Should my doctor speak to the insurance company at their request?
It is quite common for disability insurers and the WSIB to reach out and attempt to speak with your physician about your condition if you are not recovering as quickly as they expect. Language within their policies (or in the case of the WSIB, their legislation) typically permit them to obtain necessary medical information about your case, and it’s argued this is included under those terms. If you attempt to stop these conversations from happening, it could lead to you being deemed uncooperative and, subsequently, a termination or denial of your claim.
The danger is that these conversations are often “recorded” only in notes or memorandum written by the organization making the call, meaning that a doctor’s words can be manipulated, misinterpreted or oversimplified to support conclusions the doctor did not mean to make. I have seen many cases in which a family doctor, completely supportive of their patient’s inability to return to work, appears to reverse course during a phone call. This is then relied upon by the insurer in making decisions to deny benefits.
If you find yourself in these circumstances, there are solutions. First off, find out what the organization making the call recorded and present this, in a non-confrontational way, to your physician. If the doctor’s opinion has indeed been misrepresented, getting something in writing confirming this goes a long way during an appeal or litigation. With private disability insurers, some conversations are recorded live and archived, and during litigation it is often possible to get the actual voice recording, which can be helpful. I have seen cases where the voice recording has clearly been misrepresented.
These types of calls, and this question, usually arise when an insurer or the WSIB is getting ready to reduce benefits or terminate a claim. Even before such a decision comes down, if you find yourself in the circumstances above, contacting a lawyer who specializes in this area immediately can help reduce the chance of your claim being terminated, or, if necessary, is set up for success if you need to dispute such a decision.
View the next article — I’m a doctor getting asked about my patient’s insurance claim; what do I say?
This article was originally published in The Hamilton Spectator.
