People with long-term disability insurance file claims for benefits when their physical or mental impairments prevent them from working. All too often, LTD insurers seem to go to great lengths to find any way to deny these claims.
One of their most common tactics is to hire a doctor or other medical professional to review the claimant’s medical records or perform a medical exam. Then, the insurance company uses any aspect of the hired physician’s opinion it can as a basis to deny the claim. It is not unusual for these denials to be against the weight of the claimant’s medical evidence provided by his or her own treating physicians and therapists.
Conflict of interest?
An important legal issue in a federal lawsuit for LTD benefits that an LTD insurer has denied can be whether an inherent conflict of interest influenced the insurance company’s decision because it wears two diametrically opposed hats:
- Claims administrator that decides whether to approve or deny the claim
- Party of financial responsibility that will pay the claim, if approved
Obviously, the insurer’s “dual role” can create improper pressure to deny a claim that could have a potentially high payout over time.
Doctor’s subpoena in Wittmann v. Unum Life Insurance Company of America
On July 11, a judge of the U.S. District Court for the Eastern District of Louisiana upheld a subpoena in an LTD case where the claimant requested income information for a four-year period from a doctor who reviewed the medical records and who Unum had hired to do so.
Specifically, the court said that it was proper and not an “undue burden” to require the physician to show his total income for those years through tax returns as well as how much of that income came from Unum for providing his professional opinion in LTD claims. Accordingly, he was ordered to provide to the claimant any available documentation of the income from Unum.
This makes sense. If Unum was, in effect, a significant source of income for a doctor, that physician could feel pressure to provide opinions that would make it easy for UNUM to deny disability or minimize the claimant’s impairments.
In Wittmann, the judge said that the income information the claimant sought is “relevant to the existence and extent of Unum’s alleged conflict of interest.” Interestingly, only Unum objected to the subpoena. The doctor it hired did not. According to the court, a protective order covering the subpoenaed records would protect any privacy concerns the physician might have about disclosing his income information.