by artisttia » Sun Sep 26, 2010 09:53 pm
I have been receiving disability benefits since 2006 as a result of neuro deficits related severe migraines. SSD gave me disability on the first go round. It is my former employer that I am starting to have problems with. Apparently, there is a clause that if my neuro deficits in any way are caused by a mental health issue they can stop payment. They forced me to undergo a neuropsych exam. Being a nurse, this test is not a good indicator for this although time and time again insurance companies utilize this test. Prior to my neurological incident in 2006, I was seeing a therapist for PTSD and still am. It never affected my job performance. Regardless, I'd like a copy of the results of the neuropsych exam. I am being refused this document. Is this legal????
Posted: Mon Sep 27, 2010 05:11 pm Post Subject:
SSD gave me disability on the first go round
Count yourself among the lucky few!
there is a clause that if my neuro deficits in any way are caused by a mental health issue they can stop payment.
Stop your Social Security Disability? Not your former employer. Only Social Security can do that. If you're talking about some other form of disability insurance, then the answer is, perhaps. It depends on the contract.
I'd like a copy of the results of the neuropsych exam. I am being refused this document. Is this legal????
Absolutely not!! You have the right to see or obtain a copy of any of your "Protected Health Information" in the possession of any health care provider under the provisions of HIPAA -- this is federal law. You should have been given a copy of the provider's PHI disclosure at the time you were examined. It tells you that in the disclosure. There can be a requirement that the information will only be disclosed to another healthcare professional, but it may not apply in this case.
Can you be charged for the copy? Yes, but not more than a "reasonable amount" for the copy -- like 10 cents per page . . . not a blanket $25 or $50 fee to get the copy.
Posted: Mon Sep 27, 2010 06:19 pm Post Subject:
They almost definitely have limitations for mental health. Almost every employer group plan has these limitations.
I don't know if it is legal for them to not give you a copy of the records. Max is more knowledgeable than I in that area. Max, does the insurance company count as a "health care provider"? I'm asking because they are the ones who did the test and have it in their possession, but they certainly aren't providing any health care. In this case, there isn't any health care provider who has the test results. Is it possible that this doesn't apply to them? (I doubt it.)
Posted: Mon Sep 27, 2010 06:51 pm Post Subject: Subject continued
Thanks. I thought I was entitled or at least my psychologist was entitled to a copy. The document I signed at the time did say that the neuropsychologist would not be providing care but a had been under the impression that I was entitled to a copy of my report even if the disability insurance company paid for it, if not me, at least my therapist.
The disability company representative also interfered with the collateral interview with the designee I was permitted to select on the standardized form sent out by the IME company. This is the STANDARD for that they use for all patients. The called the neuropsychologist and told her not to get information from the collateral interviews. I feel that the spirit of the IME was violated. Do I have any recourse. I'm being told by the disability company they had the right to do this
Posted: Tue Sep 28, 2010 03:42 am Post Subject:
does the insurance company count as a "health care provider"?
andIn this case, there isn't any health care provider who has the test results
No, the insurance company doesn't qualify as a health care provider, but the MD they sent the client to is a health care provider and he keeps copies of everything he sends to the insurance company -- how else will he defend against a claim for malpractice or some other offense, and that's who HIPAA governs.
As far as the insurance company is concerned, access to their records may be governed under the Fair Credit Reporting Act, or other state laws. In California, for instance, we have something called the Insurance Information Privacy Act, and that gives insureds particular rights to information about them in the insurance company's files.
What this post sounds like now might be a Workers' Compensation dispute. The OP has already qualified for Social Security Disability -- the employer's assessment has nothing to do with that.
The Independent Medical Examiner (IME) is supposed to be exactly that . . . INDEPENDENT. Meaning, not influenced by the insurance company in making a professional judgment or assessment. I'm not certain the insurance company has the right to prevent that information from being seen by the IME -- it is supposed to help close any gaps in the IME's knowledge.
If this is a workers' comp case (rather than a private STD/LTD policy, aka "disability company"), then I would recommend filing a complaint with the agency that oversees the whole process (in California, its the Dept of Industrial Relations). If it is a private disability case, then the state Dept of Insurance is the place to file a complaint. Perhaps also any state agency that oversees the Mental Health Services community.
Posted: Tue Sep 28, 2010 09:29 am Post Subject:
Max, based upon what you just said, maybe she is simply requesting the information from the wrong party. She is requesting it from the insurance company when whe needs to be requesting it from the doctor.
I have no idea why you would think that this is worker's comp since this isn't an on the job injury. It sure seems like a group disability policy to me.
Posted: Wed Sep 29, 2010 07:01 pm Post Subject:
maybe she is simply requesting the information from the wrong party
Always a possibility. But if the request came in to the insurance company, they would either forward it to the provider, or return it with a better explanation that the OP needs to contact the provider. Same should be true of the former employer's response to a request like this (but some HR/benefits people are idiots).
I have no idea why you would think that this is worker's comp since this isn't an on the job injury
I only raised the question because the complete facts are missing. It certainly could have been a WC claim to begin with. Notice the statement in her original post:
It is my former employer that I am starting to have problems with
Why would the employer even be involved if it was not a WC claim? A claim against a group LTD/STD policy is between the claimant and the insurance company -- the company's not going to get involved (too many privacy issues to be concerned with), and especially not since Social Security has determined her to be disabled -- not an easy hurdle to overcome in its own right.
On the other hand, WC can become far more adversarial, because the employer's future premiums are directly on the line as it relates to claims experience. They have a vested interest in minimizing claims expense/experience, where the rates are per $100 of payroll. Much less so with group LTD/STD, because we're only talking about a rate per $100 (or $1000) of benefit.
And even though the employer may be writing the checks to the insurance company, most LTD/STD group plan premiums are either paid for by employees directly (through payroll deduction, if the coverage is voluntary/contributory) or result in imputed income in order to provide the benefit tax free (when the plan is noncontributory). The employer has far less interest in any claims payments in that circumstance, unless the claims experience is unusually high.
Also the OP talks about the "IME" -- a term very much associated with Workers' Compensation claims.
Just my opinion, you know. We'll leave it up to the OP to clarify the situation more for us all.
Add your comment