Disability Insurance Blog

Insurer Avoids Providing Documentation Which Would Reveal Bias Of Hired Doctors


Tuesday, February 14th, 2012

In ERISA long term disability insurance claim disputes, a fertile battleground has been found regarding the issue of the doctors repeatedly hired by insurance companies, either directly, or through various third part vendors, to review records and issue reports to support the denial or termination of a long term disability insurance claim. The evidence of bias which can be gathered through discovery can be significant, and in some cases, could mean the difference between success and failure in litigation.

A recent decision highlights the significance of the issue. Hartford Insurance, one of the largest providers of long term disability insurance benefits, recently sought to overturn a decision from a California federal court that ordered it to produce significant materials which would reflect on the nature and scope of its relationships with third party vendors and the hired doctors. To accomplish its goal of overturning the discovery decision, Hartford Insurance chose to agree to a less favorable standard of review of its claim determination for the termination of a long term disability claim.

By way of background, in ERISA disability insurance litigation, claims are reviewed by a Judge either under a de novo standard of review or an abuse of discretion standard of review. The abuse of discretion standard is favorable to insurance companies, as many courts have indicated that a claim decision will be upheld under that standard as long as it is supported by some evidence in the record. In contrast, the de novo standard of review will determine whose position is more correct, rather than whether the insurance company abused its discretion.

So here, Hartford Insurance agreed to lessen the deference afforded by the Court for the sole purpose of avoiding producing the discovery materials about its relationships with the doctors and vendors. The clear implication of Hartford Insurance’s strategic decision is that they would rather lose this one long term disability litigation than reveal evidence of its relationships which could impact a myriad of other ERISA disability litigation.

Rowell v. Aviza Technology (Hartford Life)