Recently we discussed the impact a disability insurance paper review can have on ERISA disability claims. A “paper review” is where the insurance company doesn’t even bother having their own medical professional perform a personal examination, but instead rejects someone’s case based on the documentation they provide.
Though these paper reviews aren’t as accepted in mental health cases, they are a fairly common practice for insurers when the claimant is complaining of a physical impairment.
Claimants’ attorneys have tried to fight back against this practice in physical disability cases, but for the most part, they have had little luck.
Courts Back Disability Insurance Paper Review for Physical Ailments
One example of this occurred in 2008. A court rejected the argument made by a claimant’s lawyer that the insurance company’s decision—based on a paper review—was arbitrary and capricious. The court held that there is absolutely no law in place requiring the insurer to conduct a personal exam.
In short, the simple fact of using a paper review does not make a decision arbitrary or capricious.
In 2013, a court went even further, allowing physicians who were not Lyme disease experts to offer their opinions in a case involving Lyme disease because they were believed to be “sufficiently qualified.”
What does this mean if you are filing a claim about a physical condition?
One, it tells you that a disability insurance paper review is not only something you may have to face, but also that you probably aren’t going to be able to overturn it based on the lack of an examination. And two, you need to make sure you get as much evidence to support your claim as you can before going through the filing process.
The stronger and clearer your case is, the harder it will be for your insurance provider to deny you.
Additionally, a smart and experienced disability lawyer may be able to find other evidence to back the assertion that your insurer’s decision to deny, based on a paper review, was arbitrary and capricious or otherwise should be overturned.
For a free legal consultation, call (800) 562-9830
Knowledge and Preparation Are Your Strongest Allies
In the end, the best way to win a disability claim is to understand how disability laws work and what you must provide to your insurance company to get the benefits you need. Part of that is understanding disability insurance policies, and the other part is working with a lawyer experienced in ERISA law.
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