Question

Before I present my appeal, can I acquire exams and conduct an IME on my own (to avoid bribery/bias from Hartford)?

Asked on November 7th 2019 by Michael J.
Here is an update on my previous review message regarding Hartford’s over 21 month delay in alerting me of an offset/overpayment issue I had listed on their annual update forms and returned to The Hartford 21 months prior. First I must tell you I’ve been receiving LTD benefits from The Hartford for over 10 years with no problems. I abided by and followed the specific instructions and always returned completed insurance forms from my doctor as well as from myself in a timely fashion and ALWAYS sent BACK via U.S. Certified mail to “cover my ass-ets”. Since my LTD policy is mandated by my ERISA right’s, I sent a “Letter of Appeal” to Hartford and included the misguided and misinformed letter of receipt and Hartford’s failure to notify me for over 20 months what I had listed in there LTD update forms. I had included evidence with misguided Hartford letter’s, etc. as proof which explained Hartford’s fault and lack of notifying me 20 months prior of the offset problem I had clearly listed on the forms to continue my LTD benefits. However, my “Letter of Appeal” was denied stating that The Hartford is not liable for any clerical administrative mistakes that Hartford makes. As retribution (I believe) on behalf of The Hartford, my file was transferred to a “Senior Ability Analyst” and letters were received requesting more and more medical information from me and about my medical file from my Doctor to determine my disease and functionality, etc. My doctor did not send the files as specified and the “Senior Ability Analyst” alerted me that she needs these files or I could be terminated. In turn, I abided by her requests and contacted my Doctor’s office and had the specified medical charts and dates sent to the “Senior Ability Analyst”. Then, the “Senior Ability Analyst” responded to me that the “medical nurse” at The Hartford could not decipher/nor read my Doctor’s notes of symptoms and side effects I was/am experiencing. He requested I tell my doctor to type a summary report about the state of my medical condition in order for the “medical staff at the Hartford” to review, and again, forewarned me about a deadline… or else, I’ll be terminated. I relayed this request about the typed summary report when I saw my Doctor, and it did not ‘sit well’ with my Doctor, who became furious and had an adverse disdain dealing with LTD Representatives, in turn he never responded. To verify Hartford’s complaint about my Doctor’s illegible handwriting, I also requested a copy of my files and found that I could read most of my Doctor’s notes, and wondered why the “Hartford medical staff” couldn’t? The “Senior Ability Analyst” and “the medical person” at The Hartford continued to harass my doctor and his assistants requesting answers about my condition, to no avail. Now, as I was approaching the age of 60 years old, the “Senior Ability Analyst” at The Hartford ordered an IME which I initially had to cancel since it was on the same day as my Doctor’s appointment for Lab Work. Again, the “Senior Ability Analyst” continued to harass my Doctor and his staff to questions she wanted clarification on, to no avail. With no response by my Doctor, the “Senior Ability Analyst” became frustrated, she again ordered an IME by the third party MCN, on a Saturday. Unfortunately, I again had to: first contact MCN (as instructed in the MCN letter) to cancel and attempted to reschedule the IME, however the MCN Receptionist said she could not reschedule nor cancel the appointment and was advised to contact my “Senior Ability Analyst” to reschedule due to a prior commitment I had out of town for that weekend. I e-mailed Hartford’s “Senior Ability Analyst” about rescheduling the IME again, and received an e-mail/ letter from the “Senior Ability Analyst” at The Hartford stating if I don’t attend the already re-scheduled IME I would be terminated. Several weeks later, a letter arrived in my ‘physical’ mail box from the “Senior Ability Analyst” stating due to my two cancellations for the IME my benefit policy is terminated, and in addition my total outstanding disputed remaining balance of an offset/over-payment is due. Before I present my Appeal in hopes of re-activating my Hartford LTD case/file and amend Hartford’s decision to terminate my policy, may I acquire exams and other tests on my own – as well as hire a licensed Occupational Therapist to conduct an UNBIASED IME and Functional capacity evaluations that outpatient medical facilities offer? The simple reason being, Doctor’s and IME services that I choose would not be paid by (and allegedly bribed by) The Hartford. Medicare covers these tests through hospital outpatient specialized services conducted by OT Occupational Therapy Division. If my appeal proves favorable to support my disability, will Hartford approve the evidence I submit and re-activate my file and later schedule me for their own “biased” IME and again cancel my policy?

Answer

Answered on November 7th 2019 by Attorney Stephen Jessup

Michael, yes. In the course of an appeal you want to get as much beneficial information as possible, to include an IME or FCE of your own. The bigger issue from a legal perspective is the position they are taking as it relates to the failure to attend the IME. In some cases courts have found it a reasonable basis to deny a claim for failure to attend an IME as the policy creates an affirmative dutiy to attend. Please feel free to contact our office to discuss in greater detail.