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Court Permits Insurer To Hide Identity Of Medical Reviewer

Thursday, December 9th, 2010

In a disturbing decision from a Federal Judge, one court has permitted a long term disability insurance company to hide the identity of its medical reviewers who provided the insurance company with opinions that were utilized to deny benefits to an insured.

In Houser v. Alcoa, Inc., a case from the Western District of Pennsylvania, the court stated that because the qualifications of the reviewer were provided (indicating that the reviewers were board certified and in active practice), there was no basis to discredit the qualifications of the reviewers and thus attack the reviews. The court held that a claimant’s entitlement to a full and fair review does not mandate the specific identification of the medical reviewer. The court also noted, however, that the claimant never specifically requested the identity of these reviewers, a potential practice pointer for claimants.

Frankel & Newfield aggressively pursue the identity and credentials of the medical reviewers involved with our clients’ claims, as we have created a wealthy database of information about many of the third party vendors providing support to insurers, and the individual doctors who facilitate these improper claim decisions. If you are facing this issue with your disability insurance company, please do not hesitate to protect your rights, and contact our firm.

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Frankel & Newfield does not currently handle any Social Security Disability Insurance claims.

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