Paper Reviews of Medical Records: How Disability Insurance Companies Make Decisions
Tuesday, June 14th, 2016
One recurring issue that plagues disability insurance claims is that of an insurer’s reliance upon the opinions from a paper only medical review. This is often a surprise to claimants, because it sounds so absurd. A decision about whether or not you are disabled is not going to be made by your personal physician, nor will it be made by a doctor who examines you after being hired by the insurance company. Instead, often, it is going to be made by either a nurse or a third-party company that is contracted by the disability insurance company to review your medical records, without ever meeting, treating or examining the claimant.
Even worse – it is entirely possible that the person reviewing your medical records may not have access to all of your medical records, just a selected, edited portion that the disability insurance company deems appropriate to provide. By appropriate, however, we mean selective medical records which are likely unfavorable to your claim.
We see this type of claim activity over and over again, and it is as frustrating to us as it is to our clients. Many of our appeals go head-to-head with the insurance companies, like CIGNA, AETNA and UNUM, because of this exact issue. The person(s) reviewing the records are not given the complete records, and any decision they make is uninformed and/or biased.
Medical records and documented support for your claim are the second most important part of your disability case. The first is your disability insurance policy. Frankel & Newfield works closely with our client’s physicians and their staff members to ensure that medical records reflect key information about your claim. They must emphasize not only your medical status, but how your medical condition impacts on your abilities to perform the material duties and tasks of your occupation, or potentially any work at all.
Another area where we see insurance companies attempting to get out from paying benefits is through the use of incorrect, outdated and fundamentally flawed occupational descriptions. We were battling an ERISA Appeal where the insurance company was relying on a description of an occupation that went back decades ago and was no longer relevant. No, we’re not making this up – we don’t have to.
If your disability claim has been denied based on a paper review, or through a flawed vocational assessment, you will need the help of an experienced disability insurance law firm that has dealt with these issues. Visit our ERISA appeals page to read about the appeals that we have won, and then call us at 877-LTD-CLAIM (877-583-2524) to learn how we can help you.