Submitting claim for "Income Protection" - few queries..

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dubdub123

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Unfortunately, I have been severely struggling with my mental health and have been signed off work for some time.
I need to fill in a claim for income protection (thru employer).

Has anyone guidance on this process? I keep putting off completing the form but really need to tackle it.

How much detail around medical data should I provide? I was diagnosed as autistic and having ADHD in recent years, should I provide details of those diagnoses? To provide a full picture?
should I provide details of the ASD service/specialist that provided the diagnosis or not relevant as they didnt treat me in any way.
I've dealt with Occupational health doctor through work who specufied that I am not fit for work - should I provide their info?

I've to list "Barriers preventing a return to work" - do I just list my symptoms here?

It's asking for expected return to work date but that's unknown for now



If anyone has gone through this process I'd appreciate any feedback on any of the steps.

Thanks
 
The insurance provider almost certainly won't pay without the company doctors view firstly and in the past, as a manager, when I've dealt with this, our company doctor had to provide a report to the insurers.

To be honest, if you want to get paid, you need to provide all the details they ask for. One thing worth checking however is whether or not their is cover from conditions already diagnosed prior to you starting work,
 
I really need support on this , so would appreciate any feedback. Updating my orignal thread with how things are going..

Basically , I've been out on sick leave for some time due to mental health difficulties (anxiety , depressive mood) and have experienced months were my executive function was rock bottom and I struggled to do day to day tasks . I am continuing to put in huge efforts - medications titrating upwards / downwards and changing medicatons, along with weekly therapy with a psychologist.

As part of income protection review I was sent for an Independent Medical Exam - there were a number of issues around this
  • location - it was in a venue where people are sectioned (as well as having voluntary patients) in a HSE building. I found waiting extremely stressful, but I internalize that so much, and the psychiatrist did not think I appeared anxious
  • During the IME -
    • the psychiatrist made some comments regarding ADHD. Initially, he mentioned something along the lines of himself having ADHD ,which was actually comforting, however it transpired that he did not have an official diagnoses of ADHD and he really meant that he had some traits regarding his desk being a bit crowded. He could not relate to the feeling of having multiple questions, thoughts, going on in my brain constantly. That was very disappointing to hear that he would flippantly say about ADHD..
    • He gave unwarranted advice regarding treatment and said something along the lines that ADHD medication is really not meant for adults , that it is for children who cannot sit still. I absolutly did not feel in a position to challenge him, however knew this was BS. He was in a position of power and I knew that there was absolutely no point in challenging the comments.
  • Report issues after IME
    • The report has some actual factual inaccuracies (in one sentence someone else's name is referenced, stating we met via zoom, when it was actually in-person...
    • The most shockng this was - HE SAID I DID NOT HAVE ADHD. He based that on solely on our discussion (psychiatric assessment). He did not request additional paperwork, did not perform any screening etc. He also never mentioned this to me during the IME.
  • Background:
    • I was initally flagged for ADHD during a private ASD assessment and was recommended to seek ADHD assessment. This was based on both my discussions during the ASD assessmet and also on screenings that were made, which flagged me for ADHD.
    • Following this , I went to an ADHD specialist private service and underwent best practice assesssment including info from family, school reports provided, QbTest, other tests and discussion. And ADHD was confirmed.
  • Other medical appointments: I have been going to the company doctor Occupational Health and still currently considered not fit for work.
  • Decision
    • The psychiatrists report stated that I was fit to return to work some weeks ago , and they initially reduced payment and then stopped payment altogether
  • APPEAL
    • This has been extremely stressful for me and every time I try and sit down and write a letter about appeal, I feel totally overwhelmed.
    • Can anyone provide any guidance on how I can best approach an appeal? I feel that the IME report is significantly flawed and that the insurance company put significant weight into that . And I actually could not go back , as company doctor said I am not fit for work. I'm hoping to be able to go back in coming weeks/months on phased basis but the whole situation is causing me way more stress , when I should be focusing on recovery
 
Last edited by a moderator:
Sorry you are going through this. I don't have specific experience of this, but here are my thoughts on how to base the appeal:

- regardless of that IME assessment, the company doctor still deems you unfit for work.
- Request an alternative IME appointment(second opinion) due to inaccuracies in the report e.g wrong name & in person instead of zoom.
- Remind them that you previously have been diagnosed with ADHD and can provide paperwork confirming this.
- For the alternative IME ask for a neutral location.
Bear in mind, it is possible you may have to pay for the alternative IME, but I don't specifically know.

Take care
 
ADHD is recognised as a disability in Ireland under the Disability Act 2005. As a result, your employer are required to make reasonable efforts to help you perform your work.

However, your employer also has a letter from a qualified psychiatrist stating you do not have ADHD. Regardless of your issues with how the assessment was done, this is a letter, in writing from a qualified medical professional and carries weight.

You mentioned you have had your own private diagnosis done. Was this done by a qualified and suitable medical professional?. If not, it is worthless. If it was, have you sent this in writing to your employer.?

In order to return to work, was a formal fit to return to work assessment done by your employer. That should then lead to a plan to allow you to return to work.

Are your company aware that the insurance company has stopped paying you?
 
Landscape said:
Sorry you are going through this. I don't have specific experience of this, but here are my thoughts on how to base the appeal:

- regardless of that IME assessment, the company doctor still deems you unfit for work.
- Request an alternative IME appointment(second opinion) due to inaccuracies in the report e.g wrong name & in person instead of zoom.
- Remind them that you previously have been diagnosed with ADHD and can provide paperwork confirming this.
- For the alternative IME ask for a neutral location.
Bear in mind, it is possible you may have to pay for the alternative IME, but I don't specifically know.

Take care
Click to expand...

Thank you for this reply. This is very helpful.
I'm currently going through report to list out issues and concerns.
Really appreciate this feedback
 
Peanuts20 said:
ADHD is recognised as a disability in Ireland under the Disability Act 2005. As a result, your employer are required to make reasonable efforts to help you perform your work.

However, your employer also has a letter from a qualified psychiatrist stating you do not have ADHD. Regardless of your issues with how the assessment was done, this is a letter, in writing from a qualified medical professional and carries weight.

You mentioned you have had your own private diagnosis done. Was this done by a qualified and suitable medical professional?. If not, it is worthless. If it was, have you sent this in writing to your employer.?

In order to return to work, was a formal fit to return to work assessment done by your employer. That should then lead to a plan to allow you to return to work.

Are your company aware that the insurance company has stopped paying you?
Click to expand...

This is a huge concern. This medical professional (psychiatrist at IME) did not follow any best practice regarding ADHD assessment whatsoever, and totally undermined my diagnosis.

My ASD assessment was completed by appropriate professional based in Ireland, and as part of screening, I was flagged for ADHD and the recommendation was to seek assessment.

With a totally separate service based in Ireland, i went through private assessment which included QbTest, thorough questionnaires, input from family member, in person interview and review of childhood school reports. Absolutely none if this was followed during IME.

I need to get this updated as its absolutely appalling that the psychiatrist can throw out a diagnosis, without adhering to best practice. I'm not sure if I can request an update based on GDPR. Ive already sent a letter from ADHD professional.

The company doctor, who reviewed me again AFTER the IME, stated I was not yet fit for work. I will have another review.

Company are aware that im not being paid by insurance. They havent specified any supports they can provide as the appeals process seems to be in my hands only.
 
For clarity, was your diagnosis done by a qualified medical practitioner. ? If it wasn't, and an "appropriate professional" is not a doctor, then it is quite possible the insurance company sees it as worthless. I would if I were in there shoes

I'm not arguing that the insurance doctor was correct BTW, or that he did or did not follow best practice but he is a medical specialist, albeit not an independent one in this case.

GDPR is irrelevant here from what I can see, It's your data.

Company are under no obligation to pay you sick pay, providing what they are doing is in line with their company policies and the law. However, they do have a duty of care to you, regardless of the insurance companies view and the last point sugests they may be falling down in that regard.
 
Peanuts20 said:
For clarity, was your diagnosis done by a qualified medical practitioner. ? If it wasn't, and an "appropriate professional" is not a doctor, then it is quite possible the insurance company sees it as worthless. I would if I were in there shoes
Click to expand...
I tend to agree. I can never get my head around the alphabet soup of qualifications in this space.

A physician is a physician though.
 
@Peanuts20 @Dr Strangelove
Yes the ADHD assessment was performed by a specialist (medical experts). I attended in person for certain medical checks, and I had to take QbTest, fill in paperwork ahead of time, complete the relevant screenings etc They are also prescribing ADHD medication. So all that is perfectly all good.
The diagnoses has never been questioned by the insurance , but it's their own IME report where they undermine both the ADHD report and that I am still experiencing anxiety / depression. It's exgtremely dangerous as they absolutely should not be veering into treatment , but the only inference from the report is that I don't have ADHD and I have resolved anxiety disorder now.. so in that case, I would infer that I no longer need anti-anxiety medication or ADHD medication - I feel the whole scope of the IME has gone far too wide. AT no point, was it EVER explained that they were going to run a neurodivergent assessment .

My immediate concern now is writing up an appeals letter and outline my concernsabout the quality and standard of the IME report.
It's contradicting other medical evidence and diagnoses that followed best practice - if the insurance company rely on this to make a decision andstand over their decision then they are basically ignoring other medical evidence and the fact that I am actually still being treated for anxiety/depression.

Honestly - it seems that they can literally say what they want in the IME without any basis and ignore best practice. I don't know how to navigate this . I'm exhausted and drained and should be focussing on recovery, but this whole situation has dragged me down further.

Any further feedback on what I can potentially call out , how to navigate really appreciated .
 
Sorry to be pedantic but are the specialists who diagnosed you registered specialists in that area on the medical council website. If they are specialists in psychiatry, or clinical psychology then your diagnosis carries a lot of weight. If they are say gp’s with an interest in ADHA then their diagnosis carries less weight. I am not saying your diagnosis is in any way wrong but your company insurance will look at the report from their physiatrist who is a specialist in the area and weigh his opinion more highly.

I would suggest going to your gp. He will probably be able to write a letter saying.

I have been dubdub’s doctor for x years. She has struggled with y symptoms for many years and on the advice and diagnosis of Dr xxx of ADHA etc, I have been treating her with yyy drug and she is making slow protest.

I would recommend a review of dr y findings as it does not align with our consultant dr xxxx and treatment is ongoing. Etc.

And the write a letter yourself saying you disagree with dr y diagnosis because
1) the non diagnosis of ADHA is incorrect because Dr y did not do a full assessment - he did not conduct tests x,y,z as Dr xxxxx, registration number xxxxx did. You could mention the NICE guidelines for best practice (there may be equivalent HSE ones but I don’t know)
2) There were factual errors in the report, list them, and it was not a true reflection of the IMA as you recall.
3) You said that Dr Y conducted a neurodivergent assessment so say, inappropriate testing was conducted as the reason for your ill health currently is ADHA and not neurodivergence as agreed by your GP (the person who gives you your sick certs) and company doctor.

I personally would stray away from any mention of inappropriate comments or the setting for the IME as I think that muddies the complaint, but if you think these are significantly material to your complaint then add the but maybe just limit your complaint to facts and not emotions.
4) Dr y said x,y,z to me during the meeting which I believe were inappropriate.
5) the location in zzzz building for the assessment was inappropriate because my xxxx symptoms require a calm peaceful environment so I could not focus and process the questions during the IME properly.

During the IME did the doctor ask about your specialist and was he furnished with copies of the diagnosis reports to assess as well. If not I think you could complain about that too.

It sounds like you have a good case to make and I would guess on the basis of your complaint you will be sent for a new IME. Perhaps you could insist on an advocate to attend with you to provide you with support.
 
As someone who has gone through this. This is all standard procedure from some Insurance companies. They will try to wear you down do not be surprised. You will also more than likely have to provide yearly reviews etc. I would be interested to know the name of the Insurance company.

Give them the name of all your specialist doctors and tell them to contact them for whatever info. they want. Let them do the footwork and they will probably have to pay for the information. Do not do the footwork for them.
If your company doc says you cannot go back to work, end of story, you cannot go back to work. Ask the question if they are questioning their judgement / experience / diagnosis.

You say "As part of income protection review I was sent for an Independent Medical Exam" ...Who paid for this?
If the Insurance company paid for this it was not an "Independent Medical Exam".

What are the exact qualifications of the Independent Medical Examiner. Should be easy to find. If they are not qualified in the field in question he is not qualified to make any judgement on you.

They do not seem to have any medical grounds to refuse your claim. If the IME cannot even write a competent report you cannot respect his judgement. You say he even got names wrong and zoom call when none took place. Who was he diagnosing?

You will have to appeal but they cannot ignore your medical specialists advice/diagnosis/expertise.
State how that the procedure they are putting through is affecting you. Be blunt. Keep all documentation obviously.

I've to list "Barriers preventing a return to work" - do I just list my symptoms here?............. No, Just say your current diagnosis and advice from medical professionals is you are not fir for work. Let them contact the relevant professionals directly if they want information.
Give them permission to contact your doctors to show you are not hiding anything. Give them their names etc and say they have permission to contact them. Again do not do the footwork for the insurance company.

It's asking for expected return to work date but that's unknown for now........Yes Unknown. Again will be based on medical advice from relevant professionals.

Best of Luck they will not make it easy. But stick with it you will get there in the end.
 
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