Physicians are not usually English majors nor are they trained in insurance law. So, when they write medical reports for disability patients who require their help in dealing with insurance companies, doctors do not always meet the needs of their patients.
Doctors are busy people whose main objective is to heal the sick and injured. Many physicians feel that ancillary duties, such as writing reports to disability insurance companies, are burdens which have to be borne and, in effect, interfere with their main function – healing. These physicians see the need to file medical reports and evaluations with insurance companies as a bother and pay less attention to them than they do to the healing arts.
But, a proper medical report may be just as important to a patient as is the cure, because it may hold the key to the patients’ wellbeing for the rest of the patient’s life. This is particularly true in the disability income insurance field where a patient tries to guard his or her most valuable asset (the ability to earn) against the disaster of serious illness or injury.
A careless phrase or inexact description in a medical report gives an all too eager insurer the excuse to deny a disability income claim. And this inattention unwittingly bring the claimant’s world crashing down. Unfortunately, this has happened many times and causes the misery of disability claimants to be geometrically compounded.
A disability income claim is usually a relatively large one for the insurer. Since a claim dollar saved is a claim dollar earned, one can’t blame the insurer for jumping on a report from a claimant’s physician which gives the insurer the slightest hope that the patient is not disabled so as to qualify the patient for disability income insurance payments over the long haul.
And, if the claim falls under the jurisdiction of Employee’s Retirement Income Security Act, (ERISA), the advantage in a contested claim action is definitely with the insurance company. Insurance companies have full time staffs of lawyers and investigators who go over each claim and its supporting documents with a fine tooth comb. At the first hint of a discrepancy in the claim, the insurer has the right to deny it and put the claimant (the doctor’s patient) to the burden of proving the validity of the claim.
You can just imagine the level of proof required to get the insurer to voluntarily change its mind and say, “OK, we’ll pay”.
What this means is that the claimant and counsel have the job of getting the reporting physician to understand the importance of clear and accurate reporting of the patient’s condition and prognosis. The doctor must be made aware that carelessness and inattention are not an option and that the required reporting is just as important a part of the patient’s treatment as surgery or medication.
Once the doctor understands this, a cooperative, professional effort for the benefit of the client is easily achievable. If the physician will give the attorney a few minutes on the phone, the outline of what information is important to the insurer can be laid out so as to guide the doctor to provide complete, accurate, relevant data and opinions in the medical report.
The physician may be willing to provide the patient (and thereby the attorney) with a copy of a proposed report so that they may review it for accuracy and for any omitted important material. This gives the claimant and the attorney a chance to suggest to the doctor inclusion of such material in the report to the insurance company. Such cooperation speeds up the process to the benefit of the claimant.
It is likewise vital that the patient and attorney be responsive to the needs of the physician in preparing the report. There should be no inordinate delays in reviewing and responding to a doctor’s suggested report. Further, no burdensome requests should be put forth to “gild the lily”. Only corrections or omissions which are thought to be necessary should be suggested and the claimant and the lawyer should enforce reasonable time parameters on themselves in making these suggestions.
It is obvious that a medical person will not be as familiar with the language of a disability income insurance policy as a lawyer practicing in that field of law. It is the task of the attorney, if given the opportunity, to explain the evaluation process of the insurer to the doctor so that the doctor files a report which answers the questions the insurer would have concerning the patient’s condition in the light of this evaluation process.
For example, a surgeon who develops a condition which causes his hands to shake involuntarily might be able to continue in the practice of medicine but be unable to continue to practice as a surgeon. If the surgeon has a policy which insures against being unable to practice as a surgeon (own occupation), then a poorly worded report stating that the surgeon can continue to work in a general practice might cause the patient all kinds of difficulty with the insurer even though the reporting physician knows that the surgeon clearly can no longer practice in the field of surgery.
Insurers love incomplete medical reports. They will try to use such reports to ask for more and more information to delay the payment of benefits. Such a report puts a tougher burden on the shoulders of the patient to refute it and clarify its meaning. And, even the reporting doctor will have the additional burden of undoing a mistaken or incomplete report or prognosis.
Once people in the medical field realize that in a good many cases, wellbeing of the patient does not end with the last office visit, they will give the requirements of reporting on disability claims the attention it deserves. This is especially true in disability income insurance matters. The requirements of these reports are often technical. But, doctors should know that the future peace of mind and wellbeing of their patient may very well depend on it.
Cooperation between the legal and medical professions is in the best interests of the patient because it offers the best method for providing the required medical information in an accurate, complete and meaningful way.
You, the patient, deserve no less than this
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