Medical records reviewers offer skewed opinions that often go against the word of your treating physician. Here’s how we can help you win your case regardless of what the independent physician says.
What Is ERISA?
It seems there are more and more Short Term Disability and Long Term Disability claims coming to our attention here at Herbert M. Hill, P.A. involving what are referred to as “Medical Records Reviewers Reports.” This is a fairly new process instituted with recent changes in the federal regulations governing claims pursuant to the federal statute commonly referred to as “ERISA” or, the “Employee Retirement Income Security Act.” ERISA is the federal statute that governs most Long Term Disability claims arising under policies or plans maintained by private employers.
Independent Reviewers
Previously, the reports generated by the medical records reviewers were only seen at the last minute, with no opportunity on the part of the claimant to comment or contest the content of those reports. While the regulatory process envisions these “medical records reviewers” as independent physicians allegedly rendering unbiased opinions, these doctors are rendering nothing but bought and sold opinions.
When we receive these reports, our response is immediate. We send it to our client for comment and input, we prepare our own comments and we also seek input from the treating physician who will have the most insight on the reasons why the medical records reviewer’s report is flawed.
Are Their Reports Accurate?
Usually, the reviewers simply “cherry-pick” their way through the medical records to find the information most supportive of their predetermined conclusion. In most cases, it is apparent that the reviewers do not even prepare the medical records summary on which they rely. One way to determine this is to assess the 1,000s of pages of medical records they supposedly reviewed with the two (2) to three (3) page summary and then the long report which they supposedly prepared and then review the invoice for their services.
It is not possible for a competent doctor to do such work for the amount of the invoice which is usually in the $1,000.00 range. The only conclusion is that not all of the work was done by the doctor the insurance company was required to hire. The insurance companies prepare and hand-feed the doctor the information the insurance company is relying on to support the denial of benefits.
How We Respond
It is necessary that the response be timely and well-presented as it will likely end up as evidence in Court. The initial deadlines are not binding as long as the insurance company is made aware that additional time is needed. While additional time is taken by this office when necessary to present the best possible response, it is also our intention to respond as quickly as possible to keep your claim moving along.
Discussing Your Case
If you would like, after discussing your case, we can set a conference. In most circumstances, that conference would be free of charge but in no circumstance would you be under any obligation to hire me nor would you feel any pressure from me to do so.
Herbert M. Hill, P.A. is a law firm located in Orlando, Florida, with a practice extending throughout the state of Florida. While the vast majority of cases handled are for disability insurance benefits, areas of practice include employee benefit claims of all sorts. The firm handles any claims arising under the Employee Retirement Income Security Act (known and referred to as “ERISA”) for disability benefits, medical benefits, retirement benefits of any sort, including pension, 401k, termination agreements or the like as well as claims arising under private disability policies.
