Created By: Beaudette, Donald
Created Date: 04/21/2014
Note: it was never communicated to you at the time of re-open liability acceptance in 2007 that benefits due to behavioral health conditions (depression/anxiety) are limited by your policy to 24 months of benefit payments. Physical impairment can run concurrently, which in your case it has, and such benefits are only limited by the maximum duration of your policy, which is age 65.
Physically, it appears you have had years of tx for physical conditions, most notable for pain — fibro, TMJ, neuropathy, etc., which has not been successful…
[Define “success” in treating intractable pain? I’m still here, aren’t I?]
Advise insured that dependent on responses above—not sure what our next steps will be given no current providers. Policy does require being in reg and appropriate care… though that needs to be medically determined and give your length of tx w/no results, its not clear to me if such would be applicable.
Also–possible we could send you for an IME–that too would have to be determined by our medical staff.
Based on last medical info received and/or the past medical info and reviews, medical comment is needed in order to determine the necessity for updated APS form and/or to clarify what regular and appropriate care would be for the insured based on her dx’s and cx’s, and what medical benefits would be anticipated from such if the insured were to pursue new/additional treatment.
I don’t find an answer to these questions in the copy of my file.