How to fight a Monster – Insurance Company - Countering an Attack
How to fight a Monster – Insurance Company - Countering an Attack
The following is a letter which was drafted and sent to the insurer after my case manager decided to falsify documentation and data by claiming we had a phone conversation where we discussed the details of my case closure. This phone conversation never took place and it was my word against theirs. Unfortunately for my case manager I keep records of my interactions and was prepared for such false accusations.
Please note: Insurers will use phone conversations as an escape goat as what is discussed cannot be confirmed nor denied as only that the phone call happened. This is why its imperative to request communications be in writing. At the very least documentation of phone records should be kept, even a screen shot of incoming/outgoing calls can save a world of headaches when the accusations start flying.
It should also be considered that specifying that any request by the insurer should be made in writing is, including those made within consultations with the insurer. Again it is impossible to confirm or deny what was discussed when in a meeting. Keeping in mind that the case manager will write a report with what THEY perceive the meeting was about.
Check the rights you have in your area, but in some areas you are allowed to record the meeting (with your phone for instance) if you explicitly disclose your intent to record the conversation. I have utilised this method in the past, if they can record you for “training purposes” , you can record too. If they refuse they do not have to partake in the conversation.
To whom it may concern,
My name is D.B. claim number -----------. I am writing to you to regarding a letter I recently (30.06.2017) received informing me of Insurers Work Capacity Decision - Fair notice. This document claims a conversation took place with my current case manager S. on the 21.06.2017. Apparently in this phone conversation we discussed the upcoming review of my work capacity, returning to work with my pre injury employer, ceasing entitlements to weekly benefits and the opportunity to provide further information regarding my case by the 05.07.2017 for an upcoming review.
First and foremost this conversation never took place, I have provided a screen shot of my call log which attests to this fact and am more than willing to contact my mobile phone service provider to attain a more formal record which I guarantee will reflect the same information. If this conversation did in fact take place I would have advised S. that all service providers have indicated that I would not be able to return to my pre injury employment or duties due to physical and lifting requirements etc. in that particular field. Hence why I have undertaken study at the recommendation of Insurer and other service providers to change career type to office based employment. I would have inquired as to why S. has not responded regarding the MRi of the cervical spine which is still pending and pertinent to the upcoming review and was discussed in our one and only actual phone conversation which occurred on the 30.03.2017, which again I also have a record of. I also would have inquired as to why S. continues to withhold the approval needed to apply for entitlements for reimbursement of medicines, again discussed on the 30.03.2017. The data requested for the 05.07.2017 would all most certainly be in order as I am organised, open and honest regarding my case progress. Importantly, I would ask about the tax records which were going to be sent out to me regarding entitlements which have not arrived. However, most importantly I would have asked about my study, which I was advised to undertake and which continues to be unacknowledged by GIO since re-opening the case. Which various emails have been sent but still no definitive answers have been given to my array of specific questions regarding the matter.
Observing this information it is clear that I have not been given fair notice due to complacency regarding my case file. S. has failed to address many issues regarding queries, has been aggressive and dismissive in our interactions, but more importantly S. has falsified data regarding my case. This is not only unprofessional but extremely unethical and absolutely deplorable behaviour for someone who is dealing with a demographic who is injured, sensitive, in pain and in need of empathy, compassion and understanding in their current condition. I implore Insurer to investigate further and examine any case S. has worked on for similar discrepancies and patterns of complacency, disrespect and aggressive behaviours.
The request to provide further information regarding my case by the 05.07.2017 for the upcoming evaluation is incredibly unreasonable, as it is clear that during that time it will be impossible to organise the approval and then arrange the MRi of the cervical spine by that date considering it is now the 04.07.2017. However, the data I am responsible for is ready for submission. I have a case study specifically observing pain which I would like to present (---Case Number--- Statement of Injury 2017) and a document summarising my experience in the first few months after my injury occurred (N.C Injury 1), both which have been attached to this email for your records and consideration when evaluating the upcoming review of my work capacity. I also request an updated review from each of my service providers be submitted to compile a contemporary view of my current condition and symptomology when examining my current capacity. Thank you.
Regards
D.B