Disability Insurance - sweet spot

The client is recommended by a medical expert with whom I often do business, in her case, he is the treating physician. The client consults me because her insurer has stopped paying her disability benefits.

There are then two things to do: collect all the medical records of the insured and order a copy of the file of the insurer. We should not rely only on the information of the client for  his medical records; it is also necessary to check with external and reliable sources, in this case, the Régie de l’assurance-maladie du Québec. As for the file of the insurer, it is necessary to obtain it in order to know what it contains. It is surprising that sometimes, the only source of medical information of the insurer consists of the statements of the attending physician  on the forms of the insurer which often lack essential medical information.

We thus obtain the medical records of the client which are sent to a medical expert, who is not the attending physician for reasons related to the therapeutic alliance that must be established between the physician and the patient. The medical expert, a physiatrist, produces an expert evaluation which concludes that the disability of the insured would benefit from additional treatments.

I send all medical records, one large package, contained in a bound and coiled folder, with the physiatrist’s detailed expertise supported by scientific literature, to the insurer who reconsiders his decision and resumes the benefits retroactive to the date on which he has interrupted them.

It is neither the first nor the last time that a dispute is settled like this with an insurer.