One of the biggest challenges for ERISA claimants is that there claim can be denied or terminated based largely upon an opinion which is specifically paid for by an insurance company. Many of the largest LTD insurance companies regularly rely upon a limited number of doctors, who perform “paper reviews”, never personally examining a patient, before formulating an opinion that they are not disabled.
Since these doctors are regularly utilized by the insurance companies, one would expect that the overwhelming majority of the opinions favor the insurance company. In our practice, we see the same doctors utilized again and again – but have often been stymied in having Courts appreciate the significance of this biased relationship between the insurance company and the so called “independent” doctor. While some courts are starting to appreciate this, the tide has not completely turned.
Thus, it is refreshing to see a decision which takes apart the paper review, chastises the insurance company’s reliance upon one piece of data from a treating physician (to the exclusion of other evidence supporting impairment), and overall takes a skeptical eye toward the conduct of the reviewers. Ultimately, the Court decided that a remand was appropriate to have Hartford once again review the claim, with updated, in-depth evidence of the claimant’s functionality, consideration of the award of Social Security benefits, and discussion with the claimant’s treating physicians.
Pauley v. Hartford Life & Acc. Ins. Co.
We vigorously pursue ERISA LTD cases in litigation, particularly where the denial or termination is predicated upon an opinion of a paper reviewing provider. Our law firm has secured some of the most extensive discovery to reveal the issues of concern regarding this cozy relationship between paper reviewing doctor, insurance company and many of the third party vendors often utilized by insurance companies.