THE INSURANCE COMPANY DOCTOR’S TECHNIQUES TO SUPPORT A DENIAL
April 7, 2016
The insurance company doctor is an essential cog in the insurance company’s denial mechanism. The insurance company doctor typically writes a memo or report on which the insurance company purports to base its claims decision. Techniques that an insurance company doctor commonly employs to assist the insurer in denying claims include:
(i) asserting erroneously that the policyholder has no “objective” evidence of a disability when, in fact, clear objective evidence exists to support the disabling symptoms;
(ii) minimizing the significance of the existing “objective” evidence of disability when its existence is impossible to deny; for example, the insurance doctor may characterize a 3 mm disc herniation — a condition well known to cause incapacitating pain — as “minimal” or “mild”;
(iii) asserting that the policyholder has no “objective” evidence of disabling symptoms due to such conditions as migraines or lupus even though persons afflicted by such conditions can experience incapacitating symptoms in the absence of “objective” signs; in fact, because no tests exist to objectively confirm symptoms of certain illnesses, it is well recognized medically that patients often experience disabling symptoms when no “objective” evidence is present;
(iv) taking entries in medical records out of context — such as selectively seizing upon entries to support the denial while disregarding other entries that render such “cherry picked” entries meaningless; for example, the insurance company doctor may state that the medical records establish that certain medications control the policyholder’s symptoms when the records reveal that these medications worked initially and then, over time, become ineffective;
(v) asserting that the policyholder has a great number of normal findings when these normal findings are irrelevant to the pertinent abnormal finding(s); for example, the insurance doctor may assert that a policyholder with a herniated disc has no evidence of impaired motor function and is therefore not disabled when, it is well recognized medically, that a person can suffer severe pain from a herniation in both the back and legs in the absence of impaired motor function.
These techniques are just a few of the many the insurance company doctor will employ to attempt to deprive a deserving policyholder of disability benefits. As long as there are people who are willing to sell their souls as the expense of the desperately disabled, there will be insurance company doctors.