Why Insurance Companies Choose Paper Reviewers Instead of Independent Medical Examiners
Being injured or so severely sick that you miss work is a painful experience. Ensuing disability increases your worry and frustration about how soon you will get better and how you will cover your expenses without a regular paycheck.
That is why many people carry both short and long-term disability insurance. They are told and expect this insurance will cover their needs when they have a qualifying disability that justifies a monthly payment.
Unfortunately, disability insurance companies are not thrilled when they have to pay out claims. They may deny claims outright or take steps to reduce the amount of money they need to pay out for each claim. This can happen when a disability insurance company has your medical issues reviewed on paper instead of with an independent medical exam.
Difference Between Paper Reviewers and Independent Medical Examiners
When a person files a disability claim, they allege that they have suffered from a sickness or injury that prevents them from doing their occupation, at least in some capacity. Before the insurance company pays out the claim, they want to ensure that the person has actually suffered injuries or a debilitating sickness and will conduct a medical review. Often, this review may happen in two unique ways.
Paper Reviewers
A paper review or a paper-only medical review of an injured or sick person’s medical record is exactly what it sounds like. If your insurance company conducts a paper review of your medical issue, you will never see or speak with the doctor who reviews your injuries or sickness. You might question how that doctor can make an accurate determination about whether you have suffered injuries or your sickness and how they fairly determine your ability to work. You would be right to question.
With a paper review, the insurance company is more likely to have a doctor decide that your medical condition is not as severe as you allege and deny your claim. Remember, the disability insurance company pays the paper reviewing doctor to give their opinion so, they usually side with the insurance company. The doctor simply reviews your prior medical history and minimizes the extent of your injuries and downplays your sickness. It’s also important to note that not every person who conducts a paper review is an actual doctor, or a doctor in the right specialty.
Independent Medical Examiners
Independent medical examiners can often be biased, too, as the disability insurance company often hires them. Furthermore, many of these “go to” IME doctors lack the credentials to properly review your disability.
Before you attend an exam with an independent medical examiner, hire a lawyer. An LTD lawyer can prepare you to provide an independent medical examiner with the information they would not get by simply looking at your paper medical records. Be prepared with a detailed list of the care, treatment, tests, doctors, therapists, employment job description and x-rays, MRI’s and/or CT scans.
Insurance Companies Prefer Paper Reviewers
Insurance companies prefer paper reviewers to independent medical examiners. Their reasons all center on what the insurance company wants, not what is best for you. Their “hired guns” can minimize, normalize, then rationalize you aren’t that sick or injured so you don’t get a dime.
Cheaper
For the insurance company, conducting a paper review of your medical conditions is cheaper than hiring an independent medical examiner. Since they are paying for the medical review, they will often choose the cheaper option. But the cheaper option is not always in your best interest, nor is it fairly done.
Less Objective
When someone reviews your medical history, they are looking for information about how your injuries or sickness happened, what changes it has caused to your body, and how that has hurt your ability to complete and reliably perform the important duties of your occupation. Simply looking at medical records does not provide the whole picture of what happened and continues to happen to you that disables you, physically, mentally or emotionally.
The person reviewing your medical records is often just looking to give the insurance company a reason to deny your claim or reduce the monthly disability payments made to you. And remember, this person is not always a medical doctor or worse, a doctor in the wrong specialty.
Easier to Engage
Because the person reviewing your paper medical records does not have to be a doctor, the insurance company may find it easier to locate people willing to conduct a shoddy paper review. It is also easier to simply send the documents to an individual to review instead of having them travel to see you and review your medical condition in person.
Ignores the Evidence
Because the individual reviewing your medical records never sees or speaks to you, they ignore substantial amounts of evidence that could be vital in determining whether you have suffered severe and debilitating injuries or a crippling sickness. Remember, the insurance company only wants to ignore the evidence, especially if your disability claim is strong. That’s why they will favor a paper review instead of a true or fair independent medical exam.
Lack of Objective Evidence
Not only does a paper reviewer ignore much of the medical and occupational evidence, it also does not look at objective carefully. The reviewer simply looking over your medical records does not speak with you; they can’t get a full picture about your injuries or sickness and how it has affected your occupational life. Lacking this objective evidence makes it increasingly difficult for the paper reviewer to provide an accurate determination of what you can and cannot safely do.
You Have Legal Options
Thankfully, even though it might seem like the disability insurance company is stacking everything up against you, you do have legal options. You may be able to request an independent medical examination instead of a paper review. Even if your insurance company has already denied your claim, you may be able to appeal the decision and reverse the denial course.
Unfortunately, you may not be able to do this without the guidance of a skilled and experienced long-term disability insurance lawyer. A seasoned disability lawyer will review your policy to look for ways to help you get the benefits you are entitled to from the insurance company. They can also review your claim and medical history and fight to protect your rights by presenting the evidence clearly and directly to the disability insurance company. The stronger you make your case, even on appeal, the less likely it is that your insurance company can continue to deny you payments.