Posts Tagged ‘Regular and Appropriate Care’

Don’t expect your disability claim to continue to be paid if you stop going to a doctor on a regular basis. Receiving benefits is often contractually contingent on remaining in treatment with a physician who is qualified to treat you for your claimed disability.

Surgeons, for example, are infamous for not permanently supporting disability with the statement, “there’s nothing more I can do for you.” Even so, if you are receiving disability benefits you must provide “proof of claim” of “regular and appropriate” treatment. Proof of regular care is provided via medical patient notes which is why so many insurers are so anxious to request them.

Insureds are recommended to continue with consultations so that documentation can be provided as “proof” that you remain in regular care.

“Appropriate care” speaks to the credentials of physicians you are treating with. Depression and FMS should not be treated by a family physician but a Rheumatologist.

Insurance companies are aggressively ceasing benefits for insureds who have “dropped out of regular care.” Even if your specialist tells you, “there is nothing more I can do for you”, the contractual regular and appropriate care requirement must still be met.

Don’t lose your benefits because you stopped going to a doctor for regular consultations.


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