Insurance Question

[Alastair]

Well it seems to me that the only thing to do now is to put in an NHS claim, that resolves matters immediately -- -- -- legally you are sick and cannot work. That's it! Oh by the way, your NHS sickness benefit is tax-free

It'll be your next financial year before you get your tax rebate from the revenue, so don't get excited -- -- -- lol

It sounds as if your GP is on your side so just get her to sign your off sick and that resolves the problem. I would think that Mr L. would be the ideal person has he seen you so recently and given you a physical examination as well.

Gosh don't you live a complicated life!
Best,
Alastair

I'm going to check on that tax point 'cos when I came back to England after 6 months working in Ireland our accounts dept agreed with the tax man that I'd pay no tax at first and then a reduced rate for a few months after before I went back up to normal. It might be different this way round but you've got to leave me one thing to look forward to Alastair!

My next sick note runs out on 6th Dec and the discogram's on the 7th so that really won't be a problem. I'll definitely make sure Mr L's report(s) are sent on to the ins co but I'm thinking of it as being like litigation where you need an agreed independent expert or else neither side'll ever be happy & they'll bicker 'til the cows come home - as I said to my boss, she needs to 'Woolf' them.

Yeah good thing I don't have a social life to complicate matters still further. lol

[Alastair]

Hi Gillian,
You wrote

I thought it'd be dealt with pretty quickly so I didn't see any point applying for incapacity benefit

Now you say your sick note certificate runs out 6th Dec but say here you didn`t apply as you thought it would be settled quickly(You did say Incapacity benefit which is something different)

You have me confused -- - If you have a "Sick note (NHS) from your Dr then the insurance Co are asking you to break the law by working.

Sorry you have lost me on this one

Now I'm confused too - confusing myself that's a good one! My SSP ran out ages ago and I'm not currently on benefits so I don't think it would be breaking the law to go back before the sick note runs out because at the moment the sick notes are just a private matter between me and my employers. Once I apply for benefits it will be a different matter but I would have thought that if I wanted to go back before the end of a sick note whilst on benefits it wouldn't break the law provided that I notified the DWP that I was going back to give them a chance to stop the benefits - that could happen if e.g. I healed faster from surgery than my GP expected or conservative treatment suddenly started working. At the moment my notes are 4 to 8 weeks at a time to make sure my GP and I meet regularly to discuss progress with the consultants anyway so that's unlikely to be an issue. The ins co are saying I shouldn't be getting sick notes at all I think. Technically the ins co can't force me to go back to work - they can only refuse to pay me whilst I am off work. Sounds like the same thing in practice but I suppose in their eyes it's different.

[Alastair]

Ah!!! I understand now we are both thinking "Sick notes " are SSP I get where you are coming from.

As far as I know you are right, the insurance Co cannot make you go back if you GP says you are ill and should refain from work. If they stop your benefit(The insurance Co) they could be in breach of contract. I haven` t sight of that but in your job you should be able to sort that out.

How long have you been off sick in total??

I have just looked at the first few postings,I see your insurers say you don`t need surgery (cheeky folk) so why would Mr L be offering you MAJOR SPINE surgery if it was not required??? He wouldn`t!!!! And you are not having it "For Fun"
Take care
Best
Alastair

Glad we're back on the same page

My boss has (finally) confirmed they're going to follow the procedures in the policy to the letter and go on to the ombudsman if necessary because they know the ins co's decision is wrong but in the meantime I get nowt.

13 months now. I'd been off 2 weeks when I had an epidural last Oct and as I said to Mr Lam I'm fairly sure I would have made it back to work like I always had done in the past if it hadn't been for that epidural. I don't think my back's ever settled back down from the flare up it caused.

Yeah and it's not just Mr Lam. He's the 2nd surgeon to offer it but the ins co physio said that the first surgeon only offered me it to shut me up (although my GP can confirm that when I talked about the discogram results with her before my follow up appointment with the surgeon I said that I wasn't sure whether the results meant conservative treatment was the only route or not. I really didn't know what he was going to say). If I want surgery for kicks then the ins co should be saying I need psychiatric help!

[Alastair]

Hey that sounds pretty grim not getting any payment!!

I guess that's got to come in the fullness of time?


Who is the insurance company? I'm guessing it's Norwich union -- -- -- they never liked to pay out money but liked the premiums

You've had a rough old-time over the last 13 months -- -- -- let's hope you get your surgery fixed soon, and then you have to think of a six-week recovery period minimum.

Don't rush it, it is never worth it
Cheers,
Alastair

Yeah that's one thing I should get advice on. I wondered whether the fact that my employers accept that I can't work combined with the DDA requirement to make reasonable adjustments (which includes a duty to consider paying someone who is absent for a disability related reason regardless of what their contract says) might mean that they should pay me and then claim it back. After all, the insurance is in their name not mine - it's for their benefit. Mind you at the moment I've got too many medical appointments which then take it out of me on the next day too (had a new MRI today but tomorrow I can relax in my parents' new spa - lovely if I don't sit with my lower back in front of the jets! ) so it's hard to arrange a time to get advice.

No it's Legal & General. They're probably all as bad as eachother. It's funny though. I was sorting some paperwork out the other week and came across a letter from More Than. I'd claimed on my cat's insurance - full blood work up on only the vet's word that his frequent stomach upsets made it a good idea - and they sent me a lovely letter with the cheque saying that they hope he feels better soon etc. Not to mention the fact that they processed the claim and sent the cheque out in under a week. Oh to be a cat.

It's not been fun. It's hard to stay positive but I am positive about the work I've been doing down the gym and with my pilates. I just wish that the ins co could understand that putting me through this just makes everything so much harder. Don't worry I won't rush any recovery period - I don't want to risk the surgery failing because I've just been damned stupid.

Thanks for all your continuing support & advice. It means a lot.

[sahuaro]

Gillian:
Now that I understand your situation better, it is hard to believe that the insurance contract only covers you if working causes further harm. How can you work as a lawyer (i.e., think clearly) if you are in pain and/or on meds??? Also, as a lawyer you don't need me to stick my 2 cents in but--don't accept the insurance company's choice of doctor as the "independent" medical examiner in lieu of a mutually-agreed-upon doctor. In the US, you are allowed to bring an observer to such an exam and even videotape it--you can bring anyone including another doctor, nurse, etc. Hope this helps.

Hi Sahuaro
Yeah it seems pretty odd to me too - there are so many conditions where working wouldn't cause further harm but where the employee's still unfit to work. I said the same thing about thinking clearly - I often suffer from 'brain fog' when I'm exahusted by the pain. One of my consultants said he thought there was a complete failure to understand the nature of chronic pain in the medical profession and particularly in insurance cases - can't argue with him there!

You don't need to worry on that score! If they won't agree on a mutually instructed doctor they can get their report and my employers can get their report, we can add mine in and bake a cake - or use them in front of the ombudsman which is probably more likely. Funnily enough I dug out the letter from the co which carried out the initial physio exam yesterday and it specifically said that no-one else was allowed to come in with me. It may sound paranoid to the examiner but I agree it might be sensible to tape the interview given the fact that there is an element of 'she said, she said' over the first exam. She didn't even note my report of my symptoms down correctly & when she was told it was wrong she just said that the words 'the patient reported' mean that that is what I said and she couldn't have taken info down wrong. Hmmmm