Your fear of losing LTD benefits -a major reason why you might be cut off!


#1

Most people dealing with disability claims live in fear that their disability insurance benefits will be denied at any moment.
If your Insurer is not bothering you much then stay under the radar and don’t cause any waves.
However if you are being asked to fill out activity forms or they are willing to pay for medical files or you are chosen for rehabilitation, vocational, IME’s or to meet in person with a representative of the Insurer your claim has moved to active management.
`The only reason an Insurer is willing to spend money is to save money!
Any case manager, rehab provider is held accountable for the dollars spent vs. the dollars saved. So if they don’t save dollars for the Insurer by spending dollars it is rated against their performance. They may and likely will be very kind and you want to prove that you are the good claimant, have nothing to hide and want to get better. You are willing to participate and cooperate and comply with all requests. You don’t want to get cut off as your ill/injured and need to pay bills.You don’t want to be difficult so you agree to meet them in your home, don’t ask too many questions,sign any forms they impose and trust them-they are professionals. Their rehab providers, psychologists assure you that they will advocate for you and they are there for you and your health. You are scared of getting cut off so you are determined to prove you are the good claimant!

`The only reason an Insurer is willing to spend money is to save money!
Rehab providers are unlikely to bite the hand that feeds them and many have a bias towards those who are collecting disability. Their job and future referrals is dependent on saving the insurer money. It’s not personal, its business.

You must always remain humble, reasonable and polite. Know your rights and gently educate that you do.
If out of fear of being cut off you allow them to take advantage of you-they will and you likely will be cut off anyways.

My tips when your Insurer moves towards active management of your claim:

  1. Request a complete copy of the Master policy from the Insurer and your employer-do so in writing with proof the request has been sent. (email or fax) Read it if you get it!
  2. Agree to meet them outside of your home, don’t go alone, don’t let them in your home
  3. Request a complete copy of your claim file
  4. In advance of meeting with any provider or IME request to have any required forms to be sent to you. Or offer to pick up.
  5. Send an update authorization/release of information to the Insurer and on all provider forms -sign with the following " signature is only valid on the condition that I receive full and complete copies of all medical reports and that
    they are sent to my home address at the same time they are forwarded by this doctor/provider"
  6. While going through treatment ask for copies of all medical, chart notes and information on a regular basis. Offer to pay for reasonable photo copying.
  7. Don’t go to any appointment alone. Request in advance that you video record (can be done through a phone) any physio or work hardening.
    Canadian Patient Safety Institute (CPSI) advises to record appointments.
  8. If participating in insurer chosen rehab plan ask your Doctor to place a time limit to try to ensure you do not have any set backs. See your treatment providers often and if your insurer says no need to as they are sending you to their providers-keep seeing yours too!

This can all be done in a friendly and respectful manner. It is your health and your recovery. If anything is refused just ask them to put in writing why.

Don’t bargain away your rights out of fear. The above is all reasonable and you are doing your due diligence. They may cancel rehab but you have a better chance of keeping on claim.


#2

I also advise recording all phone calls and appointments in secret-this is just my opinion and many lawyers would advise against. My experience is most claimants either wished they did or are glad they did!