Medical Records Reviewers Reports

Over the many years that I have handled Short Term and Long Term Disability claims, I used to complain in my various writings about the fact the claimant was never afforded an opportunity to comment on the “Medical Records Reviewers Reports” relied upon by insurance companies to deny benefits.

The governing federal regulations were changed recently to provide that claimants are allowed to comment.  Nonetheless, the insurance companies are abusing the new process.
Claimants are allowed to comment.  Then the insurance company sends it back to the reviewer for his comments and then back to the claimant, apparently, ad infinitum.  This has the intended practical effect of forever delaying the claim.  It is our position that the reviewers do not have an unlimited right of response.  It is clear the regulations intend for the last response to come from the claimant before the benefits determination is rendered.
One insurance company is taking the insupportable position that the new federal regulations do not apply to cases which have a date of disability prior to the their implementation.  As a lawyer who “booked” the course in law school known as “Conflicts of Law,” I can render a certain opinion that any change in the method by which a determination is made will be considered procedural in nature and, therefore, applicable to all claims then pending, regardless of the date of disability.
If you have any questions about the medical records review process of your short Term or Long Term Disability claim, please give us a call.  We are available at 407-839-0005 or, toll free, 844-454-59995.  After discussing your case, we can set an office conference, if you would like.
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 (“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.
By |2019-03-11T15:26:11-04:00March 11th, 2019|Blog|0 Comments