All insurance companies have their favorite physicians they use to support claim denials. In the past, many of them worked directly for the insurance company, but have long since retired. Unfortunately, these insurance physicians continue to leave their ethics by the wayside, reviewing and writing reports, doing doc-to-doc calls that support denial predominately. Whatever these voodoo physicians do, it’s never good news for insureds.
Unum has such a physician who is a neuropsychologist who I would have hoped had retired by now. Although I won’t mention his name publicly, if you send me an email I will tell you who he is. As a Lead Claims Specialist 20 years ago I did roundtables with this physician and I can tell you, he infrequently supported claims even then.
As an Expert Witness and Consultant, I once reported him to the Massachusetts Medical Board. It was my opinion that regardless who a physician works for, he is first and foremost a physician who took an oath to “do no harm.” Unfortunately, insurance physicians, particularly this one, interprets that as “do as much harm as you can.”
Repeatedly, I saw his name on medical reviews disputing disability for one insured or another. I’ve seen his reports from Guardian, Unum, and several others. This particular doctor is well-versed on the drill of denying disability claims. This means all of his prior experience with Unum well-prepared him with the necessary lingo to write reports denying disability to anyone.
This physician is by no means the only one. Unum had another neuropsychiatrist who because he was denied disability by the Navy denied everyone else. That was really a mess. Then, there was a female physician who was mean as hell. The last I heard she had her own practice in Maine. Although these physicians must be elderly by now and should retire, they never do.
I’ve written many articles about doc-to-doc calls, and outlandish insurance medical reviews. Therefore, I’m recommending one more time that insureds and claimants discuss the possibility of phone calls, questionnaires, and repeated requests for medical records with their doctors and decide ahead of time how this is to be handled. No treating physician is required to speak to insurance docs on the phone.
Please make sure you let your doctors know what you want them to do. This could really be a game changer if one of these voodoo doctors are asked to review your claim. Insurance companies aren’t stupid, they know who writes good reports and they use them time and again. Of course, the conclusion of the reports always supports the insurer who is signing their checks.