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.

The Ninth Holds Hartford’s Claim Tactics Show its Conflict of Interest Improperly Motivated Long Term Disability Determination

From this article:

The Ninth Circuit reversed a long-term disability denial by Hartford Life Insurance Company based on its “over-reliance” on surveillance in which it “strung together a laundry list of discrete activities over the course of four days” thereby suggesting that the Plaintiff would be capable of performing such activities throughout the day. The Court noted that the ability to perform sedentary work “in bursts” did not amount to the ability to sustain a full time occupation. The Court also criticized Hartford for glossing over the difficulties that were observed in the surveillance, such as stiffness and slow movement, instead making the conclusion that the claimant had no limitations or physical distress. The Court opined that such overstatements about the observed activity then improperly influenced the claimant’s physician when he was asked to respond to such surveillance. Also at issue with the Court was Hartford’s “paper” review versus an in-person” exam, not because such exam was required by the Plan, but because the paper review, along with the over reliance on the surveillance, reflected signs of bias. The Court also disagreed with Hartford’s rationale for denial concerning the Plaintiff’s lack of further degeneration of his degenerative back condition, and noted that after paying the claimant for 2 years, one would expect benefits to be terminated if his condition improved, and not due to the lack of progression. The Court also believed that Hartford wrongfully disregarded the finding of disability by the Social Security Administration without comparing and contrasting it, after reaping the benefit of the dollar-for-dollar offset. Montour v. Hartford

Struggle with social security

We recognize that many of the readers of this blog also consider applying to social security. This is a good informative blog for those applying for social security.

Doctors Paid To Aid Insurers In Disability Claim Denials

Disability industry's dirty secret: Doctors are hired to deny disability claims on flimsy pretext.

"Dr. Suresh Mahawar, a practicing internist in Fremont, moonlights by reviewing disability cases for University Disability Consortium.


He nearly never disagrees with the insurer.


In 202 cases he was assigned to review for The Hartford Financial Services Group between 2005 and 2007, court records show he only found nine people who were so sick or injured they could not return to work.
"

Discovery, if allowed  by the court, should be used to uncover the financial relationships between the doctor and the insurance company.
More details here