What is expected and what is allowed by the insurance company regarding occupational retraining while on LTD.
Anytime an Insurer is looking to spend money on a claim it is in the goal of closing the claim on the least cost possible, which may not be in your best interest.
- Don’t show too much optimism, even if you really want to believe you can return to work one day. On the same note be cooperative and respectful always.
- You need to know what your limitations/restrictions are and if your Doctor supports retraining. During any retraining make sure you see your doctor/psychologist/specialist during this time so you have documentation on how the retraining is affecting you.
- Any vocational consultant has a duty towards you as the client. They often forget this. Ask for any required consent or other forms required by the provider to be sent/provided to you before the appointment. Let the provider know that you are to be copied on all reports and communications as soon as they are released, and will pay for photocopies if required. Note that on consent forms, release of information requests.
- Most master policies have spending limits for rehab/vocational ie:6 times monthly benefit. Review with Insurer so you can research what you would like also. Often an Insurer wastes a lot of money on testing, transferable analysis and reduces what is available. They do a cost benefit analysis before approving a plan.
- Take someone with you to every meeting that is good at note taking, or ask for Union rep if you have. ( I believe in recording or asking to record the visits-but not all agree with this)
- Realistically look at if returning to work is a possibility for you.
Basically Insurers have lots of options and can have you do supportive employment, volunteer, short term courses so
researching what you see as doable is in your best interest. If they say you could do a certain job-like movie ticket taker-follow up with actual employers to see what the job demands are. To be a movie ticket taker at cineplex-you are also expected to be able to work concession, clean the theatres and such. It is not a sedentary job.
So when will my insurance provider ask me to do vocational rehabilitation or anything of that sort?
They usually move in on that quite quickly. You have applied for CPP-D so it is unlikely that you would be approached for rehab unless your doctor or yourself pushed for it.
Rehabilitation is a major way Insurers get claimants off claim. You want to avoid this unless you feel you will return to work, you come up with the plan and you have really done your homework.
The only other thing is that if the rehabilition is being drivin by the insurance you should attend it unless your doctor has medical justification for you not to do so. In my opinion you should attend in good faith even if you think it maybe futile. It is important to keep an open mind and to demonstrate beyond a shadow of a doubt that you have done absolutely everything to try and get back to work.
1 Like
Thank you. It’s good to know what to expect after cpp-d.
James, it is rare for insurance companies to get involved in occupational retraining…in the sense that they are not going to pay for you to go to school or other retraining. They may send you on short term courses on computer skills but that is usually it. It is more likely they will focus on programs the focus on increasing your activity level so they can show you can attend a program on regular basis, therefore, you can attend a job.
My opinion is there is a difference between being able to physically attend a job and mentally do the job.
If someone gets approved for CPP-D then why would an insurer think retraining would help?
1 Like
Retraining or vocational rehab after you have been accepted for CPP-D is only going to happen if the Insurer thinks it will help save them money. If you are 32 with Fibromyalgia and have a policy that goes to 65, even with CPP-D the Insurer may see an opportunity for cost containment.
Work conditioning and counseling could easily generate reports that an Insured could do sedentary and work is helpful for mental health. Bonus for them if you can not complete the programs because then you are cut off for not being compliant.
Most people accept bad decisions from Insurers-which is understandable but sad.
Again anytime an Insurer is looking at spending extra money and funding programs it is best to get legal advice and visit your own Doctor more often.
1 Like
If you accidentally puke on a work counsellor will it be a sign of noncompliance? 
And repeat that at every session. 
Not on purpose, of course.
2 Likes
Too funny! When I was looking for sedentary job ideas for my spouse I read many Worker Comp appeals. One claimant
took a dump on the floor in the middle of physio. He was found non compliant. Another peed all over the place on purpose during work conditioning. He also was found non compliant. My favorite was a truck driver who Workers Comp thought could sit on a doughnut cushion and do part time work while he waited for his hemorrhoid surgery. He had his wife take pictures of how severe his hemorrhoids were and sent multiple faxes to Workers Comp. He won his claim.
1 Like
Oh my … This is hilarious. 
You can’t beat that.
I don’t know anything about Fibromyalgia but is there a treatment that can improve functionality?
I’m hoping when you say “insurer”, you mean the medical experts of the insurer.
No, I mean Insurer. Your case manager identifies cost savings strategies. If you have a complex diagnosis ie; depression, chronic pain, chronic fatigue, Complex regional pain, Fibro----those claims are most likely to be targeted for strategies to get you off claim. Even with CPP-D, those claims require a great deal of proof to be accepted.
Your insurer will often refer you to a physical activation program so they can show you are pain focused and such.
The psychologist/psychiatrist will likely say you just need CBT therapy to challenge your dysfunctional or mal adaptive thought process.
The end result is you are choosing not to get better and work would be helpful. There is such bias and stigmatization on these claims that the Insured/claimant can be very harmed by these tactics.
1 Like
I have a problem accepting the insurer (who is not a medical expert) sending a person for medical treatment when they don’t know WT* they are talking about.
1 Like
Insurance companies have their own doctors/specialists who evaluate and advise on your case internally before making any decisions. They have enough resorces to hire any expert. Case managers just handle the case and cannot make medical decisions.
Not in my husbands case! It was a case manager and a GWL OT that prescribed medical treatment-without
consulting his Doctor or his then current physiotherapist.
They lied and said they would and sent him a letter that they did. Even with the request to apply for CPP-D, GWL has said they feel he would be entitled. This is just the case manager and her manager-no medical review.
I saw my GP today and his only response was that I should cooperate with my Rehab and attempt to return to work. He did not come up with any sort of plan for me. My employer has very strict rules about work restrictions and an extensive form for the GP to fill out to boot. Hopefully, I would return to my own job with restrictions, I’m not too thrilled about the prospect of working somewhere unfamiliar. I was under the impression you would be going back to your own job and eased back in. I am also told by my HR that if you can’t successfully return you can go back on your LTD. My caseworker does not tell me much about the rehab plan is that so I commit? I would really like to know what is involved. I’m hoping my HR contact will fill me in. She is finding out some info for me.