Can a disability insurance company decide to go ahead and call a claimant’s treating doctor and discuss the claim with them without the claimant even knowing about it?  Disability Insurance Attorneys Dell & Schaefer give recommendations that every disability insurance policy holder should know to avoid this situation.

GREG DELL: Hi. I’m attorney Greg Dell, here with attorney Victor Pena. And we’re going to discuss a situation that we see a lot that unfortunately results in many claim denials. And the issue is, can a disability insurance company decide to go ahead and call a claimant’s treating doctor and discuss the claim with them without the claimant even knowing about it?

VICTOR PENA: Well, the short answer is usually yes. And the reason is because, when you get those initial claim forms from the insurance company, in that packet, they usually include a whole bunch of authorizations. One of which requires you to sign off and give them authorization to contact your doctors directly. So then they can request medical records. They can reach out to the doctors and get additional information, things like that.

GREG DELL: So let’s talk about the problems we see with this phone call. We know that they can do it. And when we’re representing a claimant, what we often try to do is to say to the disability insurance company, send them a letter and say, look, if you want to speak to our claimant’s doctors, please let us know.

Because we don’t want to hear that you weren’t able to speak to them. Or we also don’t want it to be done behind our back, without the doctor being prepared. So that segues into, if we know this is going to happen, how do we protect our clients from this situation?

VICTOR PENA: Well, one of the things is what you just mentioned. You let the insurance company know, if they need to get in contact with the doctor, to let you know. And then you can make sure that the doctor’s responding, which is one of the biggest problems with doctors. They’re busy. Sometimes they don’t get the message. And oftentimes, they don’t respond at all. And then it causes a problem for the claimant.

GREG DELL: So the biggest struggle that I see is that the doctors either– two things happen. One is, the insurance company doctor, usually an in-house doctor or an outside doctor, will write some report or something and send it over to the treating doctor. The treating doctor will have some– it will be like, do you agree or disagree?

And the treating doctor might be in a rush, gets tons of stuff. And just says, I agree. And that almost always results in a claim denial. Because they’re obviously agreeing with something that’s counter to the benefit of the claimant.

The other thing is, they’ll have this phone call, and then the higher doctor will send a summary to the treating doctor and say, do you agree or disagree with what was said in this phone call? If you don’t respond, then you agree. And how often do you see that doctors don’t respond?

VICTOR PENA: Really often. A lot more often than you’d think. In fact, you can say sometimes they don’t respond more often than they do, especially where they get those letters summarizing the contents of the conversation. And then what they’ll do is just pick and choose and summarize the conversation. Just pick out little things from the conversation and make it hard for the doctor to respond.

GREG DELL: So here’s my tip for what the claimants have to do. You should tell your doctor that under no circumstances should they speak to the insurance company, or anybody, about your claim, until such time that you have given them approval. The reason for that is because, if we get involved with your claim, what we want to do is, we want to prepare the doctor for the phone call.

We want to have a conference with that doctor. We want to go see that doctor. We want to show them all of the other medical records. Let them know the total picture about what’s going on with you. We want them to understand the definition of disability in the occupation. Because really, that’s what it’s about.

The other doctors from in-house aren’t going to tell them about the definition of disability or what your occupation is. So you have to have your doctor prepped, bottom line. If they’re not prepped, 8 out of 10 times, you’re going to get screwed. Because your in-house doctor is going to, one way or the other, agree with the other doctor, unfortunately.

So very common problem we see. We recommend that you take our advice on how to avoid this situation. That if you do believe your doctor is going to be contacted, please contact us so that we can help you. This is just one of the services that we offer in terms of whether we’re helping you apply, managing your claim, or working during an appeal.

We’re going to provide you with a free review of your claim. We’re going to let you know further how we think we can help you. We’re available anywhere in the country. And we always offer a free initial consultation. We look forward to speaking with you.