More can be done to help insurance claimants complete standard forms

By Tony Poland, LegalMatters Staff • An Ontario government initiative to reduce the administrative burden on family doctors will undoubtedly benefit patients, says Ontario disability insurance lawyer Courtney Mulqueen.

However, she says she questions whether the province’s paperwork plan will have a positive impact on the insurance claims process.

“The Ontario government is trying to reduce the amount of administrative paperwork doctors do to give them more time for their patients. It is a great idea, in theory” says Mulqueen, principal lawyer of Mulqueen Disability Law Professional Corporation. “However, disability insurance claims forms have remained virtually the same for decades. Insurance companies will always need certain information and that means paperwork. That is unlikely to ever change but there are steps claimants can take to help their case.”

The Ontario Medical Association states family doctors spend 19 hours per week on administrative tasks, including four hours to write notes or complete forms for patients.

Plan to reduce unnecessary paperwork

The Ministry of Health recently announced a plan to reduce unnecessary paperwork such as sick notes while streamlining note-taking during patient appointments.

The province states it is expanding a program to more than 150 primary care providers “that safely uses artificial intelligence (AI) to automatically summarize or transcribe conversations with patients who consent into electronic medical notes.”

According to the ministry, research shows using AI scribes reduces the time doctors spend on after-hours documentation by up to 50 per cent, allowing clinicians to see an additional 12 patients per month.

The government says its initiatives “will free up to 95,000 hours annually for physicians to put back into their practices caring for patients.”

The Canadian Life and Health Insurance Association (CLHIA) announced it is also working to reduce the administrative burden on family doctors. The CLHIA is a voluntary association whose member companies account for 99 per cent of Canada’s life and health insurance business.

“Our members agree with the Government of Ontario: doctors should be focused on patients not filling out forms,” said Stephen Frank, president and CEO of the CLHIA. “Insurers are doing our part to reduce the admin burden doctors face. We’ve been working with the Ontario Medical Association, Canadian Medical Association and others to leverage technology to reduce the number of insurance-related forms doctors need to complete.”

‘Undertaken two key initiatives’

The Association states it has “undertaken two key initiatives.” CLHIA members have agreed to accept one consistent template form for short-term and long-term disability claims. Nova Scotia has already adopted the format, which is available to all plan members and their physicians across the country, according to the association.

The CLHIA is also “reducing and eliminating the use of physician referrals.” The association states that insurers have traditionally required a physician’s referral to support a claim for many services under group benefits plans. However, “new technology and alternative plan design are replacing this practice over time.” According to the CLHIA, insurers are working with employers to reduce and eliminate the need for doctor referrals for services such as physiotherapy and orthotics.

Mulqueen tells LegalMattersCanada.ca that she welcomes any initiative that improves patient care and reduces an overabundance of insurance forms. However, in more than 20 years of working for both the insurance industry and its clients, she says she has not seen a measurable difference in the quantity or quality of forms needed to support a disability claim.

“They have stayed the same and the ‘new and improved’ forms put forth by the CLHIA are almost exactly those that have been used for years,” says Mulqueen. “It is to CLHIA’s credit that it is making an effort to reduce the administrative burden on doctors. But the reality is insurance companies need information to assess claims and there is not likely much that can be done to significantly reduce doctor’s time and paperwork when it comes to disability claims. 

“Can we eliminate or shorten some forms? Perhaps, but there is only so much that can be done,” she adds. “Physicians will always be required to complete insurance forms. However, that does not mean that we should give up on finding other practical ways to reduce the time and administrative pressures off doctors.”

Mulqueen says insurers could do a better job of educating claimants on the most efficient way to complete standard forms.

Doctor overwhelmed by the request

She says she recently had a client who filed a completed form from his doctor and within a week the physician received a letter from the insurer with multiple pages of follow-up questions. Needless to say the doctor was frustrated and overwhelmed by the request, Mulqueen adds.

While she says she has no problem with additional queries, doctors may not be able to answer some of the additional questions without the claimant’s help. 

For example, the doctor will know about their patient’s symptoms, diagnosis, and treatment, Mulqueen says. They may even be able to provide a prognosis for recovery. But if they don’t have a full understanding of the claimant’s job duties, they may not be able to definitively say what medical restrictions and limitations are preventing their patient from working at their job or any job, she says.

“When a doctor receives these supplemental questions, they may not have all the answers and leave some parts blank. I have also seen doctors write the bare minimum, such as ‘disabled, prognosis unknown,’” Mulqueen says. “They may have to schedule another consultation in order to complete the form. The time needed for that adds to the physician’s workload and increases their paperwork burden.

“That can lead to a claim denial or further delays in someone getting the benefits they need to pay for treatment and recover from a disability.”

Fewer forms are always desirable but not always practical, she says. Instead, insurers could simply provide claimants with some tips on how to help the doctors fill out the forms, Mulqueen says.

“Include a checklist with the insurance forms to make the doctor’s life easier,” she says. “The CLHIA could provide some direction. Perhaps include practical guidance on the top of the form to ensure doctors include all the relevant information and detail requiring less follow-up.

Make the information process easier

“Getting all the information while the patient is in the room is going to be easier than having a doctor trying to piece it together based on medical records from someone they saw two weeks before,” Mulqueen adds.

She says she tells her clients to be mindful of the pressures on their doctors and to do everything possible to make their job easier. The goal is to provide all the information needed to support their disability claim while reducing their doctor’s time and frustration.

“You want to make it as easy as possible for your doctor. I have some paperwork hacks I share with my clients when completing these insurance forms,” says Mulqueen. “Number one is to make your doctor’s appointment solely for the purpose of the form. Do not go in with a laundry list of concerns and leave the form for the last thing on the list.

“If you are able, fill out your claim form and make a photocopy to share with your doctor,” she adds. “It will serve as a little cheat sheet for the doctor, who can confirm such things as dates, all of your symptoms and when you are no longer able to work.

“You can also fill out the general information at the top of the physician’s form, which will save your doctor time.” 

Make a head-to-toe list of symptoms

Before going to the doctor make a head-to-toe list of symptoms and include “any sort of cognitive or psychological issues that you are having in terms of depression, anxiety or memory focus,” Mulqueen advises.

“It is easy to forget things, which is why writing things down can be to your advantage,” she explains.

Mulqueen says it may also be helpful to give your doctor your work duties in writing.

“This is my job. This is what is expected of me. This is why I can’t do it. These are the things I struggle to do even at home. You don’t necessarily want to overwhelm your doctor but every little bit of information can be beneficial,” she says. “The doctor will then have at their fingertips the background needed to understand why you are making your insurance claim.

“All this will enable your doctor to better communicate to the insurance company why you can’t work,” Mulqueen adds. “That will improve the chances of your claim being approved while also saving your doctor the time and frustration that comes from your claim being denied and all the additional paperwork that would then be needed in an appeal or litigation ”