Insurance Company Doctors

Another tactic we often see is that the insurance company will often pay so-called impartial paper reviewers or, even worse, have its own in-house physicians (employees of the insurance company) dispute your treating physicians’ findings. These paid-for opinions are an attempt to create evidence the insurance company can point to when denying your claim because you are capable of work. This is particularly problematic if you appealed an ERISA claim denial without an attorney and exhausted administrative remedies because the record in court will likely be limited to whatever evidence the insurance company had at the time of its final decision.

Clients or their prior attorneys rarely understand how important this appeal phase is, and some actually rely on the insurer to obtain medical records, talk to their doctors, and actually help them with their ERISA claim. Anyone who has dealt with an insurance company knows how this will play out in most cases. ERISA claims are often won and lost in the “administrative” review phase, and this will often take a very considerable amount of work.