Treating Doctor Cooperation

There is one big stumbling block with evidence in Long Term Disability benefit claims governed by the federal statute known as the Employee Retirement Income Security Act (“ERISA”), 29 U.S.C. §1001, et seq.  That problem relates to medical evidence.  As discussed elsewhere, the trial of the claim really occurs during the Administrative Appeal process which is directed to the Insurance Company or Plan Administrator.  During this process, the claimant has no subpoena power and is, therefore, forced to rely upon the cooperative, helpful treating physician.  Because of this, it is important to maintain a positive relationship with your doctor.

            Unfortunately, some doctors do not want to participate in the process because they are concerned that they will be subpoenaed to court or have their deposition taken, with a bunch of lawyers and a court reporter showing up at the doctor’s office.  Neither of these events will ever occur in a lawsuit filed pursuant to ERISA because the Courts have interpreted ERISA to provide that there is no real trial of the case.  This is because Courts have ruled that the only evidence they can consider is that set of documents known as the Administrative Record, the documents in the possession of the Insurance Company at the time the last benefit denial was rendered.  Therefore, no new medical evidence, such as testimony in Court or otherwise, is allowed.  Perhaps if the doctor understood that there will never be any testimony, they would better understand the need the claimant has for the requested cooperation.

            Another concern is that doctors will sometimes say the information is in the medical records.  Medical records address medical issues for determining the patient’s present status and potential need for future treatment.  In your claim, there are medico-legal questions which need to be addressed which the insurance company is clearly going to get their doctors to address.  The claimant needs to have the treating doctor, the doctor most familiar with the patient’s condition, also address these issues.  Sometimes, a request is made for completion of a Questionnaire.  Sometimes, a conference is held with the doctor leading to the preparation of a letter by the doctor stating his opinion on particular issues.  Either could prove invaluable in helping you protect what may be your last income stream.

            If this or any other issues about your Long Term Disability benefits claim are causing you concern, we can set a conference to discuss the matter.  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 ERISA, for short term or long term 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.