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My Disability insurance company is in the process of

reviewing my claim. My primary...
My Disability insurance company is in the process of reviewing my claim. My primary care doctor has shared the letter that was sent by the disability company. The information that they have reported is incorrect. What is my best coarse of action.
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Answered in 10 minutes by:
9/29/2016
John
John, Employment Lawyer
Category: Employment Law
Satisfied Customers: 5,796
Experience: Exclusively practice labor and employment law.
Verified

Write the claim manager and correct the error. Get everything you dispute into the record so they will hopefully follw up on it an you preserve your right to appeal that issue.

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Customer reply replied 1 year ago
I have let my claims specialist know on three occasions and have asked her to send me a copy of information they have on file and have received no response. The letter that was sent to my primary care doctor stated that was a confidential letter and to be shared with no one else. Does it matter if Iknow about it? perhaps not because I have already let met life know they do not have all updated documents. thank you

Do not rely on phone calls - you need to have it in their records via some paperwork in case you have to appeal. It doesn't matter that you know about it..you are the protected source under Hipaa.

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Customer reply replied 1 year ago
Lucky for me, they have been requested via email. Thank you for responding. I have another question for you. Do you think that pointing out that the medical doc they had examine my paper work for be to my advantage at all? I guess the agreement is how can you assess if I am not able to work if you can't even read the medical notes correct. Also The disability insurance originally approved my claim from 12/9 to 1/21. The majority of the time the Dr notated same restrictions as before. However, when the review was sent off to the medical doctors, The insurance company did not send anything prior to last visit of 1/21, which was denied due to lack of objective findings or notes for explicit restrictions to return to work . This seems like a bad faith or omitting information to the third party to able to review the complete file. Also, my therapist submitted his chart notes along with a written statement. He wrote that at during our sessions she seems to have greatly been affected by her ability to concentrate and perform daily task of living such as mild house cleaning sweeping etc. She seems to have rallied from time to time the condition returns with more debilitating symptoms. For example she continues to have migraines. Her chronic pain causes her to experience disrupt did sleep patterns and she appears to be exhausted a good deal of the time. Based on observations she is likely unable to return to a work environment that would require decision-making and stressful. etc etc however, because these conversations are not in our notes they are denying the claim on the depression side as well. I was in a shoulder sling for almost 4 months with restricted arm movement and the inability to drive amongst anything. My coarse of action is to compare my pcp notes and line them up with the surgeons, The surgeon has sent letters to my primary care doc. to have my doc respond I agree with the surgeon. to at least have conformity. I will then have the pcp write his assessment with his treatment notes and then tsend to surgeon to have him agree with the pcp. there anything else I can do?

Pointing out inconsistency between your doctor and theirs is important. You may want to get medical source opinions from one or more of your treating doctors. Not showing the evaluating doctor the complete file is a common tactic, you should mention this.

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Customer reply replied 1 year ago
Am I able to request what the medical examiner credentials or qualifications are. May I also request to get in writing their knowledge of my diagnosis and treatments conducted are? I ask because I have a rare condition, I have found throughout the years their are not a lot of medical doctors even have extensive knowledge of my illness. even more so the surgery I had is a unique and special one in which not even very many surgeons are skilled and experienced to perform.

You can request their credentials (i.e. curriculum vitae). They dont have to make a new document for you, but whatever they have on file they must give you. They don't have to make a document detailing their knowledge of your condition - no.

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Satisfied Customers: 5,796
Experience: Exclusively practice labor and employment law.
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