Question
Individual disability policy - mental disorder claim
What happens if the claimant is not following the "appropriate care" provision because of his mental illness? He refuses to follow the Psychiatrist's plan of care because he is mentally ill, and this is documented. Is this a problem for a claim?
Answer
Ron, it can certainly be an issue for the claim. However, as you noted, it can be somewhat common in a MH situation and can be explained away. However, insurance companies love to deny claims for any reasons. Should they, we would be happy to fight them. But in the meantime, it is best to follow the provider’s plan of care or, at the very least, have the provider note that it is the patient’s conditions that are inhibiting his ability to following providers’ orders. Happy to discuss this in greater detail to help prevent a denial. Always available for a free consultation.
