you have support then you should be able to file an application in court that you are disabled and entitled to benefits. You can also try the appeal process. Wait for other advice too.

Immediately request your entire claim file (nicely) so you can review how they made their decion. You should also request the Master policy from your Insurer and employer.


Insurer forcing back to work off STD but Dr. disagrees
#3

Maria,
When I helped a friend with her 3rd appeal for disability benefits what I had her do was get copies of her past work performance reviews, a copy of her duties and obligations at work to include with the appeal. She took a copy to her Doctor and psychologist so they could write brief letter/note on what she was unable to do specific to her job.
I also had her print off descriptions of her conditions from the Mayo Clinic website and check off all sypmtoms she has along with the mayo clinic definition of her illnesses ie. http://www.mayoclinic.org/diseases-conditions/generalized-anxiety-disorder/basics/symptoms/con-20024562

You can also get a print out from your pharmacy of any medications you are taking and can ask the pharmacy for print out of side effects and such of these medications.

If you do not have a list of job demands/performance reviews from work then include a job ad for your position or go to the government website and print off a job description from there.

Please request your entire claim file along and ask both your Insurer and Employer for a copy or chance to review the Master group policy.

As for rehab explain that you are under the care of your Doctor and was following that advice with respect to the proposed rehab plan. Let them know you are always willing to participate and cooperate in any treatment that will help you recover with your Doctors approval. If you are unable to participate in rehab, you must provide medical evidence that shows participation would hinder your recovery. Your Doctor did that

In my friends case she was lucky because her claim manager wrote to her that she could try appealing but it was unlikely the decision for benefits would change. From that arrogant comment she was able to ask if he was recommending that she appeal or go to court as the Insurer had prejudged her appeal before she had submitted it.

You can also include professional reviewed journal articles on your conditions. Highlight what applies to you.

She got the benefits.


#4

Your message is sooo helpful! Thank you so much for taking the time respond. I will definitely be taking all of your advice!


APPEAL or RETURN to WORK are my only options