The following is excerpted from a second, unsolicited letter sent to the insurance company after the patient's claim was turned down.
Dear Claims Specialist:
Re: Ms.-
Your claim no-
I am writing to elaborate on the circumstances of Ms.-'s recent disability. I was surprised to hear that her claim was denied. The major points of contention appear to be that she did not see a psychiatrist, was not placed on psychiatric medication and was not seen by a medical practitioner for ongoing counselling and review. The rationale would seem to be that she did not manifest the typical medical model of illness. Therefore she could not really be sick, and therefore could not really be disabled.
Ms.- did seek counselling, but it was from friends and family. She managed to put the needs of her family foremost, and held herself together long enough to get to-, bury her husband, comfort her children and come back home. This did not happen without tears, confusion and sleeplessness. It was not an easy process. She continues to do the emotional work required to process these events. I fail to see how she can provide her own clients with the comfort and guidance required in her own work when she herself is tearful, afraid and confused. Surely the issue here is disability, not illness behaviour. I feel strongly that Ms.- is unable at this time to meet the demands of her job. I also feel that she has appropriately employed medical and nonmedical help as required. With every due respect for the complex task you do, I believe a review of the decision would best serve all involved in this case.
Thank you for your consideration. Please write or call if I can clarify any points or issues. Figure 1
Sincerely,
R Springate
Russell Springate, MD, CCFP
The patient returned to work in due course. No disability payments were awarded.
Russell Springate is a family physician in Toronto.