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Monday, October 6, 2014

Problems with ERISA Disability Claimants Refusing Treatment

Many patients don’t want to pursue treatments recommended by their doctors: some avoid seeking recommended psychological treatment to avoid a perception of stigma or due to prior unsuccessful psychological treatment; chronic pain patients refuse narcotic treatment because of the side effects; others struggling with living with degenerative diseases such as multiple sclerosis or rheumatoid arthritis feel they simply can’t cope with another treatment modality.   If your doctor recommends surgery for chronic back pain, you may have a legitimate reason to decline surgery based on the frequently poor results of surgery. 

Unfortunately, refusal to seek treatment recommended by a physician is frequently a basis for insurers in ERISA long term disability plans and for private disability insurance to deny a claim for group disability benefits.  That a claimant is receiving “appropriate treatment” is usually required to be considered disabled.  Insurance companies frequently deny claims, stating that if a patient does not pursue a suggested treatment method, the claimant is not receiving appropriate treatment, and denies benefits.  The insurance company may claim that the pain couldn't be that bad if the person is not taking strong narcotics, or that if the condition was really disabling, you would have had surgery.

What do you do, then, if you don’t want to pursue a certain type of treatment recommended by your doctor?  Discuss the issue with your doctor, and if you can get the doctor agree with your grounds for refusing the treatment, have that reflected in the medical records.  Discuss with the doctor, and have him reflect in his medical records, alternatives to the treatment you don't want to do.  Continue active treatment and testing.  

If the doctor reflects in this medical records that you are still receiving "appropriate treatment" even if you don't want to take Oxycontin, you will make is harder for the insurance company to deny benefits, and more likely that you will prevail on an ERISA administrative appeal with the insurance company.   If the doctor doesn't do this, realize that your refusal of the treatment may be basis for the insurer to deny your benefits. A Connecticut ERISA benefits attorney can give you personal, in-person guidance in how to handle such a situation, what your alternative are, and the consequences of the choice you want to make.  

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