Who Makes The Decision To Deny A Long Term Disability Insurance Claim?
Author: Attorney Gregory Dell
Through my review of thousands of long term disability benefit denials, I can tell you that 98 out of 100 hundred times the disability insurance claims examiner will only believe and listen to what their own hired doctor states. This means that if three of your doctors say you are disabled and the insurance company has the medical records reviewed by their own doctor, then the insurance company will ignore your treating doctors and agree with the hired doctor. There is no requirement for the disability insurance company to give more weight to the medical opinions of the treating doctors, however the disability insurance company is required to conduct a fair and reasonable review of all available information.
How Can The Disability Company Conduct A Fair Review When 98% Percent Of The Time They Adopt The Opinion Of The Hired Doctor?
The answer is the disability insurance company hopes that by denying the long term disability claim they will force the claimant to return to work. The disability claim examiners have been trained to send all available medical records to their hired doctors and then adopt the opinion of the hired doctor. With some of the disability insurance companies, it appears that the claims examiner does not have the discretion to disagree with the hired doctor. While the claims examiner is the one that ultimately signs a denial letter, the claims examiner at most companies are really nothing more than paper facilitators seeking the opinions of hired doctors to the detriment of claimants. In my opinion it is the Hired Insurance Company doctor that makes the decision to deny a long term disability claim. Hired insurance company doctors do not always determine that claimants are not disabled. The vast majority of hired insurance company doctors have no understanding of either a claimant’s occupation or definition of disability. The lack of knowledge and cursory reviews conducted by these hired insurance doctors create great opportunities for a claimant obtain a claim reversal through either an appeal or law suit. Most disability companies will not have a claimant physically examined as they don’t have as much control over the doctors that actually do physical exams and the doctors that actually exam a claimant are compelled to conduct a thorough exam. The hired insurance doctors rarely conduct a thorough exam and often ignore medical records as they perform cursory medical exams and don’t really review the medical records. These careless medical exams give a claimant a good chance to win a reversal of a disability denial. If your long term disability claim has been denied or you have reason to believe that it may be denied, then please contact any of our long term disability lawyers for a free consultation.