Do I Have To See My Doctor In Person During COVID-19?
Most individual disability insurance policies have care provisions, which typically require that a claimant be under the care of a treating provider in order to be eligible for benefits. The COVID-19 pandemic has made complying with certain care requirements—created in a pre-COVID world—more difficult.
What Are “Care Requirements”?
In addition to other proof of loss requirements, disability policies contain care requirements that state specific conditions that must be met in order to qualify for ongoing disability benefits. An example provision, taken from an actual policy, is below:
REGULAR CARE BY A DOCTOR – means:
- You are evaluated in person by a Doctor; and
- You receive treatment appropriate for the condition causing Your Disability; and
- Your evaluations and treatment are provided by a Doctor whose specialty is appropriate for the condition causing your Disability; and
- The evaluations and treatment must be at a frequency intended to return You to Full Time Work; and
- You must pursue reasonable treatment options or recommendations to achieve maximum medical improvement.
In-Person Requirements and COVID-19
As you can see, the first requirement listed in this care provision is a requirement to not only treat with a doctor, but see the doctor “in person.” These requirements have been problematic during the course of the COVID-19 pandemic, because many individuals have either had to forego appointments with their doctors, or utilize telehealth appointments, especially at the height of the pandemic.
When the risk of contracting COVID was high and before vaccines were available, it was easier to argue that seeing a doctor in person was too dangerous or impossible (e.g. if the doctor was seeing in-person patients on an emergency-only basis). However, as things begin to open up more and more, insurance companies will likely begin to push harder to ensure that care requirements are being followed. At the same time, some providers—such as mental health providers—may not be returning to in-person treatment as quickly as other medical professionals.
Whether or not it is reasonable for an insurer to enforce an in-person care requirement depends on your particular circumstances and the terms of your particular policy. If you are considering filing a claim, or have filed a claim, and have questions about in-person care requirements, please feel free to contact one of our attorneys directly.
