My family doctor is not supporting my disability claim. Is there anything I can do?

The role of the family doctor in LTD claims

Your family doctor plays a critical role when it comes to short-term and long-term disability claims. When you first apply for disability benefits, it is the family doctor that most commonly completes the initial medical form (often called the Attending Physician’s Statement).  In this form they provide information about your medical condition, including symptoms and treatment.  Your doctor may also be asked to comment on whether your condition prevents you from working in your occupation.

If your doctor does not do a thorough job in completing the initial claim form, then often the insurance company will deny your claim on the grounds that there is “insufficient information” to establish that you are disabled.

Your family doctor also plays an important role in the event your claim is denied. I usually recommend that my clients ask their family doctor to write a letter of support for an appeal.  The letter should include detailed information about why the doctor believes you are not capable of reliably and consistently performing your specific job tasks. If your doctor is unwilling to do so, the likelihood of your appeal being successful is low.

Even if your LTD or STD claim is initially approved, your family doctor can play an important role in making sure your benefits will continue. Your disability case manager will often contact your family doctor to request clinical notes and medical chart entries. These are the records that your doctor writes down during or following your appointments. Also, if the LTD insurance company wants to force you to participate in a rehabilitation plan, your case manager may contact your family doctor to ask for a comment on whether you are able to participate.

If your doctor’s office delays in responding to the insurance company, or delays in sending them medical records, then the insurance company might use that as an excuse to suspend or even terminate your disability benefits.

Why won’t my family doctor help me?

Many family doctors have extremely busy medical practices. They often simply don’t have the time to dedicate to thoroughly filling out insurance company paperwork or responding to questionnaires. Also, OHIP unfortunately does not properly compensate family doctors for writing appeal support letters, completing questionnaires, or filling out paperwork. As this CBC article shows, many doctors are dealing with rising overhead while their compensation remains stagnant. Of course none of this is your fault, which only adds to the frustration.

Some family doctors also have a negative attitude toward disability claims and believe that discontinuing work and collecting disability benefits is counter-productive. Some believe that best efforts must be made to continue working as long as possible even if you are suffering with severe pain or a serious psychiatric illness.

What can I do? Should I change doctors?

I usually advise my clients that changing doctors should be a last resort. Firstly, there is a family doctor shortage in Ontario and it may take a very long time to find another doctor willing to accept new patients. Secondly, even if you can find a new family doctor it will take them some time to become familiar with your medical history and they may be unwilling to immediately fill out questionnaires or write appeal support letters on your behalf.

Your best course of action is to try and break through to your doctor, appeal to their compassion, and try and communicate just how important their assistance is to your life. The following tips will hopefully be helpful to you in achieving this outcome:

1.When requesting forms to be completed or requesting an appeal support letter, always try to meet your family doctor in person. It will be easier for you to appeal to your doctor’s compassion in person as opposed to by telephone or video. You can emphasize how critical disability benefits are to your life and how much you need them to pay your rent or mortgage and put food on the table for your family.

2.Make your doctor’s job easier by giving them the information they need to fill out a disability form or to write a support letter. You can describe the severity and frequency of your symptoms and you can explain to your doctor the specific job tasks that you are not able to perform (always provide 2-3 examples of job duties that you have). If your doctor doesn’t have time for a comprehensive discussion, consider providing the above information to your doctor in bullet form (note it is important that your doctor use his/her own words).

3.If you are able, offer to pay the doctor for their time – especially if you are asking for an appeal support letter.

If none of these tips work, consider whether another doctor that you have seen, such as a specialist, might be willing to assist you. Insurance companies will usually give higher credence to a specialist’s opinion to that of a family doctor.

You may also consider asking a non-physician medical professional such as a psychologist, counsellor, physiotherapist or chiropractor to write an appeal support letter. You can then ask your family doctor to review the letter and ask them to simply write on the letter “I agree with this assessessment”.

Disability Lawyer Mark Yazdani

If you are having difficulty with your doctor and it is affecting your STD or LTD claim, please call me for a confidential, no-charge consultation to discuss your options.

Likewise, if your disability claim has been rejected or terminated for any reason, contact me to discuss preparing an appeal or if necessary, starting a court case against the insurance company.

Mark Yazdani
Disability Lawyer
416-630-8880
1-877-311-8880
info@disabledlaw.ca