This case sheds light on some of the questionable practices that some disability companies engage in when reviewing a disability claim.
Often, disability policies limit what a claimant can introduce to a judge to support his/her claim after being denied disability benefits under a policy governed by ERISA. Sometimes however, courts are allowed to consider more evidence in certain circumstances including when a disability insurer has been found to have operated under a conflict of interest.
In Whipple v. Unum Group Corporation, Dr. Whipple sought long-term disability benefits from Unum, the insurer of his ERISA governed plan. In the lawsuit, Dr. Whipple accuses Unum of operating under a conflict of interest in the denial of his disability benefits. Dr. Whipple wanted to introduce evidence to prove Unum was biased when reviewing his claim.
When reviewing Dr. Whipple’s claim, Unum relied on opinions from physicians that were being paid as employees of Unum. Unum admitted it was operating under a conflict of interest but it failed to acknowledge that four out of five of its “independent” medical advisors were actually employees of Unum.
Dr. Whipple wanted Unum to produce records indicating the Doctors used by Unum were in fact Unum’s own employees and had earned a significant income from Unum.
The court explained that as employees, the medical advisors “may have an incentive to inappropriately deny claims so as to extend or otherwise enhance their longstanding financial relationship with [Unum].” Accordingly, the court required Unum to answer questions from Dr. Whipple’s disability attorney and to produce documents requested to determine the extent of the bias and how it affected the decision to deny disability benefits to Dr. Whipple.
Disability insurers frequently rely on their own medical advisors when reviewing disability claims and courts have allowed them to do so. Courts have even allowed insurers to place more weight on their own doctors’ opinions over the opinions of a claimant’s own physicians.