Self Funded Insurance Plans

What is the name of your state?What is the name of your state?MICH

I am currently on short-term disability. It begins 31 days after I'm "disabled." This procedure is to go to a "disability determination committee" and get approval/disapproval. (It could be the president of the company saying no or yes, for all I know.) People always like to blame committees.

I had surgery in October. I was able to return to work for a few weeks and then I was transferred to a job that was 100% data entry. I did it for a week (proved I could learn it) and had to tell them I could not continue. My sight is not good (from surgery in Oct) and I couldn't handle all day computer work. They told me to get a letter from my doc saying "(I) am disabled from doing my job." They did not need to know anything else. I talked to my doc and he said "the insurance co will want to know if this is correctible." He said he could "correct" it. I've already had 2 surgeries on that eye and don't want any more.

In essence, my HR dept was asking this dr to incriminate himself saying essentially he had disabled me doing surgery. I told HR he may not do it. I asked if another dr could vouch for me. She said no, he was the dr of record. It took 9 days for my dr to get back to me. I called the office 4 times, took papers (with full explanation) to his office and it took him 9 days to respond. He acted like he didn't know what he was doing. Asked me if he should say temporary or permanent. I have this paper to HR now, but wonder if they can INSIST this one doctor write my disability. He does not like to admit the surgery didn't go well. I checked with an attorney about sending the doc a letter, but atty said "is self-funded and they can do what they want." Well, the doc faxed the letter without any attorney interference.

Now, I don't know how long I will be on this disability. STD is 6 months and if I'm able to go back to work within this time, or at the end of it, I must work for 6 months or pay back my STD.

I'm not sure about the self-funded stuff. Can they make up their own rules? I also imagine I'm protected under the ADA because of my visual difficulties. I am seeking solutions other than more surgery to see if I'm able to go back to work. I'm only about a year from retirement. Can you offer advice on this self-funded thing and them insisting only this one dr can say I'm disabled. I say that is like asking a dr to say he committed malpractice and put it in writing. I could be half-dead and if a dr didn't want to write the letter, how could I make him/her? Thank you.

Can they make up their own rules? To the extent that this appears to be a salary continuation plan (and not any type of insurance benefit), yes, as long as they don't engage in any discriminatory practices that are unlawful.

I also imagine I'm protected under the ADA because of my visual difficulties. It all depends on how severe your vision problems are and whether they "sigificantly impair a major life function."

Can you offer advice on this self-funded thing and them insisting only this one dr can say I'm disabled. He is your treating physician. Your employer has every right to insist that he provide a statement regarding your current medical condition.

I say that is like asking a dr to say he committed malpractice and put it in writing. Huh? Who else besides a licensed physician can make a valid determination regarding a patient's medical status???

I could be half-dead and if a dr didn't want to write the letter, how could I make him/her? You can't. You consult with another physician and if you believe the first physician treated you improperly, you report him to your State's physician licensing agency.

The only thing goofy I see going on is that your employer is not using an outside disability benefits administrator to make a decision on whether an employee's medical condition is such that disability benefits (i.e. the apparent salary continuation plan) should be paid. Making that decision internally is foolish because this can be very complicated stuff but it's not illegal.

Thank you

Thanks for your response. My remark about my physician was because he was waffling, basically ignoring me. It took 9 days for him to return my phone call. I called his office 4 times, took papers out once. He is the one who did surgery on my eye this time and prior to that, both eyes.

By saying "(I)am disabled because of my eyes" is like him admitting he disabled me during surgery. Since my employer demands that from him, the treating physician, what would happen if he refused? I can see this happening if not to me, then someone else. It seems that if I had a couple of different doctors giving their opinions, just one doc's word might not mean the whole ball of wax. For example, say I started malpractice on my eye surgeon.........(have not and don't plan to) why would he co-operate and write me up as disabled? He probably wouldn't.

Thanks. Now, I might let them know I've just been diagnosed with carpal tunnel. This has happened within the past few days. I thought since I'm off because of my eye problem, it's a good time to check and see if the carpal tunnel needs fixing. That would put another "disability" piggy-backing on the other one.

By saying "(I)am disabled because of my eyes" is like him admitting he disabled me during surgery. That's your opinion but that's not a qualified medical opinion. If you believe the doctor committed malpractice, consult with another doctor and then see a personal injury attorney if indeed he botched your surgery.

Since my employer demands that from him, the treating physician, what would happen if he refused? Your disability benefits could and proabably would be denied.

It seems that if I had a couple of different doctors giving their opinions, just one doc's word might not mean the whole ball of wax. Okay, but then what does your employer do if they have one doctor's statement saying you're too disabled to work and another who says you're not? (This is why it's dumb for employers to make these decisions rather than retaining a qualified third party administrator to do so.)

For example, say I started malpractice on my eye surgeon.........(have not and don't plan to) why would he co-operate and write me up as disabled? He probably wouldn't. Given the amount of time it takes to initiate legal action, I expect you would be well established with another doctor by that time. I certainly wouldn't continue to see a doctor I thought was incompetent or negligent.