Hi,
recently preparing for an STD/LTD claim and am being questioned, “what makes you able to work today and not tomorrow after seeing your doctor”. The insurance company seems to think all issues are like a broken leg, good one day and bad the next but in the case of severe fatigue or mental issues the decent can be gradual and the decision to stop work may be a mutual agreement between you and your doctor. How do I defend this to the insurance company that said that they would reject the claim if the last date worked didn’t coincide with an event like a doctor appointment that is weeks away.
Its like I have to go see the doctor and never return.
I am not a lawyer but offer these thoughts.
You went to your doctor because you have reached your breaking point, like drowning in quicksand or slugging through thick mud. Or whatever is true to you. You worked the day before, but were you there in body only. Is the struggle too much?
Sometimes we all fall and need help getting up.
If your doctor is starting you on medications and/or upping current medications it can take time to get over the side effects
and for the meds to work. You may need to get some counselling to get back on track.
I went off on stress/mental health leave and here is how I handled it.
When I was questioned why I could not work I said I’m just broken and need time to find my way back.
When the case manager said that was not good enough I told her I could not deal with her right now and requested her email/fax.
I then sent by email my application for disability that my doctor filled out.
Copies of my prescription receipts and name of counselor I had booked to see.
I printed out symptoms of major depression as well as symptoms of general anxiety disorder from the Mayo clinic’s website and circled the symptoms that related to myself. The Mayo clinic also explains Major Depression and General Anxiety Disorder so I included that too.
Turns out that my fatigue, depression was a crashed thyroid-so I sent that next email. With copies from the Mayo clinics website info on Thyroid and symptoms.
It worked well for me and as I was trying to get well I asked to only communicate in writing as talking made me anxious.
Good Luck and I hope you feel better soon.
While you wait for your doctors appointment-go to a walk in or a health clinic that can vouch for you. Or you could apply for EI for illness if you know your doctor will support you and if your claim for STD is denied Tough situation to be in.
EI should be applied for within 4 weeks off work-so if your claim is going to be initially denied -might be an option.
There has to be a logical reason for the date you finally stop work to go on disability. Often this is the date you go to the doctor and he or she says I am putting you off work. That is normally the easiest and best way to handle the day you stop working.
I am in no way suggesting you are doing this, but it is critically that you not finesse the last day of work in any way. Like waiting to do it after a vacation, or until some project is complete, etc. I have seen people try to do this and it creates problems.
With most cases I see, the answer is as Allyoops says, people stop work because they have burned the candle at both ends and have reached a point of mental or physical breakdown. Most people work far beyond the date they should have taken a sick leave. So what happens is that most people stop work when they have a complete mental breakdown or some incident at work due to the stress they are under.
In explaining why today and not yesterday, you need to explain that you have not been effective at work for some time. That it has been a long struggle. That you finally reached your breaking point, etc. Ultimately your doctor has to agree and support you on this. It will be critical for your doctor to specifically say that he or she supports you being unable to work from the day you stopped.
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