Query - " Patient competent to manage his/her own affairs"?


#1

Hi,

I have been on disability for close to 6 years. In the last 4 years or so, only “yearly” Plan member update form had been requested and no request for Physician’s form.

This Plan member update form is requested typically at the end of the year or start of the year; This year, as it was not received, I called the provider to inquire on this.

Now, few days after I inquired, they have requested - i) Plan member update form and ii) Attending Physician’s update form.

Query 1:-

This is the first time I am receiving “Attending Physician’s update form”. In this form, there is a question that asks
"In your opinion, patient competent to manage his/her own affairs? Yes/No.

Q: I wish to know the significance of this question and the probable reasoning for the request of this information?

Is the above question, primarily in regards to whether a disabled person can manage their own financial aspects of the life or does it relate to other aspects of diability.

Please share your thoughts on this.

Query 2:-

Q; With the request for Physician’s input after 4 years, should I be ready for request for new set of documentation/reports?

Thanks in advance for all your help.


#2

I don’t know why they ask.
Maybe so they know if they should expect you to respond to their requests.

Maybe there is a new case manager.
If your condition hasn’t changed tell them that and you haven’t had to do a medical update for 6 years.


#3

It is a standard question on medical forms. Usually has a yes or no type of answer. They maybe reviewing your file to see if any options for rehabilitation. You should request a full and complete copy of your claim file for your records.


#4

I would not necessarily read too much into the new forms and questions. insurance companies change their forms over time. I think they are adding questions like this to make sure they are not seen to be taking advantage of people who are not competent to manage their own affairs. Also, it could be something they want to know in case they ever wanted to offer you a lump sum payout of your claim.

Insurers do continue to review claims over time, so based on what your doctor says, it is possible they could have more investigations, etc.


David Brannen

Disability Lawyer with Resolute Legal

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#5

Thanks very much jammer.