mdfreed@ziebmef.uucp (Mark Freedman) (07/09/89)
(July 6, 1989)
The following article describes my experiences with The Paul Revere
Life Insurance Company in regard to a long term disability (LTD) policy
which I purchased in 1981.
I apologize for the length of the article and for its tone, which
often resembles that of a badly-written soap opera. I don't particularly
need a mailbox full of flames right now, so I'd appreciate a bit of
tolerance if this is inappropriate for this newsgroup.
I believe that my experience may be of interest to anyone who currently
believes that they are covered by long term disability insurance, or anyone
considering the purchase of such a policy. I am also interested in hearing
from others who have had good or bad experience with LTD insurance.
To summarize, I became unable to work in October of 1987. Paul Revere
paid benefits from January 1, 1988 until October 16, 1988 (10 1/2 months).
On November 27, 1988, I was informed that benefits had been terminated as of
October 16, 1988. I spent the next five months trying to pry an explanation
from Paul Revere and, with the help of my doctor, to have benefits reinstated.
I wrote to Paul Revere on May 10, 1989, stating that I saw no reason to
continue to pay premiums to a a company which refused to act in good faith,
for a policy which provided so little protection in case of illness.
Paul Revere replied by cancelling the policy as of May 22, 1989.
I doubt that my experience with Paul Revere is unique, or that another
insurance company would have acted differently. The Paul Revere policy is
significantly more expensive than the other policies which I considered.
I had hoped that the high premiums would purchase better protection.
A detailed description follows.
================== the policy ====================
I purchased long term disability insurance from The Paul Revere
Life Insurance Company in 1981, when I became an independant consultant.
At the time, my insurance agent pointed out that the LAST thing one needs
when ill is to be worrying about financial security, or to be fighting
with an uncooperative insurance company.
The policy appears to provide exceptional coverage. It is
job-specific (see below), benefits continue to age 65, there is a
cost-of-living-allowance rider, etc.
Relevant paragraphs include:
"Total Disability" means that as a result of such injury or
sickness the insured is unable to perform the duties of his
regular occupation and is not engaged in any other gainful
occupation.
N.B. the reference to "the duties of his regular occupation". Many
of the less-expensive policies require TOTAL disability, i.e.
being unable to perform ANY type of work.
B. Total Disability - Sickness. If such sickness results in
continuous total disability while this policy is in force and
requires the regular and personal attendance of a licensed
physician, the Company will pay periodically the Monthly
Indemnity for Total Disability from Sickness at the rate set
forth in the Policy Schedule, beginning with the stated commencement
date for sickness and during the continuance of such total disability
for a period not exceeding the Maximum Benefit Period ......
N.B. The Maximum Benefit Period is "To age 65". To me, this paragraph
implies that benefits will be paid while the policy is in force and
the beneficiary is under the care of a licensed physician. I see no
mention of a one-year limit on benefit payments.
============ my disability =============
At the end of October, 1987, I had to stop working. This was due
to a combination of physical and emotional problems (chronic pain from
botched dental work, eye problems, exhaustion, a sense of hopelessness
due in part to my physical problems).
I had been at the client's site for about a year, but was having
increasing difficulty functioning. The work environment on this project
probably contributed to my distress. I eventually had to inform the
project manager that I could no longer do the work (system design,
documentation, prototyping, and development).
In addition to the specialized skillset required to perform the tasks
listed, and the ability to concentrate and keep track of many details,
consulting work requires a positive attitude, confidence, and the ability
to market oneself and one's ideas.
I had been seeing a GP who specializes in psychotherapy for about six
months prior to this. When I stopped work, he referred me to a non-OHIP
therapist for concurrent therapy.
I had hoped to return to work after several weeks of rest. Since I
could not return to the project, I defined "return to work" as when I
began actively seeking a new contract.
In January, I realized that I could not continue seeing the non-OHIP
therapist while relying on my savings. I discussed the situation with my
doctor, and he suggested that I utilize my LTD policy. I obtained the
necessary forms, which he completed and submitted to Paul Revere. Paul
Revere sent a field representative to interview me.
In April, 1988 I received a benefit cheque retroactive to January
1, 1988. I then received a cheque and a progress report form at intervals
of roughly one month (the actual period varied, seeming to grow longer
each time). I completed my portion of the form, and gave it to my doctor
to complete and submit to Paul Revere.
In June, 1988, I received notification from Rapid-Med Plus, a "loss
control" company retained by Paul Revere, stating that they had retained
a psychiatrist on behalf of Paul Rever to prepare an "independant
assessment" of my condition.
This psychiatrist did not ask about the nature of my work, or how my
disability prevented me from adequately performing it. He spent most
of the forty-five minute interview asking about my girlfriend (at that
time); whether she was Jewish, whether we planned to get married, whether
we were having sexual relations, whether I enjoyed these. Since he wore
a skullcap, I assume that he is Jewish, and is actively observing Jewish
traditions.
I found the focus of the interview to be distressing and inappropriate
and wrote to the College of Physicians and Surgeons on July 15, 1988,
requesting clarification of the purpose of this focus. Specifically, I
asked how the psychiatrist could determine my ability to do my work when
he hadn't determined the nature of this work, and I asked why he had
seemed exclusively concerned with my relationship. I have considered
writing to the Human Rights Commission as well, since the psychiatrist's
apparent bias could be construed as racism.
In July, 1988, I learned that my mother (71 years old) had cancer. My
father (86 years old) had been ailing and depressed for some time and
could not be left alone while my mother was in hospital for surgery. I
went to Montreal (where my parents live) to help my brother manage the
situation (we both live in Ontario now). We arranged for a part-time
homemaker to stay with my father, and one of us stayed in Montreal until
my Mother returned home.
My mother recovered from her surgery and was prescribed a series of
monthly chemotherapy treatments.
When I returned to Toronto, the relationship which had so concerned
the psychiatrist deteriorated rapidly (it would have failed anyway, but
the stress of my parents' illness and my trip to Montreal accelerated
the process).
I received a reply from the College of Physicians and Surgeons in
October, 1988. Included was an extremely defensive six-page letter from
the psychiatrist.
The first five pages list his academic and professional achievements, and
include statements such as "there is no validity whatsoever to Mr. Freedman's
implied complaints" and "it really is not appropriate for any patient to be
trying to tell a professional how to do their job".
He also states "when a child of Jewish parents becomes involved in a
relationship with someone non-Jewish, there is considerable emotional
turmoil".
Oddly enough, he did not bother to investigate other possible sources of
"considerable emotional turmoil". My mother is a survivor of The Holocaust,
my childhood was less-than-wonderful, etc. Obviously, a "professional"
realizes that the only significant source of stress in a Jewish child's
life is a relationship with someone non-Jewish.
In the last paragraph of his letter, he states "There is one more thing
that at this time you should be aware of. This is not the first time that
Mr. Freedman has complained about professional treatment. He has previously
complained about dental treatment".
I find it interesting that he considers a complaint about a dentist
which I filed in 1985 to be relevant to my queries about a psychiatric
interview which took place in 1988.
Nowhere in his letter does he bother to explain how he can determine
whether I'm able to perform the duties of my job without having asked
what these duties are. Since I asked only two questions, I find it odd
that he chose to ignore one of them.
I had not heard from Paul Revere concerning the psychiatrist's report,
and I was under considerable stress from other sources, so I chose not to
pursue the matter at the time.
(in April, 1989, I learned from Paul Revere that this psychiatrist
had predicted my return to work in October 1988, based on this interview.
More about this later.)
The last benefit cheque which I received covers the period ending
October 16, 1988. As always, I gave the progress report form to my doctor,
and he completed it and sent it to Paul Revere.
Neither I nor my doctor heard from Paul Revere until November 27,
1988 (this date was provided by Paul Revere ... I remember only that
it was near the beginning of December).
(Paul Revere claims that they tried to contact me before this date. I
was usually at home, I have an answering machine which is always on (I
use the machine to screen calls when I don't want to be disturbed), and
there was no mail strike of which I'm aware).
I was contacted by telephone by the field representative, and informed
that my benefit payments had been terminated as of October 16.
I explained that I was still seeing my doctor every week, and that I
was still unable to perform the principal duties of my work.
The field representative came to see see me the next day (according to
Paul Revere, November 28).
He mentioned the "independant assessment", and I explained why I believed
that the psychiatrist retained on behalf of Paul Revere had not been thorough
and impartial. I also explained that I had written to the College of
Physicians and Surgeons for clarification.
The field representative then stated that Paul Revere automatically
terminated benefits after one year, and that it was my responsibility to
prove that I was still unable to perform my work.
We agreed that my doctor would write to Paul Revere describing my current
condition and, once Paul Revere explained what information was required, he
would arrange for the necessary consultations.
My doctor wrote to Paul Revere the following week (early December).
Neither I nor my doctor heard from Paul Revere until I received a
letter dated January 10, 1989, stating "You indicated to Mr. Bowler that
you might be forwarding a further report from your attending physician.
Since we have not received what you report, we are now closing your claim".
I telephoned Paul Revere. They confirmed that they had not received
the letter from my doctor. I reiterated my doctor's intention to arrange
for consultations with his colleagues once Paul Revere had explained what
was required.
I then spoke with my doctor, and he wrote to Paul Revere again, describing
my condition and stating "if further information is required, please contact
me for its provision".
At this time, I had begun to feel more positive. My father's health had
improved significantly (he had stopped taking nearly all of his prescribed
drugs). My mother had completed five of the six prescribed chemotherapy
treatments. I had seen a dentist who specializes in TMJ problems, and was
planning a course of action intended to relieve my chronic pain. I expected
Paul Revere to explain their requirements to my doctor so that he could
arrange for the appropriate information to be provided. Once again, I
could see the possibility of returning to work within a few months.
Neither I nor my doctor heard from Paul Revere.
I wrote to the Superintendant of Insurance of Ontario on January 31,
1989, describing the situation.
I spoke to a Consumer Service Officer on February 16, 1989. She
explained that:
Paul Revere was not legally obligated to contact me before
suspending my benefit payments.
Paul Revere did receive Dr. Gabel's letter of January 13, 1989,
but had ignored it.
Paul Revere is not legally obligated to respond to a letter from my
doctor, to explain their reason for terminating benefit payments, or to
explain what information they require to resume these payments.
The Consumer Service Officer mentioned the report prepared by the
psychiatrist on behalf of Paul Revere.
I had expressed to the field representative my concerns about the
impartiality and thoroughness of this "independant assessment",
particularly considering the traumatic effects of my parents' health
problems. He had indicated that it was not the major factor in the
decision to terminate benefits. Note that this report was not mentioned
in the letter of January 10, 1989.
In March, 1989, I received a letter dated February 28, 1989
from the Superintendant of Insurance which summarized Paul Revere's
position.
I photocopied all relevant documentation and sent it to the consumer
help column of a local newspaper (Star Probe). To my surprise, I learned
that they would not touch the case since I had already consulted with the
Superintendant of Insurance.
I also spoke with a lawyer, as suggested by the Consumer Service Officer.
In his opinion, my only recourse was to obtain an assessment from an
impartial psychiatrist, and to sue Paul Revere for breach-of-contract.
He expressed the opinion that this sort of lawsuit would be tied up in
court for years, that it would be extremely expensive, and that I would
probably lose, since Paul Revere has the resources tie up the case until
I exhausted my savings.
On March 7, 1989 I wrote to Mr. Bruce Garand, the Senior Vice President
and General Manager for Canada of Paul Revere, describing the sequence of
events, and asking, once again, for clarification.
On March 16, 1989 I saw a psychiatrist paid by OHIP (rather than Paul
Revere). He refused to get involved in a dispute with an insurance company.
He also stated that he would not consider preparing an assessment until he
had seen me at least four times over a period of several months, and that
this assessment would not reflect my ability to perform the duties of my work.
I received a letter from Mr. Garand dated March 16, 1989, in which
he states that "based on the opinions expressed by the independant
psychiatrist and a consulting psychiatrist who reviewed the medical
information on file, it did not appear that further benefits were
warranted".
It is interesting that a psychiatrist paid by OHIP refused to assess my
ability to do my work, and refused to prepare ANY sort of assessment until
he had seen me at least four times over a period of several months, while
the psychiatrist paid by Paul Revere to prepare an "independant assessment"
was able to predict my recovery in October based on a 45-minute interview
in June, during which his chief concern was my relationship with a non-Jewish
girl. I find it incredible that the "consulting" psychiatrist, also paid by
Paul Revere is able to prepare an assessment without ever speaking with me.
Obviously, Paul Revere's psychiatrists are more talented than those
paid by OHIP.
Mr. Garand states that Paul Revere received the letter from my doctor
dated January 13, 1989, reviewed it, and closed the file. In fact, the
letter from Paul Revere dated January 10, 1989 states that my file was
closed since the letter from my doctor had not been received.
Mr. Garand also states "We did, as you point out, pay disability
benefits for approximately one year". January 1 through October 16 is not
one year, nor have I found the clause in my insurance policy which limits
benefit payments to a one-year period. I did consider cheaper LTD policies
which limited benefit payments to a five-year period, but chose the more
costly policy from Paul Revere.
Finally, Mr Garand states "our claims manager did attempt to call Dr.
xxxx (my doctor) on many occasions". Apparently, Paul Revere needs to
implement a program to train its staff in the use of the telephone.
Paul Revere sent a letter of apology and a copy of Mr. Garand's letter
to my doctor at this time.
I received a letter from The College of Physicians and Surgeons dated
April 25, 1989 which states that my original inquiry will be processed towards
the end of May. I wrote, expressing my confusion in light of the apparent
differences between psychiatrists paid by Paul Revere and those paid by
OHIP. I am awaiting a response.
At the end of April, 1989, my doctor expressed the opinion that the
ongoing dispute with Paul Revere had become a significant factor in delaying
my recovery.
I wrote to Paul Revere on May 10, 1989, stating I saw no reason
to continue to pay premiums to a company which refused to act in good
faith, for a policy which appeared to offer so little protection.
Paul Revere replied by cancelling my policy as of May 22, 1989.