All disability insurers require those who file claims to remain in “regular” care. The word “regular” means, (and this is my definition), “the frequency of medical consultation with a physician who has credentials to treat the claimed disability.” The frequency of treatment is determined by the physician based on the individual’s medical history and diagnosis.
All insurance companies aggressively review claims to determine if insureds are remaining in regular care. Even if the treating physician says, “there’s nothing more I can do for you”, you MUST remain in regular care. Most of my readers know I’ve said many times, “no medical proof, no claim”, regular care is one of the most important requirements to remaining on claim.
The proof of claim used to determine “regular care” are patient notes, which is why insurance companies spend so much time and money chasing them. In fact, although insurers put a great deal of chasing effort on “forms”, the most credible proof of claim are patient notes. Disability insurers have been known to deny claims when there are no patient notes to back-up regular care.
The most dangerous time for insureds to meet the regular care requirement is when relocation requires finding new treating physicians in new locations.
It’s a really good idea to seek out new physicians and provide them with complete patient files before actually moving. The process of finding physicians in the current environment is very difficult, but once you provide an insurance company with a change of address, it appears they suddenly become a pack of dogs chasing down who the new doctors are.
Unum, in particular, is now frequently contacting physician offices to ask about frequency of treatment and when next appointments are. It’s all “regular care” related, and letters to insureds are going out threatening claim denials unless proof of “regular care” is provided.
The bottom line here is that you can’t have a disability claim and not remain in regular care. A good example would be having a claim for severe depression with medication being given by a family physician instead of bi-weekly counseling and medical management by a psychiatrist. Physicians must be well-credentialed, and qualified to treat the claimed disability. Another example is relocating and not having a doctor for an unreasonable amount of time.
All insureds must remain in regular care and be able to provide patient notes as proof of claim when asked to do so. Failure to provide patient notes is perceived as lack of “regular care” and claims are denied. This is an issue that all insureds should take very seriously and act accordingly to insure that there is at least one primary treating physician on record who is signing disability forms.
If anyone has any questions about “regular care” please feel free to contact me. Disability claims is NOT an area where once a physician supports disability you’re done. The process goes on and on for as long as benefits are paid. The “regular care” requirement remains to maximum duration.
