When Disability Requires You to See an “Independent” Doctor
Holly was recently kicked off her private disability plan. After a year, she won back her coverage. In this series, she walks us through the various steps she took and what it was like to navigate this experience.
After over a decade of coverage from a private disability insurer and Social Security Disability, and completing the frequent evaluation-related paperwork several times a year, I received a different notification from the private disability insurer than I’d ever seen. They notified me that they wanted me to see an independent doctor for evaluation. I wasn’t sure whether or not to be alarmed and focused on the fact that I’d been diligent with my required paperwork and had loads of medical records to support my case.
Why did I need to be evaluated by an independent doctor?
When you are selected for an evaluation by an independent doctor, it could be that you are the unfortunate random pick of the draw. These companies often choose randomly when it comes to who has to complete these extra steps of evaluation for continued coverage. However, it could also be that you’ve been singled out if you turn in tardy or incomplete paperwork. You can also be chosen due to the fact that you have a lengthy payout ahead of you (which happens when disabled earlier in life). It is very hard not to feel singled out, but in most cases, it’s the luck of the draw.
Was I going to lose my coverage for migraine?
It’s important to remember that most times, the doctors who are hired by an insurance company to evaluate a case are being paid to find reasons to justify your removal from coverage. Many times, once your case has been moved to be evaluated by an independent doctor, it can be likely that you are on your way to being removed from coverage regardless of what you say or do in the appointment. To this end, it is a good idea to consult with a lawyer who specializes in disability (whether it be private or social security) to help prepare you for every step.
Is there a way to approach the appointment?
Some people suggested that I play up my condition during the appointment to illustrate its hold on my life. I don’t have it in me to fake anything so I was myself. I later learned that if you go in looking disheveled and trying to prove you have migraine, you will be accused of faking. If you try to pull yourself together to articulate your condition, you will be accused of being too well for continued coverage.
How could I have prepared ahead of time?
I later learned from a lawyer that it would’ve helped to consult with the lawyer prior to the appointment (as soon as I received notice of the appointment with an independent doctor) and to pay for a private nurse to accompany me to the appointment to help document the experience. This document would come in handy in the appeal process. We don’t get to choose the doctor who evaluates our case - so it’s important to go in with eyes open as to what they are looking for.
Surveillance is also likely. Either before or after the appointment, the insurance company may send private investigators to follow you who will try to catch you doing anything they feel is outside the bounds of having migraine/being disabled. This information is sent to the independent doctor to strengthen the case of your being removed from coverage.
When did realization hit?
It honestly didn’t occur to me until after this appointment that I was likely to lose coverage. I couldn’t believe that the inept doctor they assigned me to see would hold the key to my financial future.
Have you ever been summoned to an independent doctor as part of a disability evaluation? Please share your experiences or thoughts on this experience in the comment section.
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