One topic which has weighed on my mind recently is that of Insurance Company contact with my client’s Health Care Providers.
Too often this is handled in a fashion designed to discount or even change the clear opinions of your doctors regarding their medical findings and related physical restrictions. Let me identify some of the tactics employed by your Insurance Company contact.
The first tactic of insurance company contact involves a letter sent to your treating doctor asking him to sign off on some statement allegedly made during a telephone conference with either the doctor or one of his staff. This is coupled with a demand for an immediate response. Then, when the artificial deadline is not met, the suggestion is made that the doctor is uncooperative. Usually, that deadline is the result of the insurance company sitting on the claim for so long that it does, in fact, need something immediately but only because it wants to “look busy” in the face of its own inactivity and hopefully place the blame elsewhere for its own failure to act. Of course, your doctor is running a real world medical practice within office and out of the office appointments and schedules which have been pre-set and must be met. Also, the doctor has a reasonable expectation of being compensated for his or her work, something almost never offered by the insurance companies. Indeed, if the offer to pay was made, the doctor would likely take the time to fully consider the matter, something the insurance company does not want when it is trying to put words in the doctor’s mouth.
I love to call insurance companies “it” because, in fact, that is what they are, especially when it comes to insurance company contact. Despite the commercials about being on your side, insurance companies are heartless and soulless legal fictions with no purpose other than to make money. You are the one at whose expense the effort is now being made to make that money by saving on the payment of a legitimate claim for benefits which they agreed to pay, at least when the premiums were being paid.
Another tactic is for the insurance company to have its hired gun “medical records reviewers” call up and impose upon an alleged professional courtesy with your treating doctor, insisting that the phone call is taken immediately. The number of times the author has seen these medical records reviewers make comments about treating doctor’s findings totally inapposite to the actual opinions expressed by the treating doctor would be considered astonishing if it were not the actual routine practice employed by these insurance company hired guns.
One of the first steps taken by Herbert M. Hill, P.A. when hired for representation on a disability benefits claim, whether on a private policy or on a group policy governed by ERISA, in which benefits have been denied is to advise the insurance that there is to be no further contact with my client treating doctors without our prior knowledge. All such insurance company contact have to be in writing and given to us as well such that we can ensure the doctor is given adequate time to respond and fully consider the opinion he is being asked to render. Every effort is made to tightly control such contact. This is necessary because we are never given the chance to speak with the physicians hired by the insurance company about the predetermined opinions for which they routinely pay.
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 with your Insurance Company Contact, 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.
Herbert M. Hill, P.A. is a law firm located in Orlando, Florida with a practice extending throughout the state of Florida and the southeastern part of the United States. Areas of practice include disability and 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.
