Losing Benefits Because Of Facebook

[MA-Caver]

An insurance company investigating the validity of a claim is business.
Facebook is a pleasurable past time on the computer/internet... they BOTH don't belong together.
Besides the photos are inconclusive. Or as someone stated she could've been trying to enjoy herself to get herself OUT of her depression. Therapists will agree that finding a distraction or doing something that you enjoy is a benefit to getting out of depression.
Judging a person solely on photographs is a piss-poor way to determine their mental state.
The insurance company has no claim whatsoever on these grounds.
If she has been clinically diagnosed then she has a valid claim... PERIOD.

Story below:

http://www.cbc.ca/technology/story/2009/11/19/quebec-facebook-sick-leave-benefits.html
Depressed woman loses benefits over Facebook photos

Last Updated: Thursday, November 19, 2009 | 9:45 PM ET


A Quebec woman on long-term sick leave is fighting to have her benefits reinstated after her employer's insurance company cut them, she says, because of photos posted on Facebook.

Nathalie Blanchard, shown here on a beach holiday during her sick leave. (Facebook)
Nathalie Blanchard, 29, has been on leave from her job at IBM in Bromont, Que., for the last year and a half after she was diagnosed with major depression.
The Eastern Townships woman was receiving monthly sick-leave benefits from Manulife, her insurance company, but the payments dried up this fall.
When Blanchard called Manulife, the company said that "I'm available to work, because of Facebook," she told CBC News this week.
She said her insurance agent described several pictures Blanchard posted on the popular social networking site, including ones showing her having a good time at a Chippendales bar show, at her birthday party and on a sun holiday — evidence that she is no longer depressed, Manulife said.
Blanchard said she notified Manulife that she was taking a trip, and she's shocked the company would investigate her in such a manner and interpret her photos that way.
"In the moment I'm happy, but before and after I have the same problems" as before, she said.

 

[punisher73]

I agree with the company. They have paid her for a year and a half for not working.

Many people have depression and still work, she should have tried to work something out with the company before hand before posting pics from the beach, strip clubs etc. I have heard of companies changing job duties, scheduling etc to help work around the issue. I wouldn't pay somebody to not be working and have other people having to pick up the slack or not being able to hire a replacement.

 

[CoryKS]

Protip: set your profile to private and don't friend your employer or their insurance company.

 

[Bob Hubbard]

ProTip: stay off the internet when you don't want someone to know what you're up to, and never tell anyone anything you wouldn't want getting out.

 

[Bruno@MT]

As you know that is my ground rule for internet communication. But this has nothing to do with that. If someone is clinically diagnised with depression, than that is that, and trying to snap out of it is a good idea.

This is just one of the benefits / symptoms of a capitalistic health insurance provider whose bottom line depends on refuting and revoking benefits as much as possible. All hail the mighty dollar.

 

[Bill Mattocks]

This is just one of the benefits / symptoms of a capitalistic health insurance provider whose bottom line depends on refuting and revoking benefits as much as possible. All hail the mighty dollar.

The money has to come from somewhere, whether it is private health insurance (from premiums) or state-funded (taxes).

I do not know where people get the idea that if the government pays for it instead of a private for-profit insurance company, it is somehow 'free'.

If it comes from premiums, I damned well expect my insurance company to do their best to cut down on fraud and excess payouts that drive MY rates up. If it's public insurance paid for by taxes, then I've got even MORE reason to complain about it, because I can't simply quit and take my business elsewhere.

I have no idea if this woman has a legitimate claim or not. I'm no doctor, and I'm certainly no expert. But I surely do think her posted photos online are fair game, and I expect the insurance company to go to great lengths to expose fraud.

This ties into my earlier statements about national insurance schemes. If it's paid for by taxes and you can't quit, then taxpayers have a vested interest and a legal right to demand that others take actions to reduce their claims. That means YOU have to eat right, YOU have to lose weight, and YOU have to stop engaging in physically risky behavior, because WE say so. If we pay the bill, you have to dance to our tune. Same goes for me too, of course.

 

[Ken Morgan]

I have no idea if this woman has a legitimate claim or not. I'm no doctor, and I'm certainly no expert.

But that’s the point isn’t it?

The insurance company, not a doctor came to the decision to end her benefits because in their opinion a clinically depressed person should be inside, with the curtains closed, taking drugs.

In order to get benefits she would have had to be evaluated by doctors, it should be a doctor clearing her for work,

It’s not like she’s claiming a back injury, and then competes in power lifting competitions.

I have no idea if she’s legit of not, but when it comes to mental illness, it should be a doctor making the diagnosis, not an insurance company investigator.

 

[Bill Mattocks]

But that’s the point isn’t it?

The insurance company, not a doctor came to the decision to end her benefits because in their opinion a clinically depressed person should be inside, with the curtains closed, taking drugs.

In order to get benefits she would have had to be evaluated by doctors, it should be a doctor clearing her for work,

It’s not like she’s claiming a back injury, and then competes in power lifting competitions.

I have no idea if she’s legit of not, but when it comes to mental illness, it should be a doctor making the diagnosis, not an insurance company investigator.

I agree that she should have the opportunity to file an appeal and to have a doctor review her condition.

 

[grydth]

In a long career, I have seen quite a lot of insurance fraud - on both sides of the table. Left unchecked, it destroys the core of the system.

I can't access the file in this case, and I don't know the laws on Disability Benefits or Workers Compensation in Quebec.

In New York, the claimant would have a right to an administrative hearing process... and the insurance company could also seek criminal prosecution. These are always ugly cases, and must be resolved individually, on their specific facts and evidence.

 

[LuckyKBoxer]

thats funny... she doesnt seem depressed to me... trips? chippendales? bars? beaches? sharing it on facebook? I would cut her off as well... depression... whatever.... and no i am not a professional, and no i have no compassion for her... she seems likes shes getting on fine to me.. lame

 

[Gordon Nore]

I can't access the file in this case, and I don't know the laws on Disability Benefits or Workers Compensation in Quebec.

In New York, the claimant would have a right to an administrative hearing process... and the insurance company could also seek criminal prosecution. These are always ugly cases, and must be resolved individually, on their specific facts and evidence.

If I read the article correctly, this would be the private insurance policy that comes with her employment. That's separate from Workers' Comp. Our provincial health programs provide for health care, not income maintenance when absent from work.

I think a lot is being made of the facebook aspect of the story. Workers' Compensation and private insurance companies have tracked claimants before -- in this case she handed them evidence that she has to answer to.

 

[dbell]

But that’s the point isn’t it?

The insurance company, not a doctor came to the decision to end her benefits because in their opinion a clinically depressed person should be inside, with the curtains closed, taking drugs.

In order to get benefits she would have had to be evaluated by doctors, it should be a doctor clearing her for work,

It’s not like she’s claiming a back injury, and then competes in power lifting competitions.

I have no idea if she’s legit of not, but when it comes to mental illness, it should be a doctor making the diagnosis, not an insurance company investigator.

Did they actually say she should be inside with the curtains closed, taking drugs, or did they say words to the effect, "in these pictures, spanning several days, and several different events, she is happy, appears to no longer be depressed, and is able to do things similar to what she may be expected to do at work: Walk (she is walking barefoot in heavy, wet sand, so walking at work should be OK). Sit for long times at a desk (she is sitting watching strippers for an extended time). etc? For what it is worth, many insurance company investigative teams actually have MDs on the staff to review these things.

I do think that the insurance companies, be the private or public SHOULD track down people abusing the system.

Now, don't get me wrong, I am not overly happy with our (US) health insurance system, and actually gave up my PA license because of the crap they make you go through to take care of patients, but I do think they probably made a right call on this lady.

And this lady was stupid to post such things on line if she didn't want them to see it!

 

[grydth]

If I read the article correctly, this would be the private insurance policy that comes with her employment. That's separate from Workers' Comp. Our provincial health programs provide for health care, not income maintenance when absent from work.

I think a lot is being made of the facebook aspect of the story. Workers' Compensation and private insurance companies have tracked claimants before -- in this case she handed them evidence that she has to answer to.

Gordon, this is a good example of how systems can differ among states/provinces/countries. In New York, too, the Disability Benefits system is separate from Workers Compensation.... but that agency's judges hear claims from both.

Also, the insurance fraud laws establish both civil and criminal penalties in this state. Criminal charges can and have been made against claimants, doctors, lawyers... and employers, too. There are also severe penalties a judge may impose upon insurance companies.

No matter the jurisdiction, these always come down to factual determinations - - - was this woman trying to recover or was she living it up while pretending? Sometimes doctors see such pictures and realize a patient has lied to them.... and sometimes the doctor will have advised the patient to do more things to get well. I hope somebody tells us the outcome.

 

[Jade Tigress]

thats funny... she doesnt seem depressed to me... trips? chippendales? bars? beaches? sharing it on facebook? I would cut her off as well... depression... whatever.... and no i am not a professional, and no i have no compassion for her... she seems likes shes getting on fine to me.. lame

So, what does depression look like? How many times have family and friends of suicide victims say, "I had no idea they were depressed, they seemed so happy"? Smiling on the outside does not mean everything is ok. The appearance of enjoyment does not mean everything is ok. The occasional enjoyment of activities does not mean there are not other serious issues going on.

As dbell said, what would you have her do? Stay inside all the time taking drugs? Just because you can experience some enjoyment does not mean you are not still clinically depressed.

And as Ken said, it's not like someone claiming a physical injury and then being spotted doing something that injury would prevent. Major/clinical depression is a serious condition and it's up to her doctor to clear her for work.

Unless you've experienced it yourself or are a doctor, do not judge another persons mental condition.

 

[Bill Mattocks]

So, what does depression look like? How many times have family and friends of suicide victims say, "I had no idea they were depressed, they seemed so happy"? Smiling on the outside does not mean everything is ok. The appearance of enjoyment does not mean everything is ok. The occasional enjoyment of activities does not mean there are not other serious issues going on.

As dbell said, what would you have her do? Stay inside all the time taking drugs? Just because you can experience some enjoyment does not mean you are not still clinically depressed.

And as Ken said, it's not like someone claiming a physical injury and then being spotted doing something that injury would prevent. Major/clinical depression is a serious condition and it's up to her doctor to clear her for work.

Unless you've experienced it yourself or are a doctor, do not judge another persons mental condition.

I agree with everything you said about depression. It is real and it is a life-threatening medical condition.

However...IMHO, a diagnosis of 'depression' should not be a 'no more questions ever' condition. In other words, once a person is diagnosed with depression, they are not 'hands off' and it is not forbidden to question it.

Yeah, it's real. But yeah, insurance companies are allowed to question it. Too much fraud.

 

[MA-Caver]

So, what does depression look like? How many times have family and friends of suicide victims say, "I had no idea they were depressed, they seemed so happy"? Smiling on the outside does not mean everything is ok. The appearance of enjoyment does not mean everything is ok. The occasional enjoyment of activities does not mean there are not other serious issues going on.

As dbell said, what would you have her do? Stay inside all the time taking drugs? Just because you can experience some enjoyment does not mean you are not still clinically depressed.

And as Ken said, it's not like someone claiming a physical injury and then being spotted doing something that injury would prevent. Major/clinical depression is a serious condition and it's up to her doctor to clear her for work.

Unless you've experienced it yourself or are a doctor, do not judge another persons mental condition.

I agree with everything you said about depression. It is real and it is a life-threatening medical condition.

However...IMHO, a diagnosis of 'depression' should not be a 'no more questions ever' condition. In other words, once a person is diagnosed with depression, they are not 'hands off' and it is not forbidden to question it.

Yeah, it's real. But yeah, insurance companies are allowed to question it. Too much fraud.

Having been clinically diagnosed at one time with depression myself is why I was so anti-insurance and all that. I was told by my therapist and the folks at the welfare center (I was homeless and unemployed at the time) to NOT work for a year, go to therapy twice a month and was given housing, food stamps, and a small bit of cash each month. As long as I stayed out of trouble (read: jail) I was free to do what I wanted as long as I was working on the "homework" my therapist gave me for my depression.
So I caved, spent time with friends, went camping did lots of stuff...
Here's the kicker... when I got home and was alone again... had time to rest, think, etc. Found out I'm still down and out.
Shortly about 10 months later I recovered and was released from the program. Some folks take longer some not quite as long.
Depression is a complex condition that can hit basically anyone.
And as Pam mentioned it's invisible.
Two years ago I lost a dear close friend to suicide as a result of her depression. Everyone thought she was a happily married woman.

:asian:

 

[Jade Tigress]

I agree with everything you said about depression. It is real and it is a life-threatening medical condition.

However...IMHO, a diagnosis of 'depression' should not be a 'no more questions ever' condition. In other words, once a person is diagnosed with depression, they are not 'hands off' and it is not forbidden to question it.

Yeah, it's real. But yeah, insurance companies are allowed to question it. Too much fraud.

This is very true. It should not be a hands off condition. It needs to monitored closely and once it's developed it is very often a life long condition. For those who have gone on anti-depressants there is a 90% relapse rate if they are stopped.

Insurance companies may question, but it is ultimately up to the doctor to diagnose. There is definitely a lot of fraud out there so I can understand that insurance companies need to investigate, and I support outing the frauds. However, in this instance, for them to deny benefits based solely on pics found on Facebook, does not support that she is faking depresssion. She may be, I don't know, it's not for me to say. That's up to her physician.

 

[Carol]

Most STD/LTD insurance plans in the U.S. limit mental health claims to a maximum of 24 months, regardless of the health of the patient once the 24 months expire.

What isn't known is the details of this lady's disability leave policy. I don't know about Canada but I know in the U.S., STD/LTD leave claims are never as simple as "We'll pay you X% when the doctor says you can't work and will keep paying until the doctor says you are clear." There are always procedures that have to be met both at the time of filing and throughout the claim. I have someone that is out long-term undergoing breast cancer treatment, and she's been complaining about how she has to be "interviewed" every week with a caseworker RN and say yeah she's still getting chemo and yeah it sucks. I feel for her but I don't have any sway over how our disability insurance carrier conducts their business.

To deny benefits based strictly on Facebook photos seems a bit ridiculous. However, if she was interviewed on a Thursday and said "I'm so depressed and I can't even leave my house, but her FB page shows that on Thursday she not only left her house but was had gone on vacation and running around the beach, then I can understand why the insurance company would have reason to pull her benefits.

 

[Stac3y]

Insurance companies may question, but it is ultimately up to the doctor to diagnose. There is definitely a lot of fraud out there so I can understand that insurance companies need to investigate, and I support outing the frauds. However, in this instance, for them to deny benefits based solely on pics found on Facebook, does not support that she is faking depresssion. She may be, I don't know, it's not for me to say. That's up to her physician.

Unfortunately, insurance companies have a LOT of control over doctors. Just sayin'

 

[Jade Tigress]

Unfortunately, insurance companies have a LOT of control over doctors. Just sayin'

Insurance companies cannot diagnose. They may have alot of control over doctors, but they cannot diagnose an illness. The doctor diagnoses it.