# Losing Benefits Because Of Facebook



## MA-Caver (Nov 20, 2009)

An insurance company investigating the validity of a claim is business. 
Facebook is a pleasurable past time on the computer/internet... they BOTH don't belong together. 
Besides the photos are inconclusive. Or as someone stated she could've been trying to enjoy herself to get herself OUT of her depression. Therapists will agree that finding a distraction or doing something that you enjoy is a benefit to getting out of depression.
Judging a person solely on photographs is a piss-poor way to determine their mental state. 
The insurance company has no claim whatsoever on these grounds. 
If she has been clinically diagnosed then she has a valid claim... PERIOD. 

Story below: 


> http://www.cbc.ca/technology/story/2009/11/19/quebec-facebook-sick-leave-benefits.html
> *Depressed woman loses benefits over Facebook photos*
> 
> *Last Updated:   Thursday, November 19, 2009 |  9:45 PM ET*
> ...


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## punisher73 (Nov 20, 2009)

I agree with the company.  They have paid her for a year and a half for not working. 

Many people have depression and still work, she should have tried to work something out with the company before hand before posting pics from the beach, strip clubs etc. I have heard of companies changing job duties, scheduling etc to help work around the issue.  I wouldn't pay somebody to not be working and have other people having to pick up the slack or not being able to hire a replacement.


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## CoryKS (Nov 20, 2009)

Protip:  set your profile to private and don't friend your employer or their insurance company.


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## Bob Hubbard (Nov 20, 2009)

ProTip: stay off the internet when you don't want someone to know what you're up to, and never tell anyone anything you wouldn't want getting out.


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## Bruno@MT (Nov 20, 2009)

As you know that is my ground rule for internet communication. But this has nothing to do with that. If someone is clinically diagnised with depression, than that is that, and trying to snap out of it is a good idea.

This is just one of the benefits / symptoms of a capitalistic health insurance provider whose bottom line depends on refuting and revoking benefits as much as possible. All hail the mighty dollar.


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## Bill Mattocks (Nov 20, 2009)

Bruno@MT said:


> This is just one of the benefits / symptoms of a capitalistic health insurance provider whose bottom line depends on refuting and revoking benefits as much as possible. All hail the mighty dollar.



The money has to come from somewhere, whether it is private health insurance (from premiums) or state-funded (taxes).  

I do not know where people get the idea that if the government pays for it instead of a private for-profit insurance company, it is somehow 'free'.

If it comes from premiums, I damned well expect my insurance company to do their best to cut down on fraud and excess payouts that drive MY rates up.  If it's public insurance paid for by taxes, then I've got even MORE reason to complain about it, because I can't simply quit and take my business elsewhere.

I have no idea if this woman has a legitimate claim or not.  I'm no doctor, and I'm certainly no expert.  But I surely do think her posted photos online are fair game, and I expect the insurance company to go to great lengths to expose fraud.

This ties into my earlier statements about national insurance schemes.  If it's paid for by taxes and you can't quit, then taxpayers have a vested interest and a legal right to demand that others take actions to reduce their claims.  That means YOU have to eat right, YOU have to lose weight, and YOU have to stop engaging in physically risky behavior, because WE say so.  If we pay the bill, you have to dance to our tune.  Same goes for me too, of course.


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## Ken Morgan (Nov 20, 2009)

Bill Mattocks said:


> I have no idea if this woman has a legitimate claim or not. I'm no doctor, and I'm certainly no expert.


 
But thats the point isnt it?

The insurance company, not a doctor came to the decision to end her benefits because in their opinion a clinically depressed person should be inside, with the curtains closed, taking drugs.

In order to get benefits she would have had to be evaluated by doctors, it should be a doctor clearing her for work,

Its not like shes claiming a back injury, and then competes in power lifting competitions.

I have no idea if shes legit of not, but when it comes to mental illness, it should be a doctor making the diagnosis, not an insurance company investigator.


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## Bill Mattocks (Nov 20, 2009)

Ken Morgan said:


> But thats the point isnt it?
> 
> The insurance company, not a doctor came to the decision to end her benefits because in their opinion a clinically depressed person should be inside, with the curtains closed, taking drugs.
> 
> ...



I agree that she should have the opportunity to file an appeal and to have a doctor review her condition.


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## grydth (Nov 20, 2009)

In a long career, I have seen quite a lot of insurance fraud - on *both *sides of the table. Left unchecked, it destroys the core of the system.

I can't access the file in this case, and I don't know the laws on Disability Benefits or Workers Compensation in Quebec.

In New York, the claimant would have a right to an administrative hearing process... and the insurance company could also seek criminal prosecution. These are always ugly cases, and must be resolved individually, on their specific facts and evidence.


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## LuckyKBoxer (Nov 20, 2009)

thats funny... she doesnt seem depressed to me... trips? chippendales? bars? beaches? sharing it on facebook? I would cut her off as well... depression... whatever.... and no i am not a professional, and no i have no compassion for her... she seems likes shes getting on fine to me.. lame


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## Gordon Nore (Nov 20, 2009)

grydth said:


> I can't access the file in this case, and I don't know the laws on Disability Benefits or Workers Compensation in Quebec.
> 
> In New York, the claimant would have a right to an administrative hearing process... and the insurance company could also seek criminal prosecution. These are always ugly cases, and must be resolved individually, on their specific facts and evidence.



If I read the article correctly, this would be the private insurance policy that comes with her employment. That's separate from Workers' Comp. Our provincial health programs provide for health care, not income maintenance when absent from work.

I think a lot is being made of the facebook aspect of the story. Workers' Compensation and private insurance companies have tracked claimants before -- in this case she handed them evidence that she has to answer to.


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## dbell (Nov 20, 2009)

Ken Morgan said:


> But thats the point isnt it?
> 
> The insurance company, not a doctor came to the decision to end her benefits because in their opinion a clinically depressed person should be inside, with the curtains closed, taking drugs.
> 
> ...



Did they actually say she should be inside with the curtains closed, taking drugs, or did they say words to the effect, "in these pictures, spanning several days, and several different events, she is happy, appears to no longer be depressed, and is able to do things similar to what she may be expected to do at work:  Walk (she is walking barefoot in heavy, wet sand, so walking at work should be OK).  Sit for long times at a desk (she is sitting watching strippers for an extended time). etc?  For what it is worth, many insurance company investigative teams actually have MDs on the staff to review these things.

I do think that the insurance companies, be the private or public SHOULD track down people abusing the system.

Now, don't get me wrong, I am not overly happy with our (US) health insurance system, and actually gave up my PA license because of the crap they make you go through to take care of patients, but I do think they probably made a right call on this lady.

And this lady was stupid to post such things on line if she didn't want them to see it!


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## grydth (Nov 21, 2009)

Gordon Nore said:


> If I read the article correctly, this would be the private insurance policy that comes with her employment. That's separate from Workers' Comp. Our provincial health programs provide for health care, not income maintenance when absent from work.
> 
> I think a lot is being made of the facebook aspect of the story. Workers' Compensation and private insurance companies have tracked claimants before -- in this case she handed them evidence that she has to answer to.



Gordon, this is a good example of how systems can differ among states/provinces/countries. In New York, too, the Disability Benefits system is separate from Workers Compensation.... but that agency's judges hear claims from both. 

Also, the insurance fraud laws establish both civil and criminal penalties in this state. Criminal charges can and have been made against claimants, doctors, lawyers... and employers, too. There are also severe penalties a judge may impose upon insurance companies.

No matter the jurisdiction, these always come down to factual determinations - - - was this woman trying to recover or was she living it up while pretending? Sometimes doctors see such pictures and realize a patient has lied to them.... and sometimes the doctor will have advised the patient to do more things to get well. I hope somebody tells us the outcome.


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## Jade Tigress (Nov 21, 2009)

LuckyKBoxer said:


> thats funny... she doesnt seem depressed to me... trips? chippendales? bars? beaches? sharing it on facebook? I would cut her off as well... depression... whatever.... and no i am not a professional, and no i have no compassion for her... she seems likes shes getting on fine to me.. lame



So, what does depression look like? How many times have family and friends of suicide victims say, "I had no idea they were depressed, they seemed so happy"? Smiling on the outside does not mean everything is ok. The appearance of enjoyment does not mean everything is ok. The occasional enjoyment of activities does not mean there are not other serious issues going on. 

As dbell said, what would you have her do? Stay inside all the time taking drugs? Just because you _can_ experience _some_ enjoyment does not mean you are not still clinically depressed. 

And as Ken said, it's not like someone claiming a physical injury and then being spotted doing something that injury would prevent. Major/clinical depression is a serious condition and it's up to her doctor to clear her for work. 

Unless you've experienced it yourself or are a doctor, do not judge another persons mental condition.


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## Bill Mattocks (Nov 21, 2009)

Jade Tigress said:


> So, what does depression look like? How many times have family and friends of suicide victims say, "I had no idea they were depressed, they seemed so happy"? Smiling on the outside does not mean everything is ok. The appearance of enjoyment does not mean everything is ok. The occasional enjoyment of activities does not mean there are not other serious issues going on.
> 
> As dbell said, what would you have her do? Stay inside all the time taking drugs? Just because you _can_ experience _some_ enjoyment does not mean you are not still clinically depressed.
> 
> ...



I agree with everything you said about depression.  It is real and it is a life-threatening medical condition.

However...IMHO, a diagnosis of 'depression' should not be a 'no more questions ever' condition.  In other words, once a person is diagnosed with depression, they are not 'hands off' and it is not forbidden to question it.

Yeah, it's real.  But yeah, insurance companies are allowed to question it.  Too much fraud.


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## MA-Caver (Nov 21, 2009)

Bill Mattocks said:


> Jade Tigress said:
> 
> 
> > So, what does depression look like? How many times have family and friends of suicide victims say, "I had no idea they were depressed, they seemed so happy"? Smiling on the outside does not mean everything is ok. The appearance of enjoyment does not mean everything is ok. The occasional enjoyment of activities does not mean there are not other serious issues going on.
> ...



Having been clinically diagnosed at one time with depression myself is why I was so anti-insurance and all that. I was told by my therapist and the folks at the welfare center (I was homeless and unemployed at the time) to NOT work for a year, go to therapy twice a month and was given housing, food stamps, and a small bit of cash each month. As long as I stayed out of trouble (read: jail) I was free to do what I wanted as long as I was working on the "homework" my therapist gave me for my depression. 
So I caved, spent time with friends, went camping did lots of stuff... 
Here's the kicker... when I got home and was alone again... had time to rest, think, etc. Found out I'm still down and out. 
Shortly about 10 months later I recovered and was released from the program. Some folks take longer some not quite as long. 
Depression is a complex condition that can hit basically anyone. 
And as Pam mentioned it's invisible. 
Two years ago I lost a dear close friend to suicide as a result of her depression. Everyone thought she was a happily married woman. 

:asian:


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## Jade Tigress (Nov 21, 2009)

Bill Mattocks said:


> I agree with everything you said about depression.  It is real and it is a life-threatening medical condition.
> 
> However...IMHO, a diagnosis of 'depression' should not be a 'no more questions ever' condition.  In other words, once a person is diagnosed with depression, they are not 'hands off' and it is not forbidden to question it.
> 
> Yeah, it's real.  But yeah, insurance companies are allowed to question it.  Too much fraud.



This is very true. It should not be a hands off condition. It needs to monitored closely and once it's developed it is very often a life long condition. For those who have gone on anti-depressants there is a 90% relapse rate if they are stopped. 

Insurance companies may question, but it is ultimately up to the doctor to diagnose. There is definitely a lot of fraud out there so I can understand that insurance companies need to investigate, and I support outing the frauds. However, in this instance, for them to deny benefits based solely on pics found on Facebook, does not support that she is faking depresssion. She may be, I don't know, it's not for me to say. That's up to her physician.


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## Carol (Nov 21, 2009)

Most STD/LTD insurance plans in the U.S. limit mental health claims to a maximum of 24 months, regardless of the health of the patient once the 24 months expire.

What isn't known is the details of this lady's disability leave policy.  I don't know about Canada but I know in the U.S., STD/LTD leave claims are never as simple as "We'll pay you X% when the doctor says you can't work and will keep paying until the doctor says you are clear."  There are always procedures that have to be met both at the time of filing and throughout the claim.  I have someone that is out long-term undergoing breast cancer treatment, and she's been complaining about how she has to be "interviewed" every week with a caseworker RN and say yeah she's still getting chemo and yeah it sucks.  I feel for her but I don't have any sway over how our disability insurance carrier conducts their business.

To deny benefits based strictly on Facebook photos seems a bit ridiculous.  However, if she was interviewed on a Thursday and said "I'm so depressed and I can't even leave my house, but her FB page shows that on Thursday she not only left her house but was had gone on vacation and running around the beach, then I can understand why the insurance company would have reason to pull her benefits.


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## Stac3y (Nov 21, 2009)

Jade Tigress said:


> Insurance companies may question, but it is ultimately up to the doctor to diagnose. There is definitely a lot of fraud out there so I can understand that insurance companies need to investigate, and I support outing the frauds. However, in this instance, for them to deny benefits based solely on pics found on Facebook, does not support that she is faking depresssion. She may be, I don't know, it's not for me to say. That's up to her physician.


 
Unfortunately, insurance companies have a LOT of control over doctors. Just sayin'


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## Jade Tigress (Nov 21, 2009)

Stac3y said:


> Unfortunately, insurance companies have a LOT of control over doctors. Just sayin'




Insurance companies cannot diagnose. They may have alot of control over doctors, but they cannot diagnose an illness. The doctor diagnoses it.


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## Cryozombie (Nov 21, 2009)

Not to mention that Depressed people can have good and bad days/weeks...


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## Bill Mattocks (Nov 21, 2009)

Cryozombie said:


> Not to mention that Depressed people can have good and bad days/weeks...



Yeah, so do I.  Where's my pile of money?  Where's my get of of work free card?  Where's my Cancun vacation on the taxpayer's dime because my mommy didn't love me enough?

I'm not saying depression isn't real.  I'm saying lots of people have rough lives.  Most of us get on with things.  I can understand it when people show irritation with those who appear to have nothing wrong with them and live off the public teat (or insurance company teat, soon to be the government teat).


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## Flea (Nov 21, 2009)

Cryozombie said:


> Not to mention that Depressed people can have good and bad days/weeks...



You beat me to it.

Let's not forget that this is a private insurance company, and as such its ultimate motivation is profit.  It's no mystery that companies will go to interesting lengths to fatten that bottom line.

I have an acquaintance who was diagnosed with schizophrenia a couple years ago, and is receiving disability benefits through her former employer.  She's pretty incapacitated as she learns to navigate a new world cast by her brains' misinformation.  She felt, and her doctor agreed, that exercise would be a good thing for her.  She signed up for ballroom dance lessons at the local community center.  The social interaction was a godsend, the dance and music were fun, and of course the exercise all worked wonders for her health.  That is until she got a nasty letter from the insurance company threatening to cut her off.  Returning to work was out of the question, so what could she do?  Naturally all the benefits of dancing went right out the window and her symptoms came roaring back.  

A year later, her doctor suggested that she try volunteering so she signed on at a home for abused and neglected children for ten hours a week.  She _adores_ children, and presiding at storytime revolutionized her life with a new sense of purpose and community.  Until she got another nasty letter (how did they even know?!)  There's no way she can support herself, so there she is cloistered at home again, all the health benefits of volunteering shot to hell. Now she's even afraid to babysit her grandchildren for fear that she'll lose everything and find herself out on the street.

The ultimate irony is that these heavy-handed tactics have assured that the insurance company will support her for life.  What alternative does she have if she can't take any concrete steps toward recovery without jeopardizing the roof over her head?  If they want to stop paying out, they should _encourage_ her to be active so she can recover.  I suspect there's a lot of that dynamic going on with the Facebook-posting woman.  I wish her well, whatever happens.


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## Archangel M (Nov 21, 2009)

So depressed that she cant WORK. But she posts this stuff? An investigation is called for.

Are we SURE that the ins. co. did this solely based on the FB stuff?

Im thinking there is more to it.


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## Archangel M (Nov 21, 2009)

I'm thinking that someone at her job thought she was scamming and ratted her out to the ins. co.


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## MA-Caver (Nov 21, 2009)

Bill Mattocks said:


> Yeah, so do I.  Where's my pile of money?  Where's my get of of work free card?  Where's my Cancun vacation on the taxpayer's dime because my mommy didn't love me enough?
> 
> I'm not saying depression isn't real.  I'm saying lots of people have rough lives.  Most of us get on with things.  I can understand it when people show irritation with those who appear to have nothing wrong with them and live off the public teat (or insurance company teat, soon to be the government teat).


I lived a rough life and right now am on a fairly decent upswing... it's a long slow curve but it's not going down anytime forseen in the future. Yet during my own bout with depression (UN-MEDICATED) I was so bad off some days/weeks that I wouldn't even WANT to find a job. 
My sucking on the government teat wasn't that sweet either. Had a lot of hoops to jump through before getting benefits and even then the milk was a bit sour (you know like 4-5 days past the expiration date... still drinkable but having that faint... after taste). 
Either way, I wandered through that long dark hall way and eventually made a major geographical relocation and things started to look up. Now with my young lady in my life and a good job I'm not feeling the downs as I used to. I have some days now and again but they're rare and short-lived. My lady just has a knack for making me feel better and we're 6 hours 1 state apart and having to chat on line for the most part until we can get together for long weekends (like THIS weekend :uhyeah: ). 

I know that people DO scam insurance companies and I know that some people just LOVE riding the system for every dime they can squeeze out of them. Some are doing VERY well just on the system... but there are those who do seriously need a long time to heal and come out of whatever funk they're in. 
I stated that I went through mine un-medicated because I have issues with a doctor that talks to me for FIVE minutes and tosses me a prescription and sends me on my way when I was supposed to spend a 50 minute session with him on the tax payers dollars. 
I knew I didn't need the drugs and I knew what I needed to get out of the funk... just needed some help along the way with a roof and 3 squares until I got back on my feet. Which is where I'm at now a full fledged tax payer with a job. 

I agree, doctors jobs are to diagnose and treat illnesses, insurance adjusters job is to pay out or deny claims based on doctor's diagnosis and treatments. 
They should've brought the woman back in to her or their doctor and make an assessment based on that examination/interview. Not because she is trying to lift her spirits with a vacation.


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## Carol (Nov 21, 2009)

MA-Caver said:


> I agree, doctors jobs are to diagnose and treat illnesses, insurance adjusters job is to pay out or deny claims based on doctor's diagnosis and treatments.
> They should've brought the woman back in to her or their doctor and make an assessment based on that examination/interview. Not because she is trying to lift her spirits with a vacation.



I agree that one shouldn't lose disability benefits because they are trying to lift their spirits with a vacation.  Another important thing to consider is the loved ones of the mentally ill person.  A vacation can help the people supporting/caring for the patient just as much as the patient.

However...its also important to keep in mind that insurance companies have definitions with regards to what constitute a valid claim, and they have processes that must be followed when a claim is made, when and how a claim will be denied, and what appeals processes are possible.

The problem that I've seen, especially in young people, is that they think that bad things won't happen to them.  Weren't we all bulletproof when we were 26?  

Unfortunately many workers don't take the time when they are healthy to understand their coverage, and ask questions about the requirements of processing a claim, or understand if the employer-paid coverage is really enough or should they pay out of pocket for a supplemental plan.

Good on ya for pulling yourself out of the dark, Ralph.  That took a lot of efforts and a lot of trying.  You being healthy is the best part of this thread.


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## Carol (Nov 21, 2009)

Archangel M said:


> I'm thinking that someone at her job thought she was scamming and ratted her out to the ins. co.



There is _something _to this picture that is missing from the story.  Insurance companies don't like to pay claims, but for STD/LTD their customers are generally medium to large size businesses that by big policies.  If even one employer drops them because they are too punitive, that is a loss of hundreds of thousands -- if not millions -- of dollars.

Even if a "friend" ratted her out to her insurance company and said "ZOMG click this link to see your claimant on vacation!" it seems like there would be more than _die inkriminierenden Fotos des Facebook_ involved in the denial of the claim.  Something doesn't match up.  My hunch is that her postings caught her in some kind of a lie about her claim, and the lie involves something more than the claimant smiling on a beach somewhere.


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## grydth (Nov 22, 2009)

Archangel M said:


> I'm thinking that someone at her job thought she was scamming and ratted her out to the ins. co.



A large number of insurance fraud tips come in from friends, neighbors, coworkers, even family members. There are a lot of fakers out and around. Cheaters can be very blatant, almost arrogant about it.... and once people see that they themselves have to work and they are paying for this, the calls and letters start coming in.

That said, if I had a dime for every unsavory _insurance_ tactic I've seen, all the refusals to pay legitimately injured folks..... well, I'd be posting from a villa in the south of France.


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## Flea (Nov 22, 2009)

MA Caver, congratulations on your recovery.  :asian:  I aspire to say the same thing myself some day.


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## Cryozombie (Nov 22, 2009)

Bill Mattocks said:


> Yeah, so do I. Where's my pile of money? Where's my get of of work free card? Where's my Cancun vacation on the taxpayer's dime because my mommy didn't love me enough?


 
All excellent questions.  But I'm not your doctor, so I cant answer that for you.  But, I'd be happy to submit a you a bill, if you'd like.


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## Ken Morgan (Nov 22, 2009)

Why do so many people mock mental health issues? They are as real as any physical injury or imbalance you can think of. Yet, just reading some of the posts here, some belittle it, and say, Just get over it. As some here will attest, if it was that easy, they would have done it already.

 Yes there is insurance fraud. Yes the insurance company should investigate this woman, but get over it folks, mental health issues are real, and can destroy your life and the lives of those around you. Just because you cant see it, doesnt make it fraudulent.


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## grydth (Nov 22, 2009)

Ken, there's nothing like a shameless fraud to destroy sympathy for the real folks: 

False military heroes... rape victims that weren't... child molestation existing only in a divorce lawyer's tactics... cancer 'victims' healthier than I.... and depressed folks whooping it up..... All of these cast an undeserved pall over genuine sufferers.

I hope Quebec does hold a hearing so maybe the truth comes out.


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## MJS (Nov 22, 2009)

Hmm....should we all be talking about this topic, seeing that we dont know the whole story? (Sorry, just a little humor as these were thoughts that were made by someone in that soldier thread)

Anyways....I think for now, I have to side with the company that the woman worked for.  I mean, we hear about fraud all the time.  Going only on what I'm reading from the article, this woman sounds like she was very depressed.  That being said, how can you go from being that depressed, to going on trips, clubs, bars, etc.?  You're too depressed to work, but not enough to party?  Something doesnt sound right here.

Now, doctors could have possibly suggested that she did some sort of activity to help with the depression, but of course, I'd imagine that would have to be verified with the doc.

I'll also say that in a case like this, posting pics or making it known what you're doing, when you're supposed to be sick, is just downright dumb.  I dont know the case with her FB acct. but unless she had it open for anyone to view, anyone viewing has to be her 'friend' or acknowledged by her.  But still....why post stuff like that, for people to see, when you're supposedly way too depressed to work?

It'll be interesting to see how thing turns out.


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## Bruno@MT (Nov 23, 2009)

Bill Mattocks said:


> I'm not saying depression isn't real.  I'm saying lots of people have rough lives.  Most of us get on with things.  I can understand it when people show irritation with those who appear to have nothing wrong with them and live off the public teat (or insurance company teat, soon to be the government teat).



Depression is a bit different from 'having a rough life' and if 'getting on with it' was so easy, you'd think people would do that before killing themselves. Saying that you can beat a depression by 'manning up' is as ridiculous as saying you can beat cancer or smallpox by manning up.


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## RandomPhantom700 (Nov 23, 2009)

Hmmm, while I agree that the company shouldn't be disqualifying her based on the photos alone, I don't think the photos alone are the whole picture (no pun intended).  I mean, paid sick leave for a year and a half?  Seriously?  

This isn't just a few pictures of her having fun.  If it was just that, I'd agree with the woman.  However, this is pictures of her enjoying vacation after a year and a half of paid leave, and presumably (I didn't explore the article, so forgive this assumption) no updates from doctors about her progress.  Frankly, what else is the company supposed to wait for before denying benefits?


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## Bruno@MT (Nov 24, 2009)

RandomPhantom700 said:


> This isn't just a few pictures of her having fun.  If it was just that, I'd agree with the woman.  However, this is pictures of her enjoying vacation after a year and a half of paid leave, and presumably (I didn't explore the article, so forgive this assumption) no updates from doctors about her progress.  Frankly, what else is the company supposed to wait for before denying benefits?



A second opinion by another doctor? An investigation followed by a formal complaint or procedure, and a chance for her to explain?

Just because some things take time does not mean benefits should be revoked. Insurance companies have to take the good with the bad. Not all of their customers can be cash cows that produce more milk than moo.

I know people close to me with chronic fatigue syndrome or other chronic ailments. Just because they cost the insurance company money does not give them the right to revoke benefits. If the insurance company does not give you your money back if you don't happen to get sick that year, they don't have a reason to cancel her benefits if she costs more than what she paid for before. That's why it's called insurance.

Additionally, they are taking advantage of her situation because they know that a) she does not have the money to fight back and pay a good lawyer and b) she does not have the energy to fight a drawn out legal battle if she is indeed having a depression (which should be the assumption as it was diagnosed by a doctor whose findings were accepted).


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## grydth (Nov 24, 2009)

Actually, many insurance companies will approach *her doctors *for opinions. They _may_ clear her by saying they advised her to do these actions.... or, often, they will feel betrayed by somebody who faked symptoms in their office - - - then went out to travel and party, and implicated the doctor in insurance fraud. Doctors will be very clear in such cases and will revise their opinions accordingly. In those cases, the fraud's own doctors' testimony sinks them.

Insurance companies often do rely on so-called independent medical exams for second opinions. Most of these 'doctors' are rightly seen as simply hired guns who will sell an opinion if the check clears. (There are some of these types treating claimants as well)

Either way, hopefully there will be some testimony taken.


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## Jade Tigress (Nov 25, 2009)

Major depression is a real and serious medical condition that should not be overlooked or minimized. I do however, believe that it is over-diagnosed. It's more than feeling blue or feeling down for a couple weeks. I also believe anit-depressants and anti-anxiety meds are over-prescribed. 

That said, I don't know if this woman is committing insurance fraud or not. People who commit insurance fraud by claiming back injuries, whiplash, etc. also undermine the legitimacy for people who really have these conditions. If she is committing fraud, that's a terrible thing to do and she needs to be busted. But if it's legit, she should not be denied benefits because she "looked like she was having a good time". Major depression cannot be diagnosed by appearance. 

The woman should be reevaluated by a doctor not associated with the insurance company. Just because she took a vacation, looked happy, and posted her experience on Facebook should not be grounds enough to terminate her coverage. Nor should _any _patient go unmonitored by a physician. A complete reevaluation should be done before making a decision either way. 

The article does state that her attorney has requested another psychiatric evaluation. I hope there is a follow up article on the results.


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