An Okotoks doctor facing her own medical emergency said her life is being unraveled because she can’t work and her insurance is refusing her disability claim.
Now, Stephanie Hart, an Okotoks physician and mother, said her family is facing the prospect of losing their house, cars and bankruptcy as she fights with RBC Life Insurance Company to try to get her disability insurance payments.
A year ago Hart was working as a family physician at an Okotoks doctor’s office and delivering babies at the High River Hospital when an old, serious knee injury flared up.
“It all started when I broke my leg 12 years ago,” Hart said. “I fell off a horse and smashed my knee.”
She underwent surgery, but was told it wasn’t fixed and would eventually become a problem again.
“A year ago it started getting a whole lot worse,” Hart said. “It was April of last year. I went to bed and the next morning I just woke up in a whole lot of pain.”
Hart stopped working at the hospital and cut back her work as a family physician to two days a week, but said by the end of the day her foot was so swollen she couldn’t get her boot on and her leg was red from the knee down.
“It was still too much,” Hart said. “I’d work four to five hours and it would take me three to four days to get over it.”
After a day at work, she’d have to take painkillers and go straight to bed. Last October, she decided to stop working by the end of the year.
She was already receiving partial disability and assumed her insurer would pay her full disability. However, in mid December she was informed her insurance would not pay her if she isn’t working at least part-time.
Hart appealed and was denied.
She said at the end of February an appeals agent told her they had put her under surveillance for two weeks in January. In that time they saw Hart grocery shop twice and told her as a result they felt she could work part-time.
“I spent $100 each time and was shopping for about a half hour,” she said. “I sat an hour in my car before I went in and an hour after I got the groceries. Then I drove home and sat in my car for another half an hour before I could bring myself to bring the groceries in.”
Hart said her physicians license is on hold by the college of physicians and surgeons while she is not working and when she contacted them to see if she could have it reinstated to work part-time in an effort to get back partial disability payments.
She was told they could not while she was taking pain killers and not sleeping regularly due to the pain. Hart said she usually only gets three to four hours of sleep a night
“It’s a cognitive issue,” she said. “I fall asleep in the middle of conversations, in the middle of meals. It’s a problem.”
Hart said she won’t know until this summer if she can have surgery that could allow her to return to family practice.
Two surgeons told her they may not be able to repair the damage to her knee.
In July, she will go under the knife so surgeons can see if they can do a knee replacement or will have to fuse the knee, in which case her career will likely be over.
In the meantime, Hart has filed another appeal. She said RBC has her X-rays and sonograms, reports from her surgeons and psychologist to review as well as a letter from the College of Physicians and Surgeons.
Hart said it wasn’t until recently, when she threatened legal action and going to the media that RBC Insurance started responding quickly to her emails and offered her some money. RBC Insurance agreed to pay her two months full-time disability payments, while they review her second appeal, she said, but she is still waiting for the payment.
“She said they are not admitting any wrongdoing, they are just doing it to be nice basically,” Hart said, adding until she sees that payment, she is unable to pay her mortgage and car payment.
In an email response to the Western Wheel RBC wrote, “While we cannot publicly discuss the details of any case due to client confidentiality, we do our best to understand each client’s unique situation to ensure we’re working with them through the claims process.”
“Every case is different, and some can take longer to review if we don’t have all of the information needed on the claim.
“In some situations where cases are taking longer than expected and we have received new information that could help support the claim for our client, we may issue an interim payment while the review is being completed.
“We understand that this can be difficult for some clients, that’s why we ensure that clients understand what is happening with their claim through each step of the process.”
Through the years as a doctor, Hart said she has seen insurance claims of her patients unfairly denied and has also been surprised to see some cases, she considered flimsy, approved.
However, she never imagined she would find herself in these circumstances.
“I’ve never seen anyone turned down where the evidence is so clear,” she said.
Hart bought the disability insurance through RBC in her last year of medical school 12 years ago. An insurance broker came to her school and she estimates at least 80 per cent of her classmates also bought the disability insurance.
Most doctors work for themselves and don’t have medical benefits so they need to have private insurance, Hart said. It costs her $400 per month.
“I thought I’d done the right thing and I was protected if the worst happened and it’s not as cut and dry as that,” she said.
Hart said she is lucky they had money saved and have been able to go for four months without her paycheque. She said she doesn’t want to see the same thing happen to other people, many of whom would be in financial dire straits immediately.
“I think there are lots of people who are not getting paid by their insurance,” she said.
