Losing Benefits Because Of Facebook

[Cryozombie]

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

 

[Bill Mattocks]

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).

 

[Flea]

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.

 

[Archangel M]

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.

 

[Archangel M]

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

 

[MA-Caver]

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.

 

[Carol]

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.

 

[Carol]

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.

 

[grydth]

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.

 

[Flea]

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

 

[Cryozombie]

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.

 

[Ken Morgan]

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.

 

[grydth]

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.

 

[MJS]

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.

 

[Bruno@MT]

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.

 

[RandomPhantom700]

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?

 

[Bruno@MT]

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).

 

[grydth]

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.

 

[Jade Tigress]

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.