When long term disability insurance companies want to avoid paying benefits, one of their favorites tactics is to cherry-pick medical records and tease out “inconsistencies.” These supposed “inconsistencies” serve as a springboard from which claims get denied or terminated.
For example, let’s say your disability is your inability to work due to your bad back, and your doctor has confirmed your disabled status. You might believe this sufficient to satisfy your claim requirements. Think again.
Most disability insurance companies have in-house nurses who review medical records and reports, scouring them for every normal finding and negative test result. The nurse will rely on this one-sided dissection of the medical information to state that these “inconsistencies” do not support the disability claim. The nurse’s findings will then be sent to an in-house doctor who won’t dig any deeper, choosing instead to rubber-stamp support for the nurse’s conclusion. Claim over.
If your benefits get shut off and you appeal your case, the disability insurance company typically hires an “external” doctor to provide an “independent opinion” which most likely will also conclude you are not disabled. Of course, the “independent doctor” is furnished by a vendor which regularly provides such medical opinions to the insurance company, a vendor depends on this income for its survival. Many of the reviewing physicians are either retired or are not engaged in a profitable clinical practice. They need this extra income for their livelihood and are ready and willing to sell their opinions for this compensation. These “paper reviewers” will detail extensive findings on all your functional abilities without the benefit of examination or testing of any kind.
At some point, the disability insurance company or hired medical reviewer may send a letter to your own doctor asking the doctor to agree with the findings that you are not disabled. If your doctor disputes these findings, the disability insurance company will ignore the dispute or find in contradiction to them.
If the disability insurance company believes it needs additional support, it will schedule an “independent medical examination” or “IME.” The doctor performing this examination usually will come from the same company that provided the paper medical opinion denying disability. So, what do you think the chances are that you will be found disabled this time? You are right if you said: “Not Good.” A number of disability insurance companies now call these “evaluative medical examinations,” rather the “independent medical examinations,” recognizing the reality that there’s nothing “independent” about these doctors.
Keeping the insurance company in check when it goes down this road, or turning things around when it has already done so, requires experience, knowledge and tenacity. Our firm manages these issues on a daily basis, having done so on behalf of thousands of claimants over the past 30 years. We know how to keep your benefits flowing and how to get them approved.
Don’t hesitate to contact us today if you are having these or other problems with your long- term disability claim or your long-term disability insurance company.
Evan S. Schwartz
Founder of Schwartz, Conroy & Hack