Can a disability carrier deny benefits to a claimant if they have never had an independent medical exam done on a particular claim?
They certainly can. Just because the insurance company fails to request an independent medical examination of an insured person, doesn’t mean they don’t have grounds on how they evaluate the claim, to terminate the claim. It’s usually done to further seek support for perhaps some findings that they already kind of felt are there. Many times these insurance companies have in-house physicians of their own that have certain findings based on the medical records and based on those findings they send out the claim to an independent medical doctor to look at what their own in-house physician is saying, what the claimant’s own physicians are saying, and as they say, generate an independent report.
But if the insurance company is going to render an opinion that a claimant is disabled how can they do that without ever examining a claimant?
Essentially what they will do is, they will go to their in-house doctors or some of their in-house nurses or sometimes send out the records that are already obtained by the claims people out to what they call independent peer review doctors. They just look at the notes, look at the records and make a determination on whether there are any restrictions or limitations.
So just by basically looking at papers, they can tell whether or not a person is able to work or not?
Yes, without ever examining the claimant they will essentially look at the paperwork and records and say that they can do their job.