Disability Insurance Lawyer Blog

Hartford's Use of Paper Reviewing Doctors Found Unreasonable

One of the biggest challenges for ERISA claimants is that there claim can be denied or terminated based largely upon an opinion which is specifically paid for by an insurance company. Many of the largest LTD insurance companies regularly rely upon a limited number of doctors, who perform "paper reviews", never personally examining a patient, before formulating an opinion that they are not disabled.

Since these doctors are regularly utilized by the insurance companies, one would expect that the overwhelming majority of the opinions favor the insurance company. In our practice, we see the same doctors utilized again and again - but have often been stymied in having Courts appreciate the significance of this biased relationship between the insurance company and the so called "independent" doctor. While some courts are starting to appreciate this, the tide has not completely turned.

Thus, it is refreshing to see a decision which takes apart the paper review, chastises the insurance company's reliance upon one piece of data from a treating physician (to the exclusion of other evidence supporting impairment), and overall takes a skeptical eye toward the conduct of the reviewers. Ultimately, the Court decided that a remand was appropriate to have Hartford once again review the claim, with updated, in-depth evidence of the claimant's functionality, consideration of the award of Social Security benefits, and discussion with the claimant's treating physicians.

Pauley v. Hartford Life & Acc. Ins. Co.

We vigorously pursue ERISA LTD cases in litigation, particularly where the denial or termination is predicated upon an opinion of a paper reviewing provider. Our law firm has secured some of the most extensive discovery to reveal the issues of concern regarding this cozy relationship between paper reviewing doctor, insurance company and many of the third party vendors often utilized by insurance companies.

DISABILITY- When it happens to you

More than 30 million Americans between the ages of 21 and 64 are disabled, and more than 25 million Americans are not able to work because of a disability. As the American population continues to age, these numbers are only going to increase. Most of these people were healthy, active and functioning until they experienced serious illnesses like cancer, heart attack, diabetes or arthritis. Accidents take their toll also, and most disabling accidents are not work related.

What can you do to prevent becoming disabled? A healthy lifestyle, not smoking, regular exercise, a balanced diet and cultivating a healthy mental and emotional lifestyle are all things individuals can do that will reduce the likelihood of becoming disabled. But there is no way to truly guarantee that you will never become disabled.

If you have recently become disabled, you may be feeling overwhelmed by your disability and the financial hardship that accompanies the loss of your regular income. It seems like your disability has generated a firestorm of paperwork from doctor's offices, hospitals, insurance companies, and the HR department from your job. The paperwork to file a disability claim is also a bit overwhelming. You are asked to provide details about your medical and work history, and it seems that the disability insurance company is gathering personal information that you may feel uncomfortable providing.

As experienced long term disability insurance lawyers, we know that these forms are made to gather information about you and your disability. They are also designed to gather information that may be used to delay or deny your claim. As you fill out the forms, bear in mind that your claim is being reviewed closely. Make sure that your primary care physician knows that you are filing a claim for disability, and ask him/her for their cooperation when it comes to sharing your medical information and filling out forms.

Many medical disabilities require a team approach - a primary care physician, a specialist, a physical therapist, a nurse practitioner. Your disability team may also need to include a long term disability insurance law firm to help you successfully navigate a disability claim. If you have any questions about filing your claim, call our offices to learn how we can help.

CIGNA DENIES LONG TERM DISABILITY INSURANCE BENEFITS FOR CALIFORNIA PROFESSIONAL

Our client contacted us after CIGNA denied a claim for long term disability insurance benefits for a psychiatrist based on the results of an IME - Independent Medical Exam - that claimed that he was cable of performing sedentary work. The doctor who conducted the IME was of course generously paid by CIGNA and we are confident that he does many similar exams on their behalf.

Our client suffers from serious orthopedic disabilities, including cervical degenerative disc disease, thoracic degenerative disc disease, lumbar degenerative disc disease, cervical spine stenosis, osteoarthritis of the basilar thumb joints and bilateral carpal tunnel syndrome, all of which are made worse by fibromyalgia, chronic myofascial pain syndrome and depression. His medical records thoroughly document his disabilities, and there is regular on-going medical care.

How then, in the face of such a medical diagnosis, could CIGNA deny him? The doctor performing the IME stated that the psychiatrist was able to perform sedentary work.

We attacked the denial with the help of the client's treating doctor, who wrote a powerful rebuttal. We also emphasized the cognitive aspects of our client's profession as a psychiatrist, which was completely and conveniently overlooked by the report. While our client's disability may have been physical in nature, severe chronic pain rendered him incapable of maintaining the intense focus and concentration needed to perform the specific duties of his profession. We won the appeal, and he is on claim.