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Tricks of the Disability Insurance Companies

September 08, 2007 - 03:51 PM
Category: Miscellaneous

Here's one we still see with some frequency in ERISA governed long term disability insurance claims.

The insurance company makes a decision that the claimant is not disabled, and writes (or calls) the treating docotor with this type of message:

"Dear Doctor, our review indicates your patient could work a 40 hour week, no problem. If you don't agree with our review, let us know within 10 days or we'll assume you agree."

Courts have ruled that no negative inference can be drawn from a doctor's failure to respond. (See Brenner v. Hartford, 2001 WL 224826 (D.Md. 2001) which points out: "Little significance can be attributed to Dr. Avin's unresponsiveness to Defendant's request for comments as the lack of response could as likely be a result of inadvertence or inattention due to other pressing demands in a physician's schedule." n.10)

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