If you’re on an approved short- or long-term disability claim, you might be worried about the current state of things — and you probably have a ton of questions about how your claim is going to proceed.
I’ll start off by saying you’re definitely not alone — I know it helps me to remember that we’re navigating this strange new world together.
In this article, as part of our COVID-19 resources, the team here has come up with some possible solutions to problems you might be experiencing: Doctor’s office closures, keeping your insurer updated, refilling prescriptions, and more. This article is also featured in our Ultimate Guide to Long-term Disability Benefits.
Doctor’s office closures
Being unable to contact your doctor is a big concern for a lot of folks. It directly affects seeing your physician, receiving treatment and prescriptions, and getting a hold of any medical records that you might need to submit. Hopefully, insurance companies will empathize and recognize the difficulties — but at the end of the day, they are businesses that want to make money, too.
This doesn’t mean that you should stop trying. You always need to put in a good-faith effort to see your doctors and specialists and participate in treatment — even now, when business closures and the state of emergency have made it a lot harder.
If your regular doctor’s office is closed, try to find written proof of this as well as the dates of closure. If they know the date that they expect to reopen, do your best to book your appointments and inform your insurer that this is the soonest you can get in. Obviously there will be delays with other patients returning for care, so try to book future appointments in advance as well.
In some cases the office will be closed but there will still be people there to receive phone calls, faxes, and emails, and respond to urgent needs. You can certainly try any of these methods. Many doctors and specialists are transitioning to virtual assessments, so be sure to ask if that’s an option if you can get a hold of someone.
Most importantly, keep track of the attempts you make to contact your doctor. Save your emails into a specific folder, record phone calls if necessary, and hold onto any fax receipts or confirmation pages.
Keeping your insurer updated
When you’re on an approved disability claim, you have an obligation to communicate with your insurer and continually prove your eligibility. This is certainly made harder with the current circumstances; but, just as above, you have to do everything you can.
If you have forms that need to be filled out but you can’t get in to see your doctor, your insurance company might accept a written report instead. It’s probably best to communicate with your representative and ask them if this would be acceptable in the meantime if your doctor can’t directly access their records.
Most large insurance companies are extending the services they will cover and accepting virtual consultations with many types of specialists. I have seen that Desjardins, for example, is temporarily allowing virtual consultations for a wide variety of health professionals. Their list even includes physiotherapy and other physical disciplines where you would normally need to be seen in person. Check with your specific insurance company to see if this is a possible way for you to continue to receive treatment.
If the insurance company books an independent medical examination (IME) for you, do your best to comply. This might mean that you have to leave your home if the specialist remains open as an essential service. If you’re absolutely not comfortable attending an in-person assessment, ask if you can do it virtually.
As always, keep records of your treatment attempts as well as any virtual consultations that you manage to receive. It’s probably better to over-document during this time; share every step of your journey with your claims representative so they know you’re trying.
There’s also some concern around refilling prescriptions. From our experience, if your doctor is out of office temporarily, it’s a good idea to speak with your pharmacist. If you have medication that you take regularly, they may provide you with refills for a period of time before you need a new prescription from your doctor. We’ve heard they will do this for up to 3 months, although of course this depends on what type of medication you need.
Please also note that currently, the The Canadian Pharmacists Association recommends that you only keep enough medication to last 30 days. Do not stockpile medications as this can lead to shortages.
While you’re at the pharmacy, ask for documentation that shows that you have continued to fill and take your medications. This might prove to be helpful to show the insurance company that you’re still doing what you can to comply with treatment.
Offsets and overpayments
If you do qualify for CERB or other benefits that might be introduced during this time, be upfront with your insurance company. Tell them that you’re applying for the money, let them know if you receive it, and keep track of what you receive. They will likely deduct the amount of these extra benefits from what they are paying you.
Well, people aren’t leaving the house much these days, but that won’t stop surveillance if you’re already under suspicion. Be especially cautious about what you post online since we’re all at home and probably using social media more than we normally would be.
For more information, check out our article: Surveillance and Long-term Disability Claims
Benefits getting cut off
There’s always a chance that you are deemed ineligible for disability benefits and your payments get cut off during this time. Currently, you might not have a position to go back to if your insurance company suggests a return to work program.
Of course, due to the potential problems with contacting your doctor and receiving treatment right now, it might be harder to get everything that the insurer is asking for to prove that you’re unable to work and complying with treatment. This is why it’s crucial to try everything you can — and to document everything that you’ve tried.
In the event that you need to appeal, it will be much easier with proof that you went out of your way to speak with doctors and get treatment despite everything that’s going on.
An approved disability claim is a fine line to walk in the best of times. I’m hoping that insurance companies are more understanding and less strict during this time, but there’s no telling what will happen.
its crucial to stay on top of things:
- Be diligent about communicating with doctors and your insurer
- Keep notes of whatever happens in the times between speaking with them
- Collect documents
- Check your email, phone messages, and regular mail frequently.
Try to stay updated with the latest news and pay attention to the changes that might affect you — hopefully things will be changing for the better.
If you’re feeling worried that you might run into problems, even after trying these tips, you might want to get a lawyer involved with your case sooner rather than later. This might just mean opening up a dialogue to better understand your options. Often, simply speaking with someone who has experience with these claims can help put your mind at ease.