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Episode 17 Who makes the final decison to approve or deny disability insurance benefits?


  • Who Makes The Final Decison To Approve Or Deny Disability Insurance Benefits? (Ep. 17)

Is it the disability insurance claim representative or hired insurance company doctor that makes the decisional to approve or deny benefits?

Most disability claims examiners do not have any medical background or training, but they should be smart enough to know that is unreasonable to rely on the medical opinions of a doctor/consultant that is paid $577,00 by the same insurance company over approximately a two year period. In every long term disability insurance claim denial deposition that our disability attorneys have taken, the claims examiner will always state that he/she made the determination to deny disability benefits. It is ironic that we always get the same answer, because it is actually the claims examiner’s hired doctor that usually determines if a claimant has restriction and limitations. Our disability lawyers have reviewed thousands of disability insurance denials and we have never seen a claim approved in which the insurance company’s hired doctor found no restrictions and limitations for the claimant. The disability insurance claims examiners essentially have an unwritten procedure of rubber stamping a medical consultant’s finding of no restrictions and limitations. Most disability claims examiners will attempt to justify their actions by stating that they are not physicians and therefore must rely on the findings of their hired medical consultant.

In this video we have an included an excerpt from the deposition of two different Standard Insurance Company employees that were involved in the denial of our client’s claim for long term disability benefits. This deposition was taken by disability insurance attorney Gregory Michael Dell. The Standard Insurance Company claims examiner in this particular case was given the task of determining whether our client, a physician, could perform the duties of his occupation. The claims examiner is specifically asked “How she deciphers between the opinions of her hired physician (Dr. Dickerman) and the opinions of our client’s treating physicians? In this case the claims examiner relied on the opinion of Dr. Dickerman, Standard Insurance Company’s hired medical consultant rather than our client’s treating doctors. Not only did the claims examiner rely on Dr. Dickerman’s finding of no restrictions or limitations, but the file was then given to another Standard Insurance Company employee that was asked to make a determination based exclusively on the findings of Dr. Dickerman. While Dr. Dickerman may be a credible doctor, a United States District Court case revealed that “Dr. Dickerman reviewed 1,939 files for Standard from 2003 to 2005, for which Standard paid him $ 577,000.” Is it unreasonable to suggest that Dr. Dickerman’s opinions may be biased in favor of the insurance company?

Please note: Disability insurance attorney Gregory Michael Dell created Disability Insurance Law TV in order to educate long term disability claimants about common issues related to long term disability insurance claims. New episodes are filmed on regular basis. Our disability videos are for informational purposes only and they are not legal advice.

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