A Federal Court in Ohio has determined that Hartford’s reliance upon the opinion of a non-examining, paper reviewing physician, was not sufficient to support a termination of disability benefits to an insured. Hartford relied upon the opinion of a physician provided by MES Solutions, an entity seen regularly as providing insurer favorable doctors to write reports justifying a termination of disability benefits.
Dr. Baum, hired by Hartford through MES, determined that the claimant had sedentary work capacity (able to work 8 hours a day, 5 days a week), despite clinical and objective findings in the record supporting impairment. When additional documentation was submitted, including the results of functional capacity testing supporting impairment, Dr. Baum refused to alter his opinion and Hartford maintained its claim position.
The Court opined that Hartford abused its discretion in terminating disability benefits, because of its conflict of interest, Dr. Baum’s failure to document what evidence he rested his opinion on, his failure to consider all evidence, and Hartford’s failure to consider the occupational requirements of the insured’s occupation.
The Court was also troubled by the lack of any in person examination, and instead the reliance upon a paper review of medical records. This is an all too common issue seen, where insurers are relying upon opinions of non-examining doctors who do incredible volumes of work on behalf of insurance companies.
Bowers v. Hartford Life (S.D. Ohio, May 17, 2010)
