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Reflex Sympathetic Dystrophy (RSD and CRPS) Reflex Sympathetic Dystrophy (Complex Regional Pain Syndromes Type I) and Causalgia (Complex Regional Pain Syndromes Type II)(RSD and CRPS)

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Unread 12-09-2012, 11:00 AM   #1
katiek
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I was wondering if anyone out there is on income protection. I am having alot of problems with mine. When I got my last job I took out superannuation as required in australia, there was a seperate policy offered for income protection and total disablement. I took this policy out and advised of my crps which i was covered for. I had been working at my job for a year when i had a huge flare up and subsiquently lost my job. My insurance company payed me without issue for the first 6 months as it became clear to them that my condition was in fact getting worse they have made it harder and harder each month to obtain the payments, another problem i have is that my specialists refuse to fill in the insurance form because they work in a public hospital and dont have the time so i rely on my gp to do them. if he was to stop doing them then i am a bit screwed. I began recording my phone conversations with the insurance company and one thing i noticed is that they will ask me the same question over and over just in a diffrent way almost to try and trip me up, they try and put words into my mouth so now i have advised i will only communicate through emial. One example is I was referred to a occupational health physician by my gp, the OHP refused to take my case on and sent me an sms message advising this, when my insurance company asked if i had seen him i advised of the fact. This was two months ago i have since found a OHP who will take me on and am waiting for a appointment, regardless of this the insurance company keep pressuring me to send a copy of the sms as they find it unusal that the Dr contacted me direct, they do not have a mobile facility so asked me to emaiil them i advised i did not have internet facility on my phone, so they said i would have to find a way to do it. thing is i do not understand the issue when i have found a ohp, Another problem i am having is that i requested to forms for the total disablment cover as after a conversation with my specialist they were quite frank and advised that as it had been over a year since the flare up and the fact the crps is progressivly getting worse and swelling i should apply for the total disablement. My insurance assesor disagreed so i asked to speak to a senior officer, i explained it to her she was very rude to me and said that at this point i wouldent be eligable, i said that my specialist had reccomended it and that the company was happy to take my premiums each month but when it came to upholding thier end of the contract they were not so helpful., she them said to me that the payemt is for people with real diseases and disablement. How ignorant of her obviously i wrote a complaint and surprise surprise haev not recived a responce. I think my main point is that i do feel like they are purposly makeing things hard for me and in a way bullying me and in a way holding me to ransom ie i do not want to see an OHP but have to or the insurance company wont pay me which means i cant pay my mortgage, i have seen many before and each have said that i can not return to work, as my condition is worse than when i last saw one and i now have quite profound cognitive problems i hardly think this dr will all of a sudden diecide that i am fit to return to full time work, i cant even dress or shower myself so how could i work a full time job. I was just wondering if anyone had similar issues and had any advice it mwould be very much appreciated
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Unread 12-09-2012, 06:02 PM   #2
ianacoustic
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Hello katiek,
It is difficult dealing with some insurance companies. However persistence is the key and documentation. When your specialist reviewed you, have they sent a written report to your GP? If so you can request a copy and send on to the insurance company as confirmation of your situation. Any report or correspondence sent to your GP can be used, it sometimes requires permission from the writer, as confidentiality is from them to your GP, but it is possible and I have obtained reports many times from our GP. I am not sure why your insurance company is being obstructive, maybe it is their "tactic" as you say, or maybe they are wanting written "proof" - I am not saying it to you, but insurance companies are a strange breed sometimes. You will have to comply with their requests as this is their "assessment method" on your condition. However if your specialist feels application for total disablement is warranted, then request the forms - they are lengthy and you can get discouaged by the sheer volume of information required, but as your case is genuine, stay with it and continue. You have the truth of the matter on your side. It can be emotionally draining dealing with these companies. Also If you can ask for written confirmation from the various specialists / doctors you have seen then do so. My wife is on income protection and has received total permanent disability. It is a process, but stay with it. We used our GP for the forms and they don't like it, but it is their duty to support you and offer this assistance as well. Although I do not understand why the insurance company is questionig your income support - I can only assume (apart from them trying to make it hard) perhaps they feel that they don't have enough information?

Be strong, and as best you can try not to let the emotional stress of this take over, don't see it as 'personal' and quietly and with self belief, gently maintain your strength of purpose without letting this outside influence drain you. I understand how it can and if you can have support around you that keeps your energy positive.

My very best to you, ianacoustic.
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Unread 12-09-2012, 08:31 PM   #3
katiek
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Thank you so much for your reply, Unfourtunatly I think it is one of thier tactics to bully and make it hard for you a friend of mine was with the same company and she eventually just gave up as the stress was too much, her husband had a very good job though and finacally they were ok. I think my main issue is it is so intrusive and you are asked questions by people who dont really know the condition. but i shall press again for the total disablement as it is a genuine case and it was reccomended to me. So far my gp has not minded filling in my forms he is very supportive but i just have to worry in the back of my mind of what if he wont do them. i think it is beacuse my specialist used to do them fine and at one appointment i was advised they would no longer do them, they take 5 minutes and could be done in the appointment, it is frustrating as i have not had any succsess with treatment they have given me but the one thing they could do to help me, ie reduce the finacial stress they refuse to do. thank you again for your advice it is very much appreciated
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Unread 12-10-2012, 09:52 AM   #4
catra121
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Quote:
Originally Posted by katiek View Post
Hi
Thank you so much for your reply, Unfourtunatly I think it is one of thier tactics to bully and make it hard for you a friend of mine was with the same company and she eventually just gave up as the stress was too much, her husband had a very good job though and finacally they were ok. I think my main issue is it is so intrusive and you are asked questions by people who dont really know the condition. but i shall press again for the total disablement as it is a genuine case and it was reccomended to me. So far my gp has not minded filling in my forms he is very supportive but i just have to worry in the back of my mind of what if he wont do them. i think it is beacuse my specialist used to do them fine and at one appointment i was advised they would no longer do them, they take 5 minutes and could be done in the appointment, it is frustrating as i have not had any succsess with treatment they have given me but the one thing they could do to help me, ie reduce the finacial stress they refuse to do. thank you again for your advice it is very much appreciated
There are many insurance companies that act this way unfortunately. Workers Comp (at least the one I had to deal with) is notorious for this. They make everything so difficult and frustrating, deny things for no reason, delay payments, etc. and the sad truth is that they do this because it saves them a lot of money. I know many people who have just given up because of the stress of dealing with it all and then the insurance company gets off without having to pay anything.

All I can say is stay persistent and try not to get too emotional about it. I know about the financial stress and what a toll it takes emotionally...so I know that what I say is easier said than done...but just try to keep it in mind. The more stressed you are emotionally, the worse your RSD will be.

That sucks that your specialist doesn't want to fill out paperwork. Every doctor I have seen handles things differently. The one doctor filled out the paperwork once, then refused...I think because they didn't want to deal with work comp or have an insurance company looking over their shoulder. Another place I went charged a $25 administration fee to fill out forms for things like FMLA or disability...but then you didn't have to necessarily have an appointment to get them filled out and could just drop them off. My current doctor just prefers to fill them out during an appointment so we can go through each of the questions together...that way I understand why she is answering the way she is and we can talk about any limitations or restrictions I have.

Good luck with everything and I hope you are able to sort it all out. Take care.
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