A Pillar Of The Insurance Company’s Denial: The Insurance Company Doctor

A technique essential to an insurance company in denying claims is the hiring of a physician consultant on whom it can rely to support its denial.

Unlike the treating physician, most of these insurance company physicians never see or speak with the policyholder. Most only perform a “paper review.” Most disregard the reasoned and informed opinions of the treating doctors. Most employ an array of techniques calculated to selectively review the medical records to support the denial rather than to fairly evaluate the claim. Most assert “reasons” to support the denial that disregard medical science as well as the policyholder’s symptoms, limitations and the functional requirements of the policyholder’s employment.

It is difficult to know how many physicians in the country are willing to sign their name to falsehoods, distortions and disingenuous critiques at the expense of the genuinely disabled. The sad truth, however, is that there exists a subclass of physicians who are devoid of ethics, a subclass of physicians who do not hesitate to wield their credentials and medical knowledge, however modest, to provide cover for patently unfair claims decision.

The insurance company doctor may be an employee of the insurance company or a contractor who is paid by the hour. He may work for a company that provides medical reports to insurance companies. Whether the insurance company doctor is an employee or contractor, the one constant is money.

Many of the physicians who support insurance company denials are semi-retired. Some of these physicians have limited or failing practices. Although some have a substantial income from their medical practice, they perceive payments from the insurance company as an essential supplement to their income. Helping insurance companies generate and sustain denials no matter how meritorious the claim and desperately ill the policyholder is simply too lucrative for this brand of physician to spurn.


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