Although medical review is perhaps the most important part of the investigation of a disability claim, it is also the most frequently used “stack the deck” procedure initiated by all US insurers, and everyone knows it!
That’s right. It’s not as though it’s a big secret that insurers misrepresent medical information to discredit claims; but, the real trick is to understand how to defend against an illusion, or medical opinions that deliberately create pictures of credibility based on bias and conflict of interest. While it’s not easy to defend against a negative, it’s not impossible either.
Physicians themselves have figured this out as well and are exhausted from filling out forms and providing patient notes that don’t seem to do any good to support patient disability claims. While most treating physicians once accepted disability claim patients it is now just as likely that physicians will turn insureds away for fear of being drawn into some sort of litigation. Physicians don’t have time for that; it’s not in their job description to support disability claims.
With the advent of credentialed insurance medical reviewer facilities, higher levels of written opinions are available to insurers looking to discredit claims from a medical perspective. Conversely, on the insureds’ side, physicians are slacking and are not providing quality levels of information that supports disability, or if they are still willing to complete and sign forms, results are not timely, giving insurers time to deny claims before medical support is ever submitted.
Today, it is even more important for insureds to submit update forms clearly describing primary and secondary diagnoses, medical restrictions and limitations, treatment plans, prognosis, and now, statements regarding appropriate and medical care. Some of the forms I am seeing from physicians are barely completed with multiple “blanks” in the boxes requesting physicians to “get off the fence” and support total disability. Fewer and fewer treating physicians are taking the time to do a good job on update forms while at the same time insurance companies are hiring highest credentialed hacks to review medical records. This is not likely to result in successful claims for very long.
Bottom line, physicians are looking to spend as little time as possible completing forms in support of their patients. This is not to say that there ARE doctors out there who go to great lengths to support their patients, and do so successfully even when they are not paid extra for their time. We all appreciate these physicians, and offer our sincere thanks.
It is important for insureds to make sure they are communicating with their physicians about the need for detailed medical restrictions and limitations. Your doctor may not be able to compete with the insurance “Voodoo doctors” but documenting clearly and specifically can go a long way to support a claim. Disability patients should take the time to talk with their doctors about the quality of paperwork needed in order to have paid claims.