When Short Term Disability or Long Term Disability benefit claims are denied an “Administrative Appeal” must be filed. This is a time when you really need an attorney to guide you through the regulatory you will encounter. The new regulations concerning the use of “medical records reviewers” hired by the insurance company to render medical opinions regarding your claim are part of that maze.
Of course, these doctors’ opinions are just basically bought and sold. I think of the clients of mine who were clearly disabled on first meeting and the ones who, although they look fine, are clearly disabled by the well-documented medical conditions found in the medical records. Yet, somehow these so-called “independent” doctors render opinions which are based whichever way the wind is blowing. They never see a patient. They “cherry pick” their way through the medical records, entirely discounting your reports of long term, chronic symptomatology and the clear diagnoses rendered by your treating doctors, even those based on verifiable objective testing.
I am always curious to see if the doctors’ invoices for services rendered are included in the documents produced. I want to see how they are being paid to rubber stamp these predetermined conclusions. Surprisingly, the invoices are generally only for a few hundred dollars. For this, they will have rendered an eight (8) to 10-page report. A few hundred dollars is barely enough to get them to affix their signature. The real cost of such a report would likely be in the tens of thousands of dollars. The only way the report could be rendered for $325.00, the amount of the last invoice I saw, is for someone else to review the records and prepare the report. I wonder if the doctor even reads it…
Then during the review of the Administrative Appeal, the insurance company is required to provide you a copy of the report and allow you 21 days to respond. Of course, they mail it to you so you do not receive until halfway through the comment period. It may be necessary to secure input from a treating physician in response to comments or opinions attributed to them. Quick and specific action needs to be undertaken.
We handle these and other issues as a matter of routine at Herbert M. Hill, P.A. If you have any questions about this issue or any other issue arising in your Short Term Disability or Long Term Disability claim, please give us a call at 407-839-0005 or 844-454-59995, 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.