Has Your Insurance Company Hired A Biased Doctor To Support A Denial Or Termination Of Your Claim?

Has your insurance company hired a biased doctor to support a denial or termination of your claim? A significant portion of disability insurance litigation is dedicated to the issue of whether insurance companies are repeatedly hiring biased doctors to avoid paying claims. In litigation, evidence of an insurance company’s doctor’s bias can be gathered during the discovery process and in many cases can mean the difference between winning and losing your claim. If you are able to obtain this information prior to filing suit, it can go a long way to discredit the opinion of the insurance company’s doctor. Accordingly, insurance companies vigorously fight to keep this information out of the hands of claimants and their attorneys.

Biased insurance company doctors is such a pervasive problem, that in 2010 Senator Max Baucus held a Senate hearing to explore the problems faced by disability insurance claimants under the current laws. Senator Baucus mentioned two of Disability Insurance Law Group‘s cases which were also featured on Good Morning America, to illustrate his point. One of those cases involved our client, Charles, who was diagnosed with multiple sclerosis (“MS”). Despite being diagnosed by eleven (11) separate physicians with MS, Standard Insurance Company hired Ellis Dickerman to review his records and he ultimately opined that not only was Charles not disabled, but he shockingly asserted that Charles did not even suffer from MS. Subsequently, Charles retained Disability Insurance Law Group. Dr. Dickerman was well known to our Firm and thankfully, we had been gathering evidence of Dr. Dickerman’s biased medical records review history for some time. We immediately appealed Standard’s denial of benefits by painstakingly outlining the flaws in Dr. Dickerman’s report (which included blatant misrepresentations of medical information) and with his credibility as an “independent” medical records reviewer. Disability Insurance Law Group was successful in overturning Standard’s decision without the need for litigation. However, many claimants are unaware of how to gather the necessary information to appropriately appeal such a denial of benefits or simply do not have the resources available to do so. As such, many claimants are forced to undergo an unnecessary and protracted litigation battle just to obtain the benefits they deserve. Many other claimants simply give up their claims. For this reason, the practice of consistently hiring the same biased doctors to review claims and write reports remains prevalent in the insurance industry.

When an insurance company denies a claim based on a medical records review by a doctor it hired, it is essential to not only scrutinize the doctor’s report (which typically includes a thorough evaluation of the records reviewed and commented on for inconsistencies or inaccuracies) and thoroughly investigate the doctor for evidence of his financial bias. This can include information about whether the doctor maintains a clinical practice or whether his/her main income is derived from performing these reviews for insurance companies; whether the doctor has been criticized by court’s in the past for inaccurate reports or “cherry-picking” information to support a denial; and whether the doctor has been reprimanded or sanctioned by a state medical board. Because insurance companies typically use the same physicians, much of this information has been previously gather in litigation. Obtaining the right information can make all the difference when appealing a denial or termination of a disability insurance claim.