Long term disability insurance companies such as Manulife, Sunlife, Great West Life, Desjardins and others will often consult with physicians when determining whether or not an insured should be paid short or long term disability benefits.
People are often surprised by the process, the results and the comments made by those physicians. The first thing that often surprises people is the use of medical consultants who review the documents on file and determine whether a person is able to work or not. People are surprised that the opinions of these consultants are given precedence over physicians who are treating the person (family doctor, specialists seen through OHIP). People will often wonder how a consultant hired by the insurer who reviews sheets of paper, is more credible than a treating physician who has seen and treated the plaintiff on an ongoing basis for a long time. People will also wonder why the insurance company believes that the physician that it is paying is more credible than the treating physicians who are paid by OHIP and who have a waiting room filled with other patients that they want to get back to.
When people are sent for assessments by their insurance company, they often wonder how the doctors have been selected. Did the doctors receive some nomination from the Court or the medical profession as fair and impartial people to be able to perform these? The answer is no. The Doctors are hand selected by the insurance company or insurance assessment centres that they hire. Some of the doctors do this sort of work after having lost their hospital privileges, some do the work because of the very lucrative fees available by doing it and others for other reasons as well. There are some very fair assessors out there (I have seen them), but there are also many who my clients have had very serious concerns about. An examination of the examiner’s reputation and past history is important.
Some clients are also surprised to read the “consent” forms that the assessors require that they sign. My policy is to tell my clients not to sign any consent forms until after I have reviewed them. There are some strange surprises on those forms sometimes. One assessment centre routinely asks patients to sign agreeing “not to make any notes” about the assessment and confirm that they will not record the assessment secretly. One wonders why the assessment centre is so concerned about notes or a recording of the assessment. Clients of mine who have attended at assessments sometimes complain that they “never said what is in the doctor’s report” or about the examiner’s conduct or procedure.
Sometimes the “consent” forms contain a waiver where you are agreeing that the assessors and assessment centre cannot be sued even if they injure you through their negligence. So, even if they do something wrong and cause you injury, you cannot sue them. Another feature is that they sometimes request the right to contact your doctor about their findings – which I sometimes wonder about and consider if it might be used to try to change your own doctor’s opinions.
The long and short of it is that you do not have to accept an opinion from the insurance company’s doctor. You are entitled to test and consider that opinion in a fair and reasonable manner. Do not give that up lightly and be sure to seek legal advice before giving up. A legal consultation is free – your future benefits are too valuable to give up without a thorough investigation. After paying insurance dues for all of those years, you should not simply give up on your rights.
Call us today for a free consultation. Steven Polak is a lawyer who restricts his practice to injury and disability claims. He is a partner with Lerners LLP (since 1929 and over 100 lawyers strong) and a member of the Ontario Trial Lawyers Association Long Term Disability Litigation section.