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Archive for the ‘Physician Issues’ Category

After roughly 25 years in the business I am absolutely convinced that one of the reasons why insurance companies harass treating physicians with vexatious requests for information is because what they get back is not what they need, or are looking for.

Most treating physicians are very close to their patients and remain supportive during every phase of patient disability. Despite the fact that they are now required to fill out forms from every possible source (SSDI, Worker’s Comp, Private Disability, Personal Injury Litigation etc.), they do the best they can while trying to do their real jobs of providing patient care. The physicians I have dealt with on behalf of my clients have been totally supportive, and it is obvious they care about the health and well-being of their patients.

However, while I am extremely grateful to the physicians who take the time to  support disability correctly, there are some physicians who continue to regard time spent in filling out forms as a waste of their time. All disability claims are paid or not paid based on the quality of medical information sent to the insurance company. And, while insurers are busy doing everything they can to find ways to deny claims, it is now more important than ever for physicians to report the totality of patient impairment, and do a really good job.

DCS, Inc. specializes in assisting treating physicians to report medical disability wisely. Although I can’t go into a great deal of my proprietary strategies in a public forum, here are a few items physicians should be documenting on a regular basis.

  • Diagnoses, both primary and secondary with ICD-10 codes.
  • Prognosis.
  • Statement as to whether patients are at MMI.
  • Details concerning the physician’s treatment plan.
  • Medical restrictions and limitations. (Activities patients may never do, versus activities they may do, but only to a limited extent.)
  • Physicians should always provide what I call a “disability statement.” If the patient is “totally and permanently disabled”, the physician should say so.
  • Physician statement regarding exercise, activity and that it is recommended as part of a viable treatment plan.

Statements from physicians such as, “No work”, or, “Patient is disabled”, is not sufficient to support private disability. The doctor needs to provide much more detail about why his/her patients are unable to work. Of late, I’m hearing physician comments such as, “What does it matter? Insurance companies don’t pay attention to me anyway.”

Although this observation may have some truth to it, insurers do pay attention to medical reports if only to try to find ways around them. Strong, well-documented medical reporting makes it more difficult for any insurer to challenge disability claims.

I also find that some patients are reluctant, or afraid to communicate what is needed to their treating physicians. I can understand this since some physicians fly by during consultations because they are so busy, particularly in the larger physician facilities. It’s hard to try to discuss disability forms when physicians give their patients 5 minutes of follow-up office time.

Physician reporting can be improved when patients also take the time to discuss why they feel they are unable to return to work. Treating physicians are NOT mind readers and shouldn’t be expected to conjure up medical restrictions and limitations relating to jobs or occupations when needed. DCS recommends that insureds and claimants show their treating physicians job descriptions and explain why they are unable to do certain things.

Bottom line, physicians who do not take the time to do a good job reporting impairment are repeatedly harassed by insurers to provide more and more information.

Medical reporting is a priority for private disability.

 

 

 

 

 

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physicians heading southThere is significant evidence to suggest that a growing percentage of treating physicians are firing, or refusing to treat patients with private disability claims, and for good reason.

Nearly 30 to 40 percent of patients treated by physicians now consists of those who require completion of paperwork to obtain benefits whether it is social security, private insurance or workers’ compensation. “I’m in the business of patient care”, one physician confided to me, “not filling out paperwork insurers ignore anyway.”

While the majority of physicians nationwide continue to muddle through the paperwork, other doctors are “fed up” with private disability insurance and the harassing manner in which their office staffs are confronted with endless requests for patient records and forms. “I don’t make any money filling out these forms”, another psychiatrist said, ” and I refuse to do it, even though I do support my patient’s disability.” Physicians clearly find themselves conflicted when trying to balance efforts to support patients who cannot work, with costly office and staff disruptions and vexatious calls from insurers.

Patient treatment notes are not only sought after by insurers because they are viewed as absolute proof of “regular care”, but narratives of treatment can be more easily misrepresented and key phrases “snatched”  so that “illusions” of work capacity can be documented by internal reviewers. The dichotomy is that patient notes are not written by physicians to support disability claims, but are personal medical diary notes of consultation and treatment. Patient notes are never written by physicians to support disability claims, but instead reflect written records of past treatment visits.

Many physicians today do not keep patient notes in their offices but employ outside vendors to maintain and store exhaustive patient records. Obtaining copies of patient notes can be complicated and costly to send out; managing patient notes requests takes valuable staff time away from patient care. Bottom line, physicians are more and more reluctant to take on the responsibility of continuously providing patient notes and filling out endless forms and are asking patients to take their treatment elsewhere.

Some physicians are also “spooked” by the idea they could be asked to testify in court. Although this is also true of workers’ compensation, physicians may view disability insurance as an ogre of useless time spent in court. In addition, some physicians may treat and support disability even though they never truly “get off the fence” and say specifically patients are disabled. Testifying a FMS patient is totally disabled in court seems a bit risky to rheumatologists even though monthly disability forms are completed for the patient.

Physicians can control insurance harassment, but rarely seem to know they can. Physicians can require insurers to submit all requests for patient notes in writing to include a set fee such as $100+ for photocopying, and administrative time. Insurers can be charged anywhere from $100 to $250+ for completing forms faxed directly to their offices. In fact, DCS suggests that physicians bill by invoice any time they receive requests for medical records. Medical records should also not be released by physicians until payment is received.

Physicians can simply direct their staff to say, “We do not accept phone calls from insurance companies. Please submit requests in writing.” Patients themselves can request copies of their medical notes to submit as proof of claim. Still, physicians can stop insurer harassment of their office staff by informing insurers the office does not accept phone calls directly from insurance companies. This policy also puts a halt to doc-to-doc calls as well. Physicians always have the option of “nipping the problem in the bud” rather than becoming disgruntled by patients who need forms completed on a regular basis. Why they don’t do this more often is a mystery.

The recent trend of physicians to refuse patients receiving private disability is a growing problem for insureds who must submit frequent “proof of claim” to their insurers. It is not helpful to insureds and claimants to continue to treat with physicians who refuse to complete paperwork and often find themselves looking for treatment elsewhere. Neurologists are the most frequent medical providers to fire patients when harassed about paperwork. Osteopathic surgeons and pain management MDs are also infamous for refusing to complete disability paperwork beyond a certain point.

The growing trend of physicians to throw disability patients under the bus is increasing at an alarming rate. Without the written support of treating physicians disability claims are likely to be denied.

DCS recommends insureds and claimants speak frankly with their physicians about the need for disability paperwork and have an understanding as to how requests for patient notes and signed forms are to be handled. Anytime physicians balk, or express dissatisfaction with filling out paperwork, patients should say, ” Since I am receiving disability and must provide proof of claim I will need to find another physician who is more willing to fill out my paperwork. Can you refer me to someone?”  It won’t take docs to long to figure out they are losing patients, and income.

Patients often take advantage of their physicians by demanding forms be filled out in a hurry, or continuously calling offices to see “where we are in getting those patient notes together.” Claimants should always offer to pay an additional reasonable fee to have paperwork completed. Insureds and claimants should always be aware of the possibility their physicians aren’t quite as hep to filling out paperwork as you might think.

Having a reliable physician is essential to any successful disability claim and current trends are indicating physicians just aren’t putting up with it anymore. Unfortunately, insureds and claimants find themselves in positions of having to constantly search for doctors who aren’t refusing to accept them as patients because they have disability claims.

Without prompt receipt of patient notes and signed disability forms disability benefits will not be paid. Once again insureds and claimants are placed in Catch-22 positions because insurers continue to harass for paperwork.

If physicians keep pulling out of the process more and more insureds will find it difficult to get paid – yet another injustice in a long list of obstacles posed by a system only insurers can profit from.

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DoctorI would like to take the opportunity today to give more information concerning Unum’s internal medical reviews particularly since the company continues its “patterns of practices” to ignore and exclude all information from treating physicians relying solely on its own internal reviewers. In fact, Unum’s hierarchy of medical review is so unfair and egregious one wonders how claims are paid at all.

Although I’ve written many articles and posts over the years I think it’s important to emphasize first and foremost that Unum’s internal medical reviewers are paid annual percentage bonuses to support the company’s agenda to deny legitimate claims. Either Unum’s physicians tote the line and grab their bonuses, or they are swiftly discredited with peers and terminated.

Medical management uses annual bonuses as leverage against its own staff to encourage competition and compliance in cooperating with the company’s business agenda. It is my understanding from a former Unum Director that internal physicians are warned by upper management not to discuss or reveal salaries or bonuses under penalty of immediate termination – pretty scary stuff.

It it important for insureds and claimants to actually think about this for a moment. Coming out the gate, there is no such thing as a fair, or objective medical review anywhere within Unum walls. It follows that every document signed by a Unum physician demonstrates the physician’s conflict of interest to render prejudicial medical reviews in an effort to bolster the company’s business agenda.

There is an old saying, “it is impossible to get someone to see the truth when their salary depends on ignoring it.” This is especially true of Unum’s internal physicians and other IME docs who sign their name to reports they know are inaccurate.

It has been suggested to me after posting my letter of complaint concerning RN reviews that RNs who render written opinions concerning medical information are actually “practicing medicine without a license.” In particular, RNs who document their opinions without knowledge, training and background in specific specialty areas, also misrepresent the content of patient notes and records because they are unskilled. Unum RNs provide documented opinions in areas in which they are not trained.

Secondly, Unum buys “board certification” credentials and then boasts about them in nearly every Unum communication referencing internal medical reviews. Most of Unum’s internal physicians are paid salaries in excess of $200,000/year. It’s clear that since Unum pays for the “board certification” credentials it expects to receive a more than favorable return on its investment.

In truth, most treating physicians are also “board certified” and Unum has no comeuppance on credentialing at all. (We recommend all insureds and claimants document board certified credentials of their treating physicians and include a current Curriculum Vitae in their claim file.) Insureds and claimants shouldn’t be intimidated by Unum’s mention of “board certified internal reviewers” since most physicians today are board certified if they’ve been practicing more than a few years.

Unum also makes a big deal about finding “board certified IME physicians” which in my opinion are false statements made in order to hire  its own IME-tried reviewers even if they are located long distances away form insureds’ residences.

Finally, Unum’s internal review process attempts to create the “illusion” of credibility so that any outside regulator or unknowing insurance official might be deceived into thinking Unum’s decision to deny claims are the right ones to  make. This is done by “hiding in plain sight” a hierarchy of medical review, which on the surface might appear credible, but is really stacking the deck against insureds.

Most Unum reviews consist of: an RN walk-in review, and OSP review (floor physician), a “board certified” specialty medical reviewer, and finally a review by a Medical Director. The RN sets the stage for the outcome of the review since no physician further up the chain of review ever disagrees with prior physicians. These patterns of business practices stack the deck against insureds and claimants and essentially denies them the right to fair and equitable reviews.

In the end, insureds and claimants can’t ever get a fair deal from Unum and employers need to know that. Those employers who genuinely seek to provide benefit coverage to protect employees should not depend on Unum’s internal review systems to supply fair and objective reviews to employees.

As a claims consultant my objection to Unum’s internal and IME medical reviews is that company physicians often document medical opinions which are medically unsound and could potentially cause harm if insureds and claimants took them seriously.

Sending opiate addicted neonatologists and anesthesiologists back to work, or alleging HIV patients with CD-4 counts of 250 can work are examples of Unum medical reviews with potential to cause death or harm. It’s insane that state regulators and Congress allow insurance companies to “cause harm” instead of preventing it.

Unum Group is a corporation and like all corporations will trample over the backs of any group of people in order to show windfall profits. I strongly suggest insureds and claimants speak candidly with their own treating physicians about Unum’s potential to cause harm and make sure medical conditions and symptoms are properly documented in the file.

In the meantime, claimants can report any Unum internal physician or nurse to the appropriate state licensing agency and ask for investigations of physicians who deliberately misrepresent patient notes and other medical information.

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Patient RecordsAs calls continue to come in from insureds concerning Unum’s medical requests to treating physicians, I begin to wonder whether my posts are read and clearly understood.

In one instance recently reported to DCS, an insured diagnosed with colon cancer was denied by Unum based on old medical information signed-off in October and November by a member of the treating physician’s staff. (This is May 2013!)

Apparently, Unum faxed a release narrative to his doctor, who without even checking patient notes, authorized a return to work full-time. Unum often sends requests for medical records including a two-page release narrative hoping treating physicians will quickly sign-off in the middle of their busy day. In fact, Unum makes daily calls to physician offices if they don’t get the work release information back. If one treating physician refuses to sign, Unum will contact another, and another, until it gets what it’s looking for.

Of course, Unum doesn’t want to involve insureds in the process since they may influence physicians to continue to advocate for total disability. Therefore, treating physician requests are faxed directly to the physician without the knowledge of insureds.

Physicians just want to make the nuisance of filling out insurance paperwork go away, and in the middle of a busy day, will sign almost anything to make that happen. Insureds and claimants must understand that they need to maintain complete control over information communicated to any insurance company concerning their care.

In a recent previous post my recommendations included having open and frank conversations with all treating physicians to discuss how insurance requests and phone calls are to be handled. Most physicians I speak to assure me they do not accept phone calls, or take the time to fill out private insurance paperwork. Still, many physicians feel they are obligated to respond to Unum, an insurance company looking to deny benefits to their patients.

Let me be clear…..insureds and claimants have control over their medical records. “Medical records” include all lab reports, consultations, mental health therapy notes, clinical consultations, fertility consultations, updates, pharmacy records, and any other medical information whether verbal, written, or collected in any data base. Medical records belong to the patient, and patients have a right to decide whether information can be released, to whom, and when.

Let me explain it this way….several years back an insured contacted me with an incredible story. Apparently, she received a call from a stranger in Portland, ME explaining that she was walking in front of Unum’s HOI when she saw paperwork rolling down the street. She chased some of it and discovered it was medical records belonging to the insured and wanted to know if she wanted them back. After several months of dishonesty from Unum, it was discovered one of its claims handlers took the paper file of the insured home, but dropped it in the street and failed to pick it all up.

This consultant has received copies of Federal Tax Returns from Unum belonging to someone other than my client. Federal tax returns contain address and social security number information. Unum had a fit when I refused to return the information to it, but instead returned it to the insured. The misconception that patient records are somehow “safe” with an insurance company is entirely unfounded.

Further, insureds and claimants have the absolute right to discuss the release or restriction of medical records with those who maintain them, such as treating physicians. Once medical records are released, they lose any HIPPA protection afforded them. Insureds and their treating physicians can mutually decide in advance how to handle information requests from insurers.

Patients are well within their rights to request they be notified of any insurance request for information and have an opportunity to review the response before anything is sent out directly from the physician’s office. If a mistake is made, the insured patient then has an opportunity to discuss their physician’s response directly with him/her. Insureds need to maintain complete control over their own patient records including potential phone calls and requests for “updates” containing questions concerning return to work.

The unfortunate fact is that once a physician responds to an insurance company in a certain way it can never be taken back, a fact any insurance company will use to make their case for denial. Physicians can’t one day provide written releases to return to work, and then the next day say patients are totally disabled. To do so discredits the physician, and nothing he/she says beyond that will be credible. Physicians know their responses will be inconsistent and therefore often refuse to “correct” errors made, even when patients are harmed by losing their benefits.

In addition, I find insureds are often far too trusting of their treating physicians. There are occasions when physicians communicate one thing to insureds, and quite another to a Unum doc contacting him/her by phone. Let’s not underestimate Unum’s clever way of intimidating treating physicians into agreeing with Unum’s agenda to send everyone back to work. Unum’s docs know what works and in most cases their methods work every time.

Approximately half of rheumatologists who treat fibromyalgia do not believe the “syndrome” of symptoms is a credible impairment for disability. Still, physicians will be very sympathetic while the FMS patient is in the office, but it can be a different story when a Unum doc is on the phone. Insureds need to have direct conversations with all treating physicians concerning, not only their physical or mental disability, but how insurance requests for updates and information are to be handled. Insureds have the right to review all medical requests for information as well as any paperwork filled out by the physician before it is sent to Unum.  

I am at a loss that so many insureds still “sit back” and give absolute control over patient records to insurers who are looking to deny their claims, which isn’t really very smart. While it is true Unum has a right to review medical records as part of the claims process, it is also true that patient insureds have absolute control as to who will provide the “proof of claim”, including the right to correct any inaccurate information prior to it reaching the insurance company.

In fact, no information should be sent directly from any treating physician’s office unless the insured has been notified of the request and given an opportunity to review the response, or have additional consultations with the treating physician prior to its release. Insureds and claimants who do not maintain control of this process are likely to get burned.

It is my hope that readers of this blog consider carefully what patient information could be provided to any insurance company and the potential of it being inaccurate, or at best, not consistent with your understanding of what your doctor will report if contacted. Do you really want to risk losing your claim because your physician communicated inaccurate information about you to your insurance company?

As a reminder to DCS, Inc.’s clients, I have an electronic brochure available to you which is often requested by treating physicians. This information is proprietary to DCS, Inc. clients, but if you are a client and have not requested this brochure, please send me a private email.

Other readers should make an appointment with their treating physicians and have the all-important discussion/agreement concerning how records requests and phone calls from insurance docs should be handled. Your claim could depend on it.

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SurgicalSome time ago I posted several articles about Unum’s abusive bad faith in denying DI claims of physicians disabled from performing their own occupations due to addiction. At that time, Unum terminated several claims of physicians who had become addicted to drugs commonly administered in the operating room.

In  most instances, physicians who are addicted to opiates sign contracts with either their licensing boards, or state agencies under which they are allowed to continue to work in some fashion i.e. under supervision only, or for limited periods of time. Physicians agree to attend meetings, and receive therapy and addiction counseling for 1-5 years. If allowed, work is usually limited, monitored, and under direct supervision of some one else.

Many years ago I managed a claim for a pharmacist who stole a 5 gallon bucket of hydrocodone from his pharmacy. He was arrested (now called an intervention) on the job by members of the Drug Enforcement Agency (DEA), and was given a second chance through an agreement with his state licensing board. Interestingly, this pharmacist did not take the hydrocodone to sell, but only for his personal use. Pharmacists are also vulnerable to addiction due to the availability of certain types of drugs.

Anesthesiologist and pain management physicians are highly vulnerable to this type of drug abuse since opiate medications are readily available in the environments in which they work. One of the most important recommendations for those misusing drugs is to change their environments, friends, co-workers and not “go back” to the same place where drugs remain readily available – at least until it is safe to do so if it ever is. Instances of physician re-offenders are quite high in the occupations of anesthesiology and pain management since the availability of drugs is ever-present.

Enter Unum and a disability claim. In order to profit by the vulnerability of physicians addicted to opiate drugs, Unum’s physicians have historically terminated these claims sending physicians back to work even when their state licensing agreements prohibit working full-time, or without supervision. Physicians are placed in a position of still receiving therapy, not having disability income, and not being able to work. With this kind of stress it’s likely many of these physicians are tempted to once again self-medicate with drugs.

Unum’s physicians neither take responsibility, nor have any accountability for the fact that at any time addicted or recovering physicians (who begin using again), could kill or cause extreme harm to those who work in the operating arena or actually administer eipdurals into patients’ spines. As long as Unum receives a huge contribution to financial reserve profit what do these physicians care?

Unum’s internal “board certified physicians” check their medical and personal ethics at the door once they are employed by the most egregious disability insurance company in the world. Given Unum’s very poor reputation as a “criminal organization”, it’s unlikely anyone would challenge the unethical recommendations of Unum’s physicians in terminating claims and returning to work “addicted” anesthesiologists, pain management physicians, and pharmacists.

This is very serious public health issue. Anesthesiologists literally hold our lives in their hands when undergoing surgical procedures and a mishap in the operating room could mean death or coma caused by a physician who is “high”, but was recommended to return to work by Unum. Likewise, pain management physicians administer epidurals, sometimes in the spine where the potential of paralyzing patients is more likely than not. Every time I have a prescription filled these days I think about whether it was filled by a pharmacist who shot up on his/her lunch break.

Unum is the only insurer to my knowledge who actively denies and terminates claims of anesthesiologists and pain management physicians who remain “at risk”, or who are still in programs of rehabilitation. Unum’s physicians completely ignore any agreements entered into directing supervision and monitoring of physicians by their state agencies. In fact, there is one Unum physician in particular who continues to write documentation recommending early returns to work for addicted physicians. (If anyone would like to know the name of this physician, please send me a private email.) I reported this physician to his medical licensing board who, at the time, was very interested in investigating his write-ups.

While it remains clear and sensible to any other normal, rational person that addicted anesthesiologists, pain management physicians or pharmacists should not prematurely return to their own occupations, it is NOT clear when Unum’s “profit” is brought into question. Although in my opinion, physicians are medical doctors FIRST, and employees of Unum SECOND, in reality it doesn’t work that way.

As I’ve said on many occasions, Unum’s physicians park their medical ethics and accountability at the door when they choose to work for a criminal organization.

This is a very serious public health issue and every physician who provides Unum with write-ups recommending terminations of claims for any insureds or claimants who have the potential of causing public harm or risk of death should have their medical licenses permanently revoked. Unum’s endless quest for profitability has the potential of getting someone killed, paralyzed, or the wrong medication.

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Handwashing 2This is an issue which shouldn’t have to be mentioned at all. Interestingly, reports I receive involving dirty and unclean IME examination rooms come from Unum insureds and claimants and not from any other insurers even when their physicians are less credible or temporary.

Unum claimants report “germy” looking examining rooms, soiled table paper, and neuropsychological test objects which obviously haven’t been cleaned or washed in years. One has to wonder how it is that so-called reputable physicians can practice with dust balls hiding in the corners of their offices when even a trip to the hospital these days can cause staph infections requiring months of antibiotic treatment. Many of Unum’s IME offices risk contamination and infection simply because they are unclean.

Although we are told to “wash our hands” to avoid flu epidemics and viruses, rarely will an IME physician wash his hands before conducting any type of personal contact examination. I don’t see any problem with insureds asking their IME physicians to “wash their hands” before touching them. If the room appears to be dirty, dusty, or not well ventilated, insureds also have the right to request that the room be cleaned and aired out before the examination.

We live in a world where the next great pandemic might be just around the corner. So, why are insureds putting up with with crud in IME examination rooms? One Unum claimant shared with me that the doctor had on a lab coat that was various shades of gray with soiled spots here and there. What could this physician have been thinking?

Sometimes insureds and claimants are so scared out of their wits during an IME that they would never mention an unclean office. Even bedbugs are finding their way into hospitals these days.

In my opinion, insureds and claimants have a right to expect any examination room and IME physician be clean and free from “germy” looking objects. Should any insureds become sick after an IME it should be clearly documented and Unum held responsible for the contamination.

In very severe cases of dirty, and/or unclean IME examination rooms, claimants do have the right to refuse to be examined until the room can be cleaned. I wouldn’t advise claimants to “use” this excuse to get out of an IME, but if the environment is not clean, and test objects are filthy, ask to be rescheduled when the office is clean and suitable for examination.

As I indicated earlier, this subject should be a no-brainer, but unfortunately, Unum’s hurry up to obtain cheap and quick IME reports has resulted in increased risk of infection due to dirty IME examination rooms and physicians who fail to wash their hands.

Any Unum insured who is required to attend an IME should take a look around the examining room to make sure its clean; insist the physician wash his hands before touching you and say adios contaminos to germs lurking in the room and on the IME physician’s hands.

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Several individuals phoned me this week with issues concerning denials, one of which was from Sedgwick. Sedgwick is a third-party administrator for self-insured employers. The company administers STD and eligibility for “retirement” under certain long-term disability employee benefit plans.  A characteristic of Sedgwick is that many of its procedures include so-called medical reviews by a “physician’s review panel”,  which is comparable to most insurance appeal protocols.

Sedgwick denied an appeal for an individual (I’ll call her Sally) who was taken out of work by her family physician.  The physician, an Internist, prescribed antidepressants for a period of 12-weeks and Sally filed an STD claim to obtain benefits for that time. Her claim was subsequently denied by Sedgwick on appeal which included a review by the “physician’s review panel.”

In talking with Sally I was able to find out that she was never in counseling, did not seek therapy, and was treated only by her family physician – an internist. Upon review, it was no wonder Sedgwick denied the claim since Sally apparently never received appropriate care.

“Appropriate care” refers to a very important disability claim criteria which must be met in almost all policies in order to be eligible for benefits. The term speaks to the fact that claimants and insureds should seek out and receive medical or mental treatment from those physicians who are qualified, and who have specialty qualifications, to treat and determine disability for the impairment(s) claimed. Receiving treatment for depression and anxiety from an Internist is like taking a broken bone to a Gastroenterologist.

All insureds and claimants should seek their medical care and treatment from physicians with “appropriate credentials” related to their cause of disability.  In reality, most specialists do not need to consult with patients more than quarterly. Therefore, for example, appropriate treatment for those diagnosed with fibromyalgia is bi-monthly counseling with a qualified therapist and quarterly visits with a Rheumatologist.

For those applying for mental and nervous claims, appropriate mental treatment should be with a LSCW (a licensed social worker), psychologist or psychiatrist. If counseling is given by a psychologist who cannot prescribe medications, it is quite common for insureds to also consult with a psychiatrist who essentially manages prescribed medications only.

In any case,  Family Practice and Internist physicians are not considered “appropriate care” for those with private disability claims, and insurers will deny those benefits eventually. In most instances, family physicians will refer patients to counseling if the impairments are serious enough to warrant leaves of absence from work. Internists who prescribe antidepressants and manage mental health issues aren’t doing their patients any favors by not referring them to therapy with qualified mental health practitioners.

Breast cancer victims should have an Oncologist; cardiac patients should have regular consultations with a Cardiologist; and Chron’s disease claims should have a Gastroenterologist on record.

Please note, alternative medicine is not considered appropriate care. Prescribing mushrooms for Lyme disease, feverfew for migraines, acupuncture for back pain, and ginger for upset stomach is not considered appropriate care. Albeit, some alternative treatments have been found to actually work, but they are not considered appropriate care for disability claim purposes. That is not to say that someone cannot take garlic to lower their cholesterol, but they must also be taking a conventional medication prescribed by a qualified physician in order to claim high cholesterol as a diagnosis for a disability claim.

All insureds and claimants are expected to remain in appropriate medical care while receiving disability benefits. Not doing so could jeopardize the payment of continuing benefits.

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