Long Term Disability Law Blog
Navigating the disability insurance claim process can be fraught with challenges, especially when dealing with doctors employed by insurance companies. These doctors play a significant role in determining the outcome of claims, yet questions about their fairness and impartiality persist. Gregory Dell, managing attorney at Dell Disability Lawyers, and attorney Stephen Jessup delve into the complexities surrounding the role of these doctors and the impact on claimants.
The Question of Fairness: A Closer Look
“Are they fair?” This question posed by Gregory Dell sets the stage for a critical examination of the practices of disability insurance company doctors. Stephen Jessup’s response is telling: “As a default, unfair in the process, especially if they’re employed directly by the company.” This sentiment reflects a common perception that these doctors may not always act in the best interests of claimants.
The issue of fairness is further complicated by the practice of cherry-picking. Dell explains, “They’re looking at every single claim with a reason to deny…highlighting either something that’s in the record that could be a positive for a claimant, and yet, they’re ignoring all of the other significant information.” This selective focus can lead to biased outcomes, undermining the integrity of the claims process.
The potential for bias is exacerbated by the financial incentives tied to the decisions made by these doctors. Dell points out, “These doctors are hired by the insurance company, they’re bonused and paid based upon their performance.” This setup creates a conflict of interest, as doctors may feel pressured to prioritize the company’s financial interests over the needs of claimants.
Moreover, the repetitive nature of using the same doctors for multiple cases raises concerns about impartiality. Jessup notes, “We’ve seen the same outside doctors…denial after denial with the same doctor.” This pattern suggests a systemic issue, where certain doctors may be predisposed to deny claims, regardless of the individual circumstances.
The Role of Internal Doctors: A Systemic Challenge
The reliance on internal doctors by disability insurance companies is a contentious issue. These doctors often operate in isolation, reviewing files without direct interaction with claimants or their treating physicians. Jessup describes the process as “a cold methodical like whatever, sign off on the lack of restrictions.” This impersonal approach can lead to a disconnect between the medical records and the reality of the claimant’s condition.
The desensitization of these doctors is another concern. Dell highlights, “They become desensitized…they do the bare minimum.” This detachment from patient care can result in superficial reviews, where critical details are overlooked or dismissed.
The Limitations of File Reviews
File reviews conducted by internal doctors often lack depth and thoroughness. Dell observes, “It’s incredible to me how they can review hundreds of pages of medical records and write three sentences.” This superficial analysis can have serious consequences for claimants, as vital evidence supporting their disability may be ignored.
The reliance on summaries prepared by nurses or file reviewers further compounds the issue. Jessup mentions, “So many times, we find that what the doctor internally was reviewing on was a complete ignoring of the medical records.” This disconnect between the summary and the actual records can lead to erroneous conclusions and unjust denials.
The Impact on Claimants: Navigating an Unfair System
For claimants, the involvement of internal doctors can be a significant hurdle. The lack of transparency and opportunity for dialogue with these doctors limits their ability to challenge unfavorable decisions. Dell laments, “We don’t have the opportunity to call that doctor up and speak to him or her.” This lack of recourse can leave claimants feeling powerless and frustrated.
The systemic nature of these challenges is further highlighted by the legal framework governing disability insurance claims. Dell asserts, “The law is not fair for these claimants that it allows these insurance companies to do it.” While the law provides avenues for appeal, the burden of proof often falls on claimants to demonstrate their disability, despite the inherent biases in the system.
Strategies for Overcoming Bias
Despite these challenges, there are strategies claimants can employ to strengthen their cases. Dell advises, “You got to go above and beyond with your medical records…really make sure they’re super detailed.” By ensuring that their medical records are comprehensive and accurate, claimants can provide a robust foundation for their claims.
Additionally, engaging with experienced disability insurance lawyers can be instrumental in navigating the complexities of the claims process. Dell emphasizes the importance of having the right representation, stating, “If you have the right lawyer…you can overcome the burden of proving you’re disabled.” A knowledgeable lawyer can help claimants gather the necessary evidence and present a compelling case to the insurance company.
The challenges posed by disability insurance company doctors highlight the need for greater fairness and transparency in the claims process. While the system may be stacked against claimants, there are steps that can be taken to level the playing field.
Reforming the Role of Internal Doctors
One potential solution is to reform the role of internal doctors in the claims process. Dell suggests a more balanced approach, proposing, “If that doctor finds that this person doesn’t meet the definition of disability, then you’re required by law to send out your review to an outside party.” By introducing an independent review process, claimants would have a fairer opportunity to have their cases assessed impartially.
Furthermore, increasing accountability for internal doctors could help mitigate the influence of bias. Jessup highlights the importance of transparency, noting, “The law has created rights for claimants to go up against these negative opinions.” By holding doctors accountable for their decisions, claimants can challenge unjust denials and seek a more equitable resolution.
Empowering Claimants with Knowledge
Education and awareness are crucial for empowering claimants to navigate the disability insurance claims process effectively. By understanding their rights and the potential pitfalls of the system, claimants can take proactive steps to protect their interests.
Dell underscores the importance of being informed, advising claimants to “hold the insurance company’s feet to the fire.” By staying informed and vigilant, claimants can advocate for themselves and ensure that their voices are heard.
Conclusion: The Fight for Fairness Continues
The journey through the disability insurance claims process is fraught with obstacles, particularly when dealing with internal doctors employed by insurance companies. While the system may be inherently biased, claimants are not without recourse. By understanding the challenges and leveraging the right strategies, they can effectively advocate for their rights and secure the benefits they deserve.
As Gregory Dell aptly states, “If you have the right lawyer, if you get the right evidence…you can overcome the burden of proving you’re disabled.” This sentiment encapsulates the resilience and determination required to navigate the claims process successfully. For those facing the daunting task of challenging an unfavorable decision, the path to justice may be arduous, but it is not insurmountable.