Insurance Question

Has anyone else come across the argument that if returning to work wouldn't cause further physical harm you have to go back no matter how much pain you're in? I've been told by my GP, osteopath, and two orthopaedic consultants that it's not reasonable to expect me to return to work. My employers have asked the insurance company how they can force me to come back in light of the medical evidence. The insurance company's answer is that if the actual disc and surrounding structures won't be made worse by sitting at a desk all day it doesn't matter what level of pain I am in (or in their terms I claim to be in). More importantly, if you have come across it, was there anything you could say to counter it?

Thanks

[spotty14]

Although I haven't had surgery or dealt with an insurance company like you mention, it just sounds like nonsense to me. Sitting puts the most stress on your spine in comparison to standing or laying down. I would guess that it depends on exactly what type of surgery you have whether sitting all day would damage the structures, and it depends on how soon after surgery they are saying you have to work. They left out one one important factor -- like, how are you feeling?

[sahuaro]

Don't know the answer to your question, but you must be really terrific at what you do if your employers want you back so badly!

Unfortunately they�re saying that I have to return to work before surgery because the insurance co�s PT says that surgery�s unnecessary and that my claims that I am in pain are out of all proportion to the problem. The surgeon I saw yesterday didn�t think they were out of proportion � he thought they were real and he said that even if returning to work might not make the physical condition worse between now and surgery he simply didn�t think I was capable of working based on what he saw. If I haven�t got it all sorted by the time I have surgery I�d imagine that the insurance co will say that the surgery was unnecessary so I shouldn�t be paid for time off required after it. It seems like a no win situation.

Think I should have put that better Sahuaro! I should have said that my employers are asking how they can be expected to force me back. They�ve said that they accept the medical evidence that I�m unfit to work but that they won�t pay me unless the insurance company pays out to them first or do enough work from home to cover my salary (not that they�ve done anything to make that possible or even offered me any work to do in months and not that anyone else was ever penalised for failing to meet their billing targets when I was consistently beating mine). I�ve not been paid anything by my employers since July and at the moment there doesn�t seem to be much prospect of it. They�re avoiding speaking to me and I think I�m probably going to have to take independent legal advice to find out whether I can force them under my contract to challenge the decision or, if they refuse to do so, pay me. It seems to me that they should be treating it a bit like a PI claim where the defendant is challenging the damages rather than running round like headless chickens saying �oh well, it looks like all we can do is give you moral support.� The main problem though is that I don�t know whether the insurance company have a legitimate argument that regardless of the level of pain it can�t harm me to go back. I can�t see how that can be right but I�ve never been in these circumstances before.

[Alastair]

Hi Gillian,
First get a letter from that last surgeon you saw which says you will be having pain etc and its bad for you.

Then look here and talk to colleageues

http://alexanderharris.co.uk/default.asp

I don`t know what I have to do to get you to e mail me and keep your private life private, Grrrr!!! - - -- lol

Best
Alastair

I'm hoping he'll say that in the report to the GP anyway.

I thought I recognised that link. I'd found it on a google search a while back but I hadn't realised that they do initial free advice. That might be worth a go just to ask the specific question about contracts. Hmmm. I couldn't use them for anything more given where they are but it's worth a go.

I figure that the Americans probably have a fair bit more experience than most of us poor limeys when it comes to coping with insurance co's. This whole harm vs pain this is the key to what I'm asking about because it sounds pretty bizzare to me but maybe it's industry standard. Hey I'm a lawyer - you can't expect me to be able to shut the hell up once I get started

[Alastair]

Hi Gillian,
just keeping to very basic principles, your doctor(GP) I presume has signed you off on the sick, the note that he signs says that you are unfit for work and that's it.

Should you work or attempt to work was claiming state benefits, obviously you would face "benefit fraud" charges which could involve a custodial sentence. There are people that checkup on those claiming benefit.

I can see no reason whatsoever how your employer could insist or suggest that you should work in these circumstances. I've also got to believe that you have a private health insurer also who would be involved in this scenario.

I think really, that's all there is to say on that subject unless you're not claiming state benefits
best,
Alastair

Yes my GP's signed me off and has indicated that she'll continue to do so. I'm not claiming state benefits. I don't have private health insurance in the normal sense. The insurance is only income protection insurance and the insurance co is the one insisting that I go back to work or, more to the point, saying that if I 'choose' not to go back to work they won't pay out.

[Alastair]

Well I don`t understand that at all. Why are you not claiming State Benefits??

Because you are not this then could mean your GP thinks you are fit for work.??

You need a letter from Mr L.(ring his secretary and explain), I think, his would be a good reference or someone medical. Unless Physios are of Court Witness status, they don`t count for anything.

I know all about insurance companies who would "Rather Not Pay". I hope its not cover which can be cancelled in the future??
Best
Alastair

When my employers put the claim for income protection insurance in I thought it'd be dealt with pretty quickly so I didn't see any point applying for incapacity benefit but my employers made it clear today that benefits are the only thing I'll be getting until the insurance claim is sorted out so I'll be applying. It also occurred to be I'm probably due a hefty tax rebate for the first 4 months of the year (yipee!). Given the fact that my GP's furious that the insurance claim was refused I think we can safely say she believes I'm not fit to work. I need to get a form from my employers before I can put the claim in. I'd imagine Mr L's report will have arrived by the time they get that sorted out.

I suggested to my boss today that we should offer up a few names for my employers & the ins co to jointly instruct someone to assess me & she thought that was better than her idea to just go ahead and get someone. The ins co's made it clear that anyone who treats me isn't impartial in their eyes so that seems like the best solution. I'd like someone who's not anti-ADR (because the ins co might try to restrict my choices if they have an anti-ADR expert) and quite a few surgeons round here are. I wondered if you might have any suggestions. The only names I've seen are Mr Sutcliffe (thanks to you) and Mr Alibone.

No the cover lasts 'til I'm 65. I think that's why they don't want to pay out - potentially it's an enormous claim although I hope to be back within a year tops. Mind you, now I know the premiums the firm's paying I'd say the insurance co's not coming out of it all too badly!