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Tuesday, December 28, 2010

Can a Doctor Hired by a Disability Insurance Company Truly Be Independent?

When a policyholder files a disability insurance claim, the disability insurance company has the right to request that you undergo an independent medical exam or IME.  In addition, the disability insurance company has the right to review your medical records, pay their own doctor to review your medical records, decide which medical tests to use in evaluating your claim, and hand pick which test results to take into consideration when evaluating your claim.  Furthermore, the same insurance company serves as the "administrative board" in claims that are challenged or appealed by policyholders.  This is especially true in ERISA type claims.  Go here to learn more on ERISA claims. 

Well, recently the United States Supreme Court handed down a decision that will begin shifting the balance a little more in the policyholder's direction regarding claims filed under ERISA.  In the case, Met Life v. Glenn, the Supreme Court was faced with the following question(s):  Can the same insurance company that pays a claim, also be the same entity that decides if payments be made or not?  Can this structure or set-up provide a fair review of a claim?
For the first time, the court decided that there is a conflict of interest that exists when reviewing the legitimacy of the claim determination.
This decision was followed by a federal court decision that stated that the independent medical exam or IME is not independent after all.
If a doctor is hired and paid by an insurance company to prepare an "impartial review" of the insured's medical records how can this be a true impartial analysis of the medical records when the doctor is literally on the insurance company's payroll.
Due to the U.S. Supreme Court's ruling, it will be interesting to see how other lower level courts decide on similar issues.

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