Tricks Insurance Companies Play Part 2: When the Insurance Company Asks the Doctor for the Wrong Information

Previously, I wrote about one trick insurance companies use to deny benefits, when they deceptively structure the attending physician’s form so the insurance company can claim it shows the patient can do the job, even though the doctor intended to state that the patient could not perform the job.  A doctor could fill out the form properly for a bed-ridden paraplegic but the insurer could interpret it as allowing the person to perform a sedentary job. 

I recently saw another insurance company trick in a LTD ERISA appeal for a Westchester County client who was disabled by migraines. The basis for the denial was the same as I’ve seen in almost every case of disability based on migraines: the medical records did not address the frequency, duration and intensity of the headaches, so there was no proof the migraines were disabling.  Given that this was the basis for the denial, in reviewing the claim file, I expected to see the insurer asking the doctors about the frequency, duration and intensity of the headaches.  

What I found instead was that even though the insurer had sent detailed questionnaires to the three treating physicians, none of the questionnaires asked about the frequency, duration or intensity of the headaches suffered by my client!  Why didn’t the insurer ask for the frequency, duration and intensity information that it claimed was crucial to establishing disability?  Do you think that the insurance company didn’t want to get the right information from the doctors, and deliberately asked for the wrong information so it could deny benefits?  

I will be able to help this migraine disability client. I have ways to establish frequency, duration and intensity, and to prove that the migraines prevent the person from performing their job.  Also, since most of my ERISA appeal practice is in in Connecticut and Westchester County, I have worked with her doctors before, so I know we can work together to prove the client’s disability from migraines.  This is an example of two things to remember when choosing a LTD appeal lawyer for any type of condition:

• Choose a lawyer who has substantial of experience with ERISA LTD appeals so he or she knows how to prove disability with your particular condition; and

• Choose a local lawyer who may have dealt with your doctors before.  Knowing how a specific doctor works, what they want to see from the lawyer, and how responsive they are quite helpful in winning an ERISA LTD appeal.