When someone buys disability insurance or joins a group disability policy at work, he or she deserves to be financially protected should injury or illness interrupt the ability to work and earn a living. Accordingly, when it becomes necessary to file a claim under his or her disability insurance policy for benefits, it should be enough proof for the insurer look at the claimant’s medical records from treating physicians as well as other objective medical evidence like lab tests, X-rays or other kinds of scans, depending on the condition.
Unfortunately, disability insurers regularly pay doctors who do not treat claimants to either conduct independent medical examinations, called IMEs, or to conduct paper reviews of the medical and other evidence in the file and express an opinion on disability. (Whether an insurer may force a claimant to attend an IME usually depends on the terms of the insurance contract.)
On our website, we provide general advice regarding ways to protect your interests when attending IMEs.
Doctors on an insurance company’s roster of paid advisors are inherently subject to bias. Their payments come from the insurer, which wants to save money by denying claims. Being on the roster can be quite financially lucrative to physicians.
Mischaracterization of injury and illness
In a recent piece of investigative journalism, nonprofit Honolulu Civil Beat took a close look at insurance-company use of doctor rosters in the context of workers’ compensation. (Workers’ compensation insurers and disability insurers have similar financial motivation to discount claims of impairment.)
After an in-depth look at almost 200 cases in which three particular doctors were used as insurance-company examiners, Civil Beat concluded that “some of the doctors who examine workers for insurance companies almost always cite reasons to cut off or minimize care or reduce payouts to workers.”
In the approximately 200 cases reviewed, in “nearly nine out of 10” the three doctors found reasons to cast doubt on the extent or nature of the claimants’ impairments. Civil Beat looked at cases in which these particular doctors’ opinions had a negative effect on claims. Not surprisingly, their opinions were frequently “discounted” on review or appeal.
The article described severe repercussions to people denied their benefits, including homelessness. Do not let a disability insurance claim denial get that far. Anyone facing a disability insurance claim should speak immediately with an experienced attorney who can level the playing field against the insurance company by seeing that physicians on the insurer’s roster are not given unfair weight against the medical evidence.