The meaning of “treatment” is more than just an initial visit to the doctor for a diagnosis. “Treatment” refers to the ongoing amount of time that you will need to see doctors, take medications, have physical therapy, and do lab work. This is also called your treatment plan.
Your treatment plan will cover not only the necessary doctor visits and medications, but also the use of assistive devices such as a cane or wheelchair, neck or back braces, etc. Failure to follow your doctor’s recommendations or prescribed treatment plan may jeopardize your long-term disability (LTD) claim.
You may be labeled a “noncompliant” patient, which will be documented in your medical records. If you do not follow the treatment plan as prescribed (such as refusing surgery), the insurance company may claim that you are refusing to do what you need to do to get better so that you can work and deny your claim.
How Will The Insurance Company Know If I Am Following My Doctor’s Orders?
The claims adjuster will ask you questions such as:
- Did you fill your prescriptions when they were due?
- Are you using your assistive devices as prescribed by your doctor?
- Did you keep your appointments?
The insurance company will also check to see if you have been truthful:
- They will check your prescription refill history.
- They will hire a private investigator to record you to make sure you are using your assistive devices.
- They will request a printout of your appointments from your doctors to make sure you are keeping your scheduled appointments.
These are easy ways for the insurance company to deny your claim. Don’t fall into the trap!
Examples of Noncompliance
Examples of when a patient is non-compliant and does not follow doctor’s orders include:
- Continuing to smoke while claiming disability due to a heart or respiratory condition, such as COPD.
- Frequently missing scheduled medical appointments.
- Not following prescribed medical treatment.
- Skipping recommended physical therapy sessions.
- Failure to take medications as prescribed.
- Skipping recommended counseling sessions with a psychiatrists or psychologist.
- Ignoring dietary or weight loss advice, especially in cases involving diabetes management.
- Continued use of illegal drugs or alcohol against medical advice.
These are just a few examples of potential non-compliance with medical advice. However, there are some exceptions. You cannot be denied for noncompliance for the following reasons:
- You cannot afford the treatment. (More on this below)
- The side effects of the medication are making your symptoms worse
- Medication from different doctors makes your side effects worse
- The prescribed medication is against your religion
- Your doctor says none of the treatment options work for your disability
- The treatment plan involves highly addictive substances
- The treatment plan involves amputation
- The treatment plan involves an experimental treatment that has not been proven to work
What If I Can’t Afford To See My Doctor?
Co-pays for medications and doctor visits can be expensive when you are being treated for a serious injury or illness. However, if you do not keep your appointments, the insurance company will imply that you are not really that sick or injured. They will say that if you were really injured, you would have to go to the doctor for treatment and since you missed your appointments, you must be better, and thus able to return to work.
This is just another trick that the insurance company uses to avoid paying claims. Work with your doctors to come up with a payment plan that will keep you from having to stop seeing them. Look into additional options for help with prescriptions like Good RX or talk to your doctor about making sure the only medications they prescribe are absolutely necessary and are only available by prescription. For example, if diarrhea is a side effect, ask them to let you use an inexpensive over-the-counter alternative if possible.
Finances are a major reason why people do not follow their treatment plans. However, unless you can prove that you have exhausted all your financial efforts to afford your treatment plan, you may still be denied. Keeping your appointments and using your assistive devices are equally important.
RELATED POST: How Do I Get Medical Treatment Without Insurance or Money?
A Long-Term Disability Attorney Can Help You Appeal a Denied Claim
To increase your chances of a successful LTD claim, it is important to show that you continue to experience severe impairments despite diligently following all of your doctor’s recommendations.
If your claim has been denied, a national long-term disability attorney at the Ortiz Law Firm can help you file an appeal. We only get paid if you win, so you can seek help without worrying about upfront costs or unexpected bills. We will focus on your case so you can focus on your illness.
We have successfully represented people in disability cases all over the United States. To learn how we can help you win your long-term disability case, call us at (888) 321- 8131.
