The Role of the Treating Physician vs. Peer Review Physician
Claims for disability benefits typically come down to an evaluation of the claimant’s medical diagnosis and treatment and the extent to which it prevents the claimant from performing the usual and customary duties of his occupation. The insurance company’s claims representative will have the claimant’s medical records reviewed and evaluated by a physician specializing in the field of plaintiff’s medical condition, a peer review physician, and request an opinion on the extent to which the medical condition restricts or limits the claimant’s ability to perform the duties of his occupation.
The disability benefits experts at MyLTDbenefits.com have successfully argued against defective peer review by insurers as to the credentials of the peer review provider, the bias of the peer review provider and/or the vendor who may hire the peer review provider, as well as to the quality of the review itself.
MyLTDbenefits.com lawyers realize that we have a responsibility to document our client’s position with well-written medical opinions, typically not just from one, but from several medical providers. A line of recent cases from the Sixth Circuit have been consistently critical of insurers for relying on records reviewers and not giving sufficient weight to the opinions of the attending physician. One court found that Liberty Life had acted arbitrarily and capriciously in denying benefits because, among other things, a file review by a neurosurgeon was clearly inadequate as it was unclear what data he had received and reviewed. In another case the court was critical of UnumProvident when it relied solely on file reviews by its in-house staff physicians and did not seek an independent medical review, either in the form of a file review or an actual examination, and for ignoring reliable medical evidence proffered by plaintiff.
To figure out the best strategy for presentation of your medical information to the carrier, and to the court if necessary, contact the long term disability benefit attorneys at MyLTDbenefits.com.