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Communicating with your insurance provider


Establishing an insurance claim

If insurance is one of your employee benefits contracted by your employer, union or association, making a claim can provide income (consistent with the terms of the plan) while you are off work due to illness or injury. Your insurance provider needs factual information about the medical, psychological and cognitive challenges that affect your work ability, even after you recover from your cancer treatment to assess the claim. You may have ongoing issues, such as cognitive or emotional challenges that affect your work. Giving your insurer this information is important for them to determine continued benefits on the claim; without it, they may stop your benefits.

Make sure your doctors are all aware of your conditions that might affect your ability to return to work. They will need to consider these when completing forms for insurance providers. Some insurance providers have their own in-house physicians, although the report from your family doctor is usually sufficient for establishing a claim. If there is conflicting information from your other doctors (including insurance in-house medical advisors), an additional opinion from an oncologist, psychiatrist, cancer care specialist or physiatrist may be required.

Sometimes, the insurance provider will ask you to assess your work readiness. If you are at all unsure of how to do this or if you are ready to resume work, ask your doctor to help you with this task. They have experience in treating people with your medical conditions and in assessing work readiness. On the other hand, discuss with your doctor if you disagree with their opinion about your work readiness. See Communicating with your healthcare team.

To hear more about research on determining work readiness and how cancer survivors can work with their healthcare service providers to determine work readiness, view this video by Mary Stergiou-Kita, PhD: Determining Work Readiness Following Cancer.

To read more about work readiness, see Am I ready to return to work? Assisting cancer survivors to determine work readiness by Mary Stergiou-Kita et al. 2016.

Staying in contact during an insurance claim

If you have already established an insurance claim, a case manager will likely call to assess your progress, even when you are receiving treatment and do not feel close to returning to work. Case managers mainly call for four reasons:

  1. They want you to stay mindful of planning to return to work because this helps people get ready when their condition gets better.
  2. They are trying to find out when you might return to work because this may influence your claim.
  3. They want to make sure that you are getting all the medical treatment you can and doing everything in your power to recover.
  4. They may offer you rehabilitation services to help you recover faster and get back to work sooner.

Often long-term disability insurers only fund rehabilitation services if they are likely to help you get back to work sooner. As well, if your claim is ending soon, you will not likely be offered rehabilitation. Your claim may end, for example, if you can no longer do your occupation but could do another. This is all the more reason to consider returning to work sooner so you can receive services to help you with your challenges.

Sometimes cancer survivors worry about talking to insurance case managers because they are afraid of saying something that might hurt their claim. Others talk about being caught off guard when a case manager calls and they feel unprepared to report properly on their situation. Here are some ideas that will help you be prepared for this call. First, keep your progress report beside your phone so that, when the case manager calls, you will be ready. Second, your progress report can include:

  • What your doctors have told you about your condition.
  • When your doctors will re-assess you.
  • Barriers or challenges slowing your return to work – to what degree, how often, and how long you have had these challenges. To assess your work abilities, try our Job Analysis Form.
  • What you have been doing to overcome these barriers.

Ask the case manager if they would fund services to help you overcome your barriers to return to work. These services could include:

  • vocational rehabilitation
  • counselling
  • exercise programs
  • work-hardening programs
  • diagnostic procedures
  • neuropsychological assessments
  • occupational therapy services to provide ideas for job accommodation

If a case manager calls, it is important that you respond fairly quickly. If you do not, the insurance provider might not approve or continue your claim. If you feel concerned about talking to a case manager, you could send them an email or leave a voicemail message with the information suggested above.

Other Resources: Tips for Working with a Vocational Rehabilitation Counsellor from an Insurance Company, Originally published by Cancer Smart Special Edition: Cancer and the Workplace May 2010 Issue 7, Wellspring.