Rude and condescending case worker


#1

I’ve been in LTD for 10 years now and the last 4 years I’ve only got a phone call once from a case manager which was last year. I contacted my insurance company a couple weeks ago requesting info on what the criteria was should I leave the country for 6-8 months out of the year but not all at once. I mentioned I was leaving next week to visit my children for less than 90 days and would be back. I got a phone call from a case manager after I had left and she was very condescending, aggressive and quite rude saying things like if I had asked my doctor that I could travel, I can’t just leave without informing the insurance company, demanding an update of my medical condition within 3 weeks, that insurance is not a free for all. I asked her what is the criteria for me leaving and how long can I leave and visit my children - she wouldn’t tell me and instead demanded an update and then she would think about it. She did say that I couldn’t leave for more than a couple of days.
Now I’m really confused.
On this forum I’ve read that leaving for up to 3 months without informing the insurance company is fine and that if you wanted to leave for longer to call and ask which I did but that went against me.
I feel like I’m in a prison.
Any thoughts on how to approach my case worker who is refusing to give me information and was quite condescending and rude? Should I report her?
How can I get a copy of my policy?


#2

You have approached this the right way by informing your insurance company. Unfortunately, this is the reaction of some within the insurance company who think it is just “horrific” that a person receiving LTD payments could ever go on a vacation or travel.

Six to eight months out of the country is a lot of time … and is likely more than your policy would allow, or more than most insurance companies would be comfortable with. In other posts on this subject, I have said that their concern is that you won’t have continuity of medical care.

So in a case like this, where you are proposing to leave for such a long time, it would have been best to have reviewed this with your doctor and have had him or her write a letter saying this travel will not interfere with your care, here are the steps we are taking, this travel is within your abilities, etc.

You are probably not going to be able to get a copy of your policy. Ask the person for a summary of the sections that relate to travel. Most policies give insurance companies wide discretion to approve or disapprove travel.

Travel for on off vacations or a one-off trip to visit someone are things the insurance company will be ok with. What you have described sounds like you will will be traveling on a regular basis. Again, this is all within your rights to travel it is just that LTD insurers will have a problem with it.


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 reliabile 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 1-877-282-5188 to speak with a member with our disability claim support team.


#3

3 months is USUALLY fine but it depends on your insurance company/policy.
I know most of the stuff I say is just my opinion and is based on my specific policy/experience.

I think the closer you are to 90 days and the longer you have been on LTD, the more you need medical approval.
My benefit booklet I got from my employer briefly details travel.
If I was going anywhere for more than a week, I would phone my insurance company.

Yes, it does feel like a prison.


#4

You did right by asking–if you went away on a frequent or longer basis and your Insurer found out after the fact—it would look very bad on you and could cost you your claim.

Go to your Doctor-get the required info and your Doctor saying the travel is OK. Let your Insurer how you will be managing your disability while away.


#5

Don’t report her yet—ask for the policy provision with respect to travel. Let her know that you are following up with your Doctor as she requested and will send the requested information.

Explain how you are going to manage your health while away and if true explain that you need your children’s assistance with helping you manage your day to day life.

BIG TIP Ego is always expensive. If she is rude to you make note of it and save for later if needed. Always let the Insurer be the one to flex their ego…don’t react. EGO always costs–let it be the Insurer who operates that way.

It is ok to say the tone of the call made you uncomfortable and the comment that Insurance was not a free ride was hurtful.

Then go on to say you are doing everything she asked. Always be humble!


#6

Thank you for your prompt reply David. I had mentioned to her the 6-8 months was a one off and wouldn’t be taken all in one go but as this is all very new to me I have learned a lot from it and hopefully my enquiry won’t cost me my claim.


#7

Thank you for your reply jammer. i read that on the forum and assumed 90 days would be fine with no doctors approval - That’s how I understood it and now she is reviewing my disability claim and wanting medical updates when all I did was enquire about an extended visit to see my children.


#8

Thanks allyoops your advice has been very helpful and has given me some direction. I was very hurt by what she said but I remained calm and respectful. Thank you for reminding me to remain humble!


#9

I think it was still better to ask the insurance company.

Best of luck.


#10

I completely agree with you - better safe than sorry.


#11

She may have misunderstood and thought you are going away for 3 months all at once.
She may also question your ability to make plans for 3 months ahead with regard to your health problems.
Your ability to commit to vacation plans = you can work.
This is untrue yet a lot of people think that way.

Why did your case manager call last year?
I’m wondering if she had already decided to look at your case more closely. :frowning:
If you can see a doctor with 3 weeks (it seems like an unreasonable time frame to me) then great.
I wonder if you got a new case manager, I’ve already had 3 over 6 months.


#12

It was difficult to get a word in with her as she kept cutting me off and not letting me explain. It wasn’t a vacation I was going on as I explained my children, whom I was living with, took their families and moved abroad and I really needed to see them it’s been hard for me to live without them because they were a great support in so many ways. But I understand that the insurance company will see it as a vacation.
My son planned everything so I’m not worried about what the ins co thinks - they can call him.

My case manager called last year as they hadn’t spoken to me in 4-5 years and just wanted an update of my medical condition. In the past they would contact my doc directly to get a medical update but she said that they would not be doing that anymore as it’s expensive and will call me instead.

I don’t think they would have called me this year as there was no case manager assigned to my file when I called to ask info on my visit abroad.
I’ve had about 5-6 different case managers in the last 10 years.
3 weeks may not be enough time for me to get a report to her and I feel she is being unreasonable and demanding.


#13

I hope all goes well for you and it doesn’t turn ugly.
It sounds like the new case manager is trying to “make a name for herself” but I hope I’m wrong.


#14

You are handling this in a responsible and good faith manner. I really doubt the insurance company will cut off payments in a situation like this. If they did, it would be a situation likely could could be turned around very quickly by suing them. This is why you need to remain calm and very reasonable in your interactions…if this ever went forward to a lawsuit it would reflect poorly on them and good on you for being up-front and acting in good faith. If you hand not brought this to their attention, and they found out after the fact and cut off payments, it would be easier for them to portray you as a schemer and sneaking around etc…they won’t be able to do that with you and it is very powerful.


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 reliabile 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 1-877-282-5188 to speak with a member with our disability claim support team._strong text