4.9/5 | Your Life, Rebuilt
Yes, you can refuse medical treatment or recommendations from your insurance company—but only if you have a valid reason and you’re making an informed decision in consultation with your healthcare providers. If you refuse treatment without solid justification, your disability benefits or coverage under your health insurance may be at risk.
Why Insurance Companies Make Medical Recommendations
Insurance companies often make medical recommendations that differ from what your healthcare providers suggest because they have a different primary objective than your personal care team.
While your care team’s role is to focus fully on patient care based on your specific needs, history, and medical situation, your insurance company is approaching things from a claims management and cost-control perspective.
Here are the main reasons for these conflicts:
1. Cost Control
Insurance companies are in the business of managing risk and expenses. They may suggest alternative treatments they consider more cost-effective, even if those options aren’t the best match for your medical condition.
2. Policy Requirements
Your policy may include obligations under the “duty to mitigate,” meaning you must try reasonable medical treatments that could help you recover or return to work. The insurer might push for treatments simply because they believe it fulfills this requirement—not because it’s what your doctor thinks is best.
3. Reliance on Independent Medical Assessments
Insurance companies sometimes send patients to third-party specialists or rehabilitation providers. These assessors don’t know your full history and may recommend interventions that contradict your healthcare providers’ plans.
4. Different Definitions of Recovery
Your doctor is concerned about your overall health, safety, and quality of life. Your insurance company, however, measures “recovery” in terms of your ability to return to any type of work—even if your symptoms persist or quality of life suffers.
5. Use of Standardized Guidelines
Insurers often use generic guidelines or protocols that aim to treat the “average” patient. These may ignore unique personal factors, prior failed treatments, or specific patient’s wishes, and leave little room for individualized care.
Understanding the Duty to Mitigate
Under most employer or private disability insurance plans, you have a legal obligation called the “duty to mitigate.” This means:
You must try reasonable medical treatments that could improve your health or allow you to return to work
Your healthcare providers will document your attempts to follow suggested care
The insurance company can challenge your claim if they believe you haven’t complied with necessary medical care or refused treatment without proper justification.
Are You Required to Accept Medical Recommendations?
You are not obligated to accept all recommendations from your insurance company—especially if they conflict with the advice of your trusted healthcare providers. The law recognizes your patient autonomy and right to informed consent. However, you must show that your refusal is reasonable and based on sound medical decision making.
Accept treatment if:
Your doctor believes it is likely to help
Risks involved are low or manageable
It aligns with your own informed wishes
Refuse treatment if:
Your doctor says it’s unnecessary, risky, or could worsen your condition
You’ve tried similar treatments before without benefit
The recommendation doesn’t consider your specific medical situation or decision making capacity
When Is It Reasonable to Refuse a Recommendation?
It is reasonable to refuse treatment if:
There are serious side effects or risks involved, as documented by your healthcare provider
The treatment is experimental or not widely accepted for your condition
You have already tried it, and it proved ineffective or harmful
Your mental capacity or health care providers support the decision
Always communicate clearly with your insurance company. Get your medical practitioner’s written opinion explaining why the recommended treatment isn’t suitable.
Nadira's Story: When Insurance Recommendations Conflict
Nadira, living in Ontario, struggled with a chronic illness that made her unable to work. Her insurance company pushed her to try a medication her doctor said could worsen her symptoms. Nadira and her physician explained the risks and documented her refusal based on her doctor’s advice. With proper support and medical evidence, Nadira’s patient's wishes were respected, and her disability claim was honoured.
What Are the Consequences of Refusing Medical Treatment?
Refusing valid medical treatment recommended by your insurance company may result in:
Denial or suspension of health insurance or disability benefits
Delays in claim approval
Requests for more medical assessments
Increased scrutiny of your medical situation by the insurer
If you provide strong evidence through your healthcare providers and show you made an informed decision, these risks can be minimized.
How to Respond to Insurance Company Recommendations
When your insurer suggests or insists on a treatment:
Consult your doctor: Discuss the recommendation and risks involved.
Assess your mental capacity: Make sure you’re fully capable of decision making about your health care.
Request written opinions: Ask your healthcare providers to write detailed notes about why the treatment may not be right for you.
Document everything: Keep records of communications with the insurer, doctor’s advice, and your own informed consent or refusal.
Communicate your decision: Inform your insurance company in writing, referencing your doctor’s advice.
When to Speak to a Disability Lawyer
If your insurance company denies your claim because you refused treatment, if you feel pressured, or if recommendations conflict with your healthcare providers’ advice, get legal advice right away.
Speak to a disability lawyer if:
You are threatened with loss of benefits for refusing medical treatments
You face complex medical decision making capacity concerns
Your insurer is overriding your doctor's recommendations
You need to protect your patient autonomy and rights
Your Rights and Responsibilities
You have the right to refuse medical recommendations from your insurance company—as long as you make an informed decision with your healthcare providers and carefully document your reasons. Never accept treatment just to please your insurer, and protect your health care rights.
If your long term disability claim has been denied, don’t lose hope. Reach out to Share Lawyers today for a free consultation. You pay absolutely no fees unless we win your case. Our team understands how overwhelming this process can be, and we are here to fight for your rights and help you get the benefits you deserve. Let us handle the insurance company—so you can focus on your health and recovery.
