Your disability insurance claim can be denied or terminated based solely upon the opinion of an unscrupulous physician hired by your insurance company. Typically, these so called “paper reviewers” make a substantial amount of money working for insurance companies. At DI Law Group, we receive numerous calls from claimants that attempted to apply for benefits on their own or were receiving benefits and were shocked to find out that their insurance company suddenly, and without warning, decided they are no longer disabled and terminated their monthly check based upon the opinion of a physician who never examined them, talked to them, or even bothered to contact their treating physician. With a physician certifying that the claimant is not disabled, it can be very difficult to overcome. Often it requires filing an aggressive and comprehensive appeal with statements from our client’s physicians and obtaining our own independent medical review or independent medical examination to overturn these unreasonable denials.
When DI Law Group prepares an appeal in which a paper reviewer was relied on to deny a disability insurance claim, we do a thorough investigation of the paper reviewer, including a background check, an evaluation of the paper reviewer’s prior court testimony, and an analysis of how often the paper reviewer is hired by insurance companies to perform these reviews. More often than not, we have already come across the physician and can extrapolate a pattern from the reviewer’s prior reports and/or have ample information regarding the reviewer’s background. This is important information for a claimant’s appeal.
Moreover, it is essential that we thoroughly evaluate the paper reviewer’s report and provide a detailed analysis of why the conclusions are incorrect, as well as pointing out any inconsistencies found in the report and with the claimant’s medical records. Often this requires that we consult with our independent medical consultants and the claimant’s physicians.
Further, we often obtain our own independent paper review and/or independent medical examination by a specialist in our client’s disability. Likewise, we closely work with our client’s physicians and obtain detailed statements regarding our client’s condition, symptoms, and limitations, as well as the physicians’ opinion regarding the insurance company’s paper reviewer’s report. Finally, we often obtain personal statements from our clients and their friends and family, clearly explaining our clients’ functional abilities.
Insurance companies commonly utilize paper reviewers to support a denial of disability insurance benefits. Typically, these paper reviewers earn a substantial income from this type of work and are motivated to find claimants not disabled. This common insurance company tactic is so pervasive that a case in which DI Law Group was able to successfully overturn a denial of benefits based on an infamous paper reviewer was featured on Good Morning America and was one of the reasons Senator Max Baucus held a Senate Hearing regarding the current state of the law.