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The Role of Overused and Insurance-Biased Doctors in Individual and Group Long-Term Disability Claims

Overused and Insurance-Biased Doctors in Individual and Group Long-Term Disability Claims

So, you filed a valid claim for individual or group long-term disability insurance benefits. During the disability claim process, you provided documentation from multiple doctors, hospitals, and pharmacies describing the nature of your injury or illness, all of your restrictions and limitations, plus pharmacy records, physical therapist or mental health counselor evaluations, and more.

Unfortunately, even if this clinical documentation proves enough to initially qualify you for individual or group long-term disability insurance benefits, it may not be enough to keep them.

Throughout your eligibility period, your individual or group long-term disability insurance company will require you to attend periodic medical examinations with so-called “independent physicians”, who often lack the proper training or specialization to properly evaluate your disability claim.

Originally designed as a method of preventing insurance fraud, these exams go by different names, but they’re often referred to as “Independent Medical Examinations” (IMEs). The problem, however, is that they’re seldom truly “independent.”

Your individual or group long-term disability insurance company may assign and pay a set of overused, overworked, and often minimally qualified doctors to examine you and determine your fitness to return to work. These improperly credentialed doctors may recommend the termination of your individual or group long-term disability benefits after a cursory 15-minute examination.

Protecting America’s Disabled From a Wrongful Termination of Individual and Group Disability Insurance Benefits

Slowly but surely, courts are catching on to the flaws in the disability “independent” examination system.

For example, if Dr. Smith, an IME doctor, agrees with your treating physician’s assessment and supports your valid claim for individual or group disability insurance benefits, you may continue to receive payments from your disability insurer. So what happens to Dr. Smith if she does this with multiple claimants? She may surely stop getting disability insurer’s medical review or examination business.

IME physician Dr. Jones, however, often certifies that her examinees are no longer disabled, have recovered or improved, and do not need continued individual or group disability insurance disability benefits. So what happens to IME Dr. Jones? She gets more disability insurance business!

Before you attend an IME, call DarrasLaw. Our award-winning disability lawyers and accomplished ERISA attorneys know what the IME doctors are looking for and can suggest protections for you during the examination.

If you are the victim of a biased IME resulting in a wrongful denial, reduction, or bad-faith termination of your individual or group disability insurance benefits, call the experienced long-term individual disability attorneys and nationally renowned group ERISA lawyers at DarrasLaw today. Our seasoned long-term disability attorneys understand disabling conditions and can help you and your treating doctors to present the proper evidence to your disability insurance carrier.

With more than 100 years of combined litigation and claim experience fighting individual and group ERISA insurance companies for wrongfully delayed, denied, or terminated benefits, we know the bad faith tricks that your long-term individual or group disability insurance company will try to play on you. To schedule your completely free disability policy analysis or free claim consultation, contact DarrasLaw today at (800) 458-4577 or message us online.

What Is an IME?

The nature of your injury or illness and disability insurance policy will determine how many IMEs you may need to endure during your disability claim period. If you have a back or neck injury, you can often expect to attend an orthopedic IME every year. The insurance company physician will typically assess whether you are still disabled and, if so, whether you’re seeking and receiving the most appropriate medical care and treatments. For example, a refusal to attend physical therapy could constitute grounds for terminating your individual or group disability insurance benefits if the carrier believes more treatment would have ended the claim.

On the other hand, you may only need to attend one IME if you suffer from injuries or illnesses like paralysis. If the insurance-company paid IME doctor certifies that you are completely disabled with no chance of recovering extensive functioning, your individual or group long-term disability insurance company may not subject you to any more periodic examinations.

After your examination, the IME doctor will send a report to your insurance company assessing the nature of your injury or illness and how it affects your ability to work. The insurance-company paid doctor or medical reviewer will typically list the medical records reviewed, then explain the results of the all-too-brief medical record review and examination. He or she will often comment on how you walked into the exam room, sat down, interacted and whether you drove yourself to the IME exam.

Bias During the IME Process

Many insurance-biased IME physicians often don’t spend more than 15 minutes with a claimant. They may ask you questions about your pain, perform some basic tests, and conduct a very brief physical examination.

An example of bias comes when the IME doctor presents the findings. Let’s say you injured your left shoulder, and lifting your left arm over your head causes you extreme pain. Still, you do so when the insurance doctor asks you to during the exam, but you experienced excruciating pain. Unfortunately, that’s likely not what you’ll see reflected in your IME report.

Instead, the IME doctor might report that you were able to lift your arm over your head with little effort and, as such, you can return to normal work duties. The insurance-company paid doctor or medical reviewer will not mention the extreme pain you felt when you did it.

The following is a list of common biased language and findings used in IME reports to help justify a wrongful termination of individual or group disability insurance benefits:

  • Patient walked into exam room unassisted and drove unaccompanied to the exam
  • Patient was able get on the exam table and sit for an extended period time and easily got off all by herself
  • Patient was pleasant to speak with, did not show any outward signs of pain and was a reliable historian
  • Patient was able to accomplish all requested physical tasks in a fluid manner
  • Patient was in good spirits, showed no cognitive issues or problems
  • Patient reports improvement but doesn’t like where she works

Did you have any idea that the insurance-company paid doctor or medical reviewer would use your walking through the door unassisted to that exam room without complaint to justify a wrongful termination of individual or group disability insurance benefits? Probably not.

Recent Lawsuits Against Insurance-Company Biased Physicians

In a recent lawsuit out of Pennsylvania, a disabled claimant injured her neck after falling. Despite not suffering any previous injuries, the doctor from the insurance company concluded that her neck injury stemmed from a pre-existing degenerative condition and not her fall. Her benefits were wrongfully terminated, and she appealed to the Department of Labor. The case was decided against the insurance company and its doctor, and declared the insured totally disabled.

The insured subsequently sued, alleging that her insurance company purposefully sent her to a doctor it knew would falsify his findings to help support a wrongful termination of her benefits.

Cases like these are becoming more commonplace as courts begin to catch on to this disability industry bias. Just because an insurance-company paid doctor declared you no longer disabled, does not mean you shouldn’t fight for your legitimate disability benefits.

Consult an Award-Winning Long-Term Individual Disability Lawyer and Group ERISA Attorney

What you thought was a positive experience with your IME doctor can turn into a nightmare when you read the final report. If you’ve had your long-term individual or group disability insurance benefits wrongfully cut off after an IME that clearly contradicts your personal treating doctor’s findings, don’t hesitate to call DarrasLaw.

Led by nationally renowned disability attorney Frank N. Darras, we know how the system works against you—and how to fight back and win. After conducting a completely free disability policy analysis and free claim consultation, we may help you fight a wrongful termination of individual or group disability insurance benefits based on a faulty insurance-biased examination. To schedule your completely free disability case analysis, call DarrasLaw today at (800) 458-4577 or contact us online.

Call our experienced, top-rated national disability attorneys at 800-458-4577 or send us an email.

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