If My Treating Doctor Says I Am Disabled, Are My Disability Benefits Denied?

If your treating doctor says that you are disabled, are my disability benefits denied?

This is a question which goes to the core of the reasons why the federal statute known as ERISA (Employee Retirement Income Security Act) is really quite a cruel joke which Congress has played on the unsuspecting employees/insureds in favor of the large employers and insurance companies.  When making a claim for Social Security benefits, the Administrative Law judge who decides the claim will give deference to the opinions of the treating physicians who have actually provided the “hands-on” treatment of the disabling medical condition.

Are insurance disability benefits denied? Unfortunately, this is not so in cases arising under ERISA.  There are specific court cases interpreting ERISA which provide that the insurance company is not required to give any deference to the treating physicians but that the insurance company may give more weight to the opinions of the treating doctor they have hired to conduct an Independent Medical Examination of you or even the treating doctor hired by the insurance company who only review the medical records in your case.

Of course, your claim may not be one which is governed by ERISA.  It would be important to have an attorney review this issue and prepare the arguments which need to be made on these points.

Please keep in mind that the foregoing is not intended as legal advice applicable to any individual person’s unique legal situation.  Its sole purpose is to give a general idea of the existing status of the law as it applies to the point of law addressed above.  You cannot rely on the foregoing as legal advice.  You cannot make legal decisions based on its contents.  If you have questions arising out of this point of law, you should contact an attorney who routinely handles claims involving policies of disability insurance.  The law offices of Herbert M. Hill, P.A. handles such cases and would welcome the opportunity to discuss your case with you, at no charge.  You can contact me at 407-839-0005 or at hmh@herbertmhill.com.

If you would like, after discussing your case, we can set a conference.  That conference would be free of charge and you would be under no obligation to hire me nor would you feel any pressure from me to do so.