Disability Claims Solutions


Give Linda a Call

Several days ago I posted an article about doc-to-doc calls, which is a very important topic for all claimants to consider. I was informed of yet another Unum doc-to-doc call that may not work out well for a claimant because the physician refused to abide by the claimant’s refusal to give authorization to communicate health information by phone.

The physician in question told the insured after the fact, “It’s  my signature on the paperwork so I have an obligation to answer questions.” When the physician was questioned further about his conversation with Unum, he failed to mention that he told the Unum doc the insured could go back to work.

So, how did we find out about that? After every doc-to-doc call, Unum faxes a follow-up letter supposedly confirming what was said during the call. Not surprisingly, it is never the truth. The letter says if the doctor agrees with the letter, he does nothing, but if he disagrees he can change the letter and fax it back.

During a doctor’s busy day, he/she may never see the fax and it is tucked away in the patient’s file. Unum assumes the doctor agrees and the claim is denied. Most patient insureds are entirely unaware of the follow-up fax and may never know that their physicians have spoken with Unum docs. If you do find out later, I adviseto request a copy of the fax to determine what was said because your physician may not tell you the truth either.

The truth about treating physicians who choose to communicate with insurance doctors is that they will never be of any use to those on private disability because they can NOT be trusted to credibility support any disability claim. Some physicians tell the patient one thing and then say another on the phone to Unum. The worst possible scenario that can happen is that the office RN or manager tells Unum on the phone patients can go back to work without checking the file or discussing status with the doctor.

Once a treating physican or office manager goes on record supporting return work, even if it is a mistake, the doctor’s office can never “take it back” or amend because nothing the doctor documents beyond that point will be considered credible. Physicians are often reluctant to tell patients “what they really think”, but they sure will tell an insurance company if asked.

Patients should  openly discuss the issue of doc-to-doc calls with their physicians and decide ahead of time what the doctor will do. Insureds should NEVER give permission for the calls (CIGNA is the exception). Anytime a treating physician sits on the fence and refuses to take a definitive position concerning work capacity, patients should move on to new physicans who are more supportive. Staying with physicians who can’t be trusted for their support is a no-win scenario.

I hope people who read my blog are listening. Sometimes I feel my articles fall on deaf ears, but the topic of doc-to-doc calls can make or break a claim. It’s that important!