Are Disability Insurance Company Doctors Fair?

Hi, I'm Greg Dell, joined by attorney Steven Jessup, and we're gonna discuss our Disability Insurance Company Doctors' Fair. And Steven, this is specifically, I'm talking about the doctors that are employed by disability insurance companies. And I wanna get your opinion and have a discussion about the fairness of these doctors and our experiences and what we see from them. So what's your thought when I say to you, are they fair? You know, I guess there's a little bit of bias because usually people call us with bad news. But I would say, as a default, unfair in the process, especially if they're employed by, you know, directly by the company. And then even, you know, we've seen the same, you know, outside doctors who are hired by, you know, these peer review companies, that same names over and over and over again, you know, just denial after denial with the same doctor. So fairness to me, no, I would say overall, definitely not fair. Yeah, I think they're more often than not, not fair, that they're looking at every single claim with a reason to deny a claim and a term that I call cherry picking, which basically means they're looking at the records and they're highlighting either something that's in the record that could be a positive for a claimant, and yet they're ignoring all of the other significant information that's in there that would support disability. And I think it's completely biased. First of all, these doctors are hired by the insurance company. They're bonused and paid based upon their performance of what they do. They know that their decision is gonna impact the earnings of the company. So it's a, it's not a good setup. It's almost like the law should say, yeah, look, you can have a doctor internally review the claims, but if that doctor finds that this person doesn't meet the definition of disability, then you're required by law to send out your review to an outside party. Yet, how often do you see that happen? Yeah, no, the times you do see that happen is usually on an appeal. Then they will send it to an outside party, but those outside parties are usually the same dozen or so doctors that you see in most cases. So many times, doesn't matter the insurance carrier or seeing the same names of the doctors, and a lot of times those doctors, if you look them up, any information you find on them is how many peer reviews or how many IMEs they've done. They're not practitioners. They're not like treating patients. All they do are these reviews for insurance companies, and I think that they are biased with this idea that everyone's lying or not being honest about restrictions, and they look for ways to deny the case or to show that this person would be capable of work. So we see and we keep a log of findings by these doctors, but I mean, there are certain companies that have the same doctor for 15, 20 years, and when we do case law research, which means that we're going out and looking at cases that have been decided, and the judges write opinions and they state, oh, Dr. Johnson or whatever the doctor's name, medical director at Unum Insurance Company, and then you find another case and another case and another case. Now granted, yeah, they have thousands of claims every year, so it's not surprising you're gonna see the doctor, but you start to see the trend and the behavior of this doctor. The other problem with these internal disability insurance company doctors is that they become desensitized, and why do you think that is? You know, I guess if you do anything long enough, it just, you take away some of the human aspect of it, you know, and it's kind of sad in the sense that as doctors, you take the Hippocratic Oath, you know, you're there to help people, but you know, they're even in a position where they're not even with patients treating, they're just looking at records, and I think it just becomes so impersonal, because they're not contacting to speak to the individual and generally not speaking to the doctor, so it's just this impersonal review. I almost like imagine in my mind they just sit alone in a room looking at records and there's just no emotion or sense of decency at times attached to it. It's just a cold, methodical, like, you know, whatever, sign off on, you know, the lack of restrictions, whatever the case may be. Yeah, I know from deposing doctors in some of the world's largest insurance companies that they basically have a little desk where it used to be like that, now they're probably just getting, they're working in their homes and they're getting sent a file, but they got dozens of them every day. Like, we need a file review on this, and they just, you know, they become desensitized. They just do, they do the bare minimum, and then they write, it's incredible to me how they can review hundreds of pages of medical records and write three sentences of which, you know, the first two are the same, you know, lacks objective findings to support their subjective complaints. Like, that's a conclusion. Like, where, you know, how are you getting to that statement yet you do it day in, day out, dozens of times every day when you're not even taking a deep dive into the medical records because you're probably not even reading the records on your own, you're relying on a nurse or some file reviewer who did the summary, and so many times we find that what the doctor internally was reviewing on was a complete ignoring of the medical records that were already there before them, and so that's the cherry picking because they're basically, there's no, like, ERISA, which is most of these cases are, doesn't give you the opportunity to go back and say, let me talk to that doctor, let me depose that doctor. When we get denials from, especially on the first level where most of these companies almost always go to their own internal insurance company doctors, we don't have the opportunity to call that doctor up and speak to him or her and say, why did you do this? Did you see this, did you see that? Those doctors will occasionally, they never call the claimant. They never call the claimant and ask, how could it be that they're rendering a decision in their entire career of treating patients, did they just look at medical records and never call the patient and say, hey, are you having this symptom? I looked at your records and saw, are you feeling this, are you feeling that? Why did they go to medical school for eight to 12 years to train to not ever consider what the patient says? They've been so long out of direct patient care that they just lose that thing. And even when they get the review from, hey, we need you to review this file, it's not review this file and let us know what you think. It's review this file and answer these four, five, six, seven leading questions that just by the nature of the question, we're asking you to try to find a way to disprove the information provided. And that's just the realm with which they think. And you know, one of the first things in medical school in the beginning is the Hippocratic oath to be a doctor is we'll do no harm to a patient, do whatever we can to help them. The other thing that every medical student's told on day one is you do not treat the chart, you treat the patient. And these doctors who are these internal doctors is all they do is treat the chart. It's the complete opposite of everything they were ever trained for, yet they do it. So who are these doctors? In my opinion, in my experience, they're usually either retired doctors who have a gig making 100 grand a year or whatever they're getting paid to nowadays probably work at home just review files, or they're often doctors who just couldn't cut it in personal practice and they're happy making 150,000 a year with a solid job with an insurance company with no pressure as long as they continue to find that more often than not claimants aren't denied. I mean, so they're not the best of the best. They're often not even in the same specialty of what the claim's about. How often do we have so many orthopedic claims and they have a general doctor, a family medicine doctor's reviewing the claim, yet how do you, insurance company, rely on your family medicine doctor versus the orthopedic surgeon, the neurologist, the also general doctor, the physiatrist, the physical therapist, the five doctors treating our client versus your go-to hired gun internal doctor who's just doing a paper review? That's the million dollar question really when it comes down to it. How this doctor reviewing a file and their infinite wisdom never, treating the patient, examining the patient, speaking to the doctors can take a look at the records and the opinions of your doctors and say, you just don't know what you're talking about. It's very insulting. Well, I don't find these doctors to be fair. I think the law is not fair for these claimants that allows these insurance companies to do it. And if the law, like every other thing in life, is gonna allow a company or an individual to do something, then people are gonna say I'm following the law. So the insurance companies are following the law and it's just not fair. So the doctors aren't fair, the law's not fair. What is somewhat fair is that the law has created rights for claimants to go up against these negative opinions that are found by doctors. And if you have the right lawyer, if you get the right evidence to the claim, to the insurance company, and you can prove, then you can overcome the burden of proving you're disabled and get the evidence to these doctors where you put them in a position where if you even think of saying that this claim is not disabled, you're gonna get blasted by a court and no reasonable person in their right mind would agree with you. So it's a situation of the way this is, but we fight this battle every day for claimants. And if claimants understand that they're not gonna necessarily get a fair shake from the internal doctor, that means you gotta go above and beyond with your medical records that you're submitting and really make sure they're super detailed and hold the insurance company's feet to the fire to say look, everything's in my medical records and if it's not in my records, here's what I'm experiencing and you better tell your doctor so that they know what's going on to make the right decision. So if you're someone out there who's having any issue whatsoever with your disability insurance claim, feel free to contact Steven or myself. No matter where you live in the country, we're available to assist you and we look forward to the opportunity to provide you with a free consultation.