I’m a doctor getting asked about my patient’s insurance claim; what do I say?

Previously, we looked at this question from the patient’s perspective. But what do you do if you’re the physician?

We all know that family physicians (the most often contacted) are extremely busy and often inundated with these types of requests for forms or information. It can be overwhelming and takes away from other patient care. However, your opinion is often of critical importance in determining your client’s eligibility for benefits. Understanding the best way to present it is often crucial for their financial well-being.

First off, specific information is key. A simple “cannot return to work due to medical condition” is often disregarded by an insurer or the WSIB. If a proper authorization has been provided, even a few short sentences sharing details of why the specific medical condition is rendering a person unable to work can make the difference in a claim being accepted or denied.

Second, if the patient is being offered light or modified work, be sure to state why this is also ill-advised (or appropriate). Showing that you’ve had that discussion with your patient and are still recommending they remain off work greatly strengthens that opinion and eliminates the argument that you were only referring to their “regular duties.”

Finally, be sure to fill out the form correctly. Car insurance, disability insurance and the WSIB all have vastly different forms, many of which contain checkboxes. I have seen many cases in which a doctor has simply checked the wrong box (despite clear language to the contrary in their rationale), which can cause chaos in the claim. Just as most lawyers do not learn administrative skills in law school but require them in practice, most physicians don’t take many classes in “form filling out” despite this being a regular request from patients.