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| Erin Ronstadt

Litigating an ERISA case: Discovering Medical Reviewer Bias

If your disability benefits have been denied, your insurance company very likely hired an “independent” physician or medical reviewer to justify the denial of your claim. Insurance companies will often hire these “independent” reviewers to review a claimant’s medical records and provide opinions regarding the claimant’s functionality, pain levels, and overall disabled status. Ironically, these reviewers will never personally meet you, and yet will find that you can return to work in direct contradiction to the opinions of your treating physicians. This outcome is not surprising, especially when you consider that these reviewers are paid directly by the insurance company.

If you were subjected to one of these reviews and your case ends up in court, you may be entitled to conduct discovery into the potential bias of the reviewers who evaluated your claim. While ERISA does not require insurance companies to defer to the opinions of treating physicians, the Ninth Circuit has recognized that there is an inherent conflict of interest “when benefit plans repeatedly hire particular physicians as experts.” See Regula v. Delta Family–Care Disability Survivorship, 266 F.3d 1130, 1143 (9th Cir.2001), abrogated on other grounds, Black & Decker Disability Plan v. Nord, 538 U.S. 822, 832, 123 S.Ct. 1965, 155 L.Ed.2d 1034 (2003). The courts have recognized that these reviewers become incentivized to deny disability in order to preserve their consulting arrangements.

From my experiences practicing in this area, I frequently see the same reviewers over and over again conducting these “independent” reviews. Conducting discovery into reviewer bias is a valuable tool for uncovering an insurance company’s improper claims handling and conflict of interest.

Contact our firm to learn more about “independent” reviews in ERISA, as well as to get information about litigating your ERISA case in a court.

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