When it comes to a disability insurance claim denial, many intricate details lead to the subsequent appeals and lawsuits. A crucial element in most claims is the attending physician’s statement, records and diagnosis. This can substantially bolster a policyholder’s disability claim, but only if it’s documented in a proper way that actually benefits the claimant.
This brings to mind the question: Should disabled claimants allow the disability insurance companies to directly contact their treating physicians without their prior knowledge or the chance to provide sufficient input in what appears in the physician’s statement? Disability insurance attorney Greg Dell discuss the implications of this and how they protect clients in these situations.
According to Dell & Schaefer, disability insurance companies do have the right to contact a claimant’s physician and request input on the case. That’s because, when the insurance company sends out the initial packet with claim forms, they usually include a stack of authorizations. One of these requires you to sign off and give them permission to directly contact your doctors for supporting and additional information.
What’s Wrong With Letting an Insurance Company Contact Your Doctor?
Greg Dell identifies the issues and dangers of a disabled policyholder allowing his or her personal doctor to communicate directly with the insurance company. When a disability insurance firm such as Dell & Schaefer takes on a client dealing with a denied disability claim, they will take the first step of sending a letter to the insurance company requesting that the firm be informed prior to the insurer speaking with the claimant’s physician. This allows the law firm representing the disabled claimant to do several things.
- When a denied disability insurance benefit makes its way to court in a lawsuit, the insurance company often claims that they reached out to the attending physician and did not receive a timely response. This gives the insurer the upper hand and allows them to defer to the opinions of their own paid doctors or medical reviewers. As Dell & Schaefer explains that if your attorneys know ahead of time, they “can make sure that the doctor is responding, which is one of the biggest problems with doctors. They’re busy. Sometimes they don’t get the message. And oftentimes, they don’t respond at all. And then it causes a problem for the claimant.”
- When the insurance company reaches out to the claimant’s doctor, they often do so without the doctor being prepared to fully and accurately answer the questions as they are presented. According to attorney Greg Dell, the doctor from the insurance company, who is typically either an in-house doctor or a hired physician consultant, will write a report and send it over to the treating doctor to “agree or disagree.” The disabled claimant’s doctor gets a ton of stuff, might be in a rush, and just says, “I agree.” This almost always results in a claim denial that is counter to the benefit of the claimant (who is also the treating doctor’s personal patient.)
- The other thing that a disability insurance company will do is deliberately make it difficult for the physician to respond. For example, as Victor Pena points out, the insurance-company doctor may have a conversation with the treating doctor and then follow it up with a written summary of the conversation contents. But they will “pick and choose” bits of the discussion and summarize it in a way that makes it harder for the treating doctor to respond.
Tips for What the Claimant Should Do
Greg Dell, whose law firm has handled many thousands of long term disability insurance claims, offers his expert advice to those facing a denial, appeal or lawsuit from a disability insurance company. When it comes to how that insurance company interacts with the treating physician, never underestimate the importance of this crucial component of the claim.
Tell your doctor that, under no circumstances, should he or she speak to the insurance company (or anybody) about your claim until you have given them approval. When you bring in a qualified and knowledgeable disability insurance law firm to handle your case, the attorneys will prepare the doctor for that ever-important phone call or physician’s statement. A lawyer will go to see your doctor, have a conference with him, show the doctor all the other medical records, and make sure they have a total picture of what’s going on with you, the patient.
Equally important, the disability attorney will make sure the treating doctor knows and understands the “definition of disability” in your specific occupation. That, stresses Greg Dell, is what it’s really all about. The insurance-company doctors are not going to tell your treating physician about the “definition of disability” or even what your occupation is.
“So you have to have your doctor prepped, bottom line,” insists Greg Dell. “If they’re not prepped, eight out of 10 times, you’re going to get screwed.” It’s a very common problem, and a qualified attorney will help you avoid this situation. If you believe your doctor is going to be contacted, reach out to the attorneys at Dell & Schaefer before that happens. It’s just one of the services they offer, which coincides with them helping you apply, manage your claim, submit an appeal to a denial, negotiate a settlement, or defend your claim in a court of law.
The initial claim review and consultation is always free, and they’ll let you know if and how they can help. Dell & Schaefer represents policyholders anywhere in the county; just contact them by phone or via the company website for an immediate response.