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Disability Claimants Suffer When non-practising Physicians Start Practicing Medicine

Friday, March 21st, 2014

We were dismayed to read a news article about guidelines on pain medication use by a company that we have seen in many of our litigated cases. Equally disturbing was the fact that this particular group is now owned by an insurance company that we actually respect. Yes, there are insurance companies who stand by their contracts and do the right thing for their claimants – we don’t write about them here because frankly, we don’t see them in our practice often.

The company we are troubled by is The Reed Group, publisher of a tome known as the MDA – a resource book created and edited by a non-practising doctor, whose core business is to conduct disability management for insurers and administrators. The book purports to be edited by a large group of medical specialists – but unlike most medical books we know, it does not include any medical references, citations or studies that are typically included in most, if not all, medical texts.

Just as candidates hire ghost writers and PR agencies to release their biographies around the time that political picks are being made, this organization publishes guidelines as a means of keeping the lid on disability claims. They pander to the employer/insurer marketplace, as a means to keeping costs low for “absence management”. In fact, the book itself does nothing to hide its intentions. The text is a pretext for establishing limits on disability benefits payments which is clearly expressed in the foreword to the book which states:

“Increasingly, employers recognize the connection between healthy workers and company productivity. One manifestation of this new awareness is employer focus on minimizing disability. To have effective partnerships around disability management and return to work goals, there must be tools that assist employers, providers, and other participants in the disability process to be successful in their efforts to minimize disability impact on the workplace. The disability duration guidelines provided in The Medical Advisor are an excellent example of such tools. These guidelines help assure a consistent approach to determining disability duration for the purposes of benefits decisions.

The Medical Advisor has been used by managed care companies, insurance carriers, physicians, disability determination companies, and third party administrators. This effort is an important contribution by providing a common basis for various stakeholders in the disability management process to discuss disability duration assessments as one component of a disability management program. (p. xv at 424) (emphasis added)

Thus, it’s no surprise that their findings concerning limiting the use of opioids – strong medications that include morphine – to help manage pain. It’s ironic that the analysts include in the report that 80 to 94 percent of the studies about opioid use involve funding from the opioid industry itself. We aren’t surprised by that, most drug studies are conducted with the funds from Big Pharma, the pet name for one of the top three largest lobbying groups in Washington. Another massive lobbying group – the insurance industry.

This book and its readers have one unified focus – to control the cost of disability insurance providers and other participants in the disability process. The introduction of the book makes it very clear that this is its purpose, along with enough corporate speak to wear out any normal person suffering from a disability.

Call us crazy, but we think that the there is one person who is the best judge of what type of medicine an ill or injured person should be taking – their primary care physician or specialist providing care and treatment. If they are working with a pain management expert or a pharmacologist who has been brought into their case to ensure the proper use of pain medicine, then that makes two, or three. But we don’t believe most people need the services of an insurance company owned purported medical publisher to get involved in their day to day health care. And we really, truly, don’t think that most of us will be on the road to better health if our healthcare decisions are made by bean counters, and not real practicing medical doctors.

Has your disability insurance company denied or terminated your benefits, claiming that you have no claim? Call our office today at 1-877-LTD-CLAIM (877-583-2524) to learn how we can help.

Justin C Frankel

Written By:

Justin C. Frankel - Disability Insurance Attorney

Justin Frankel is a founding partner of the disability insurance law firm Frankel & Newfield and is a highly skilled litigator and advocate. He has published numerous articles on the challenges facing clients with private or individual disability insurance policies and those who own group or ERISA disability insurance policies.

Learn more about Justin | See Justin’s Publications



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