Personal Injury Law

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Stepping on the little guy: Why is my disability insurance claim being denied by the insurance company?

By Steve Lombardi (index)

Disability insurance doctors, the hired gun's opinion is a trick and mistreatment of the worse kinds.

GMA did a story this week about Charles Tucker, a 48-year old accountant from Titusville, Florida who developed multiple sclerosis, filed for long-term disability insurance only to be told, 'Sorry Charlie.' After GMA got involved, the insurance company suddenly had a change of heart and decided to start paying on the claim. Why did they deny the claim should be your first question? Well suddenly they realized that maybe the 11 doctors diagnosing multiple sclerosis would have more weight than the 1 company hired gun who said Mr. Tucker did not have multiple sclerosis. I'm not making this up; read it to see if I'm telling it like it is. ABC News. GMA.

'It was the expert opinion of 11 doctors that Tucker had MS, but the insurance company doctor said there wasn't enough evidence. In an official report, he said, "the diagnosis of multiple sclerosis is not supported ... and the patient could return to a sedentary work activity."

Common sense tells us to expect that any competent and honest doctor expressing an opinion having that will be relied upon for disability purposes will know the seriousness of this patients situation. These disability claims have the kinds of consequences that mean families do or don't have enough to eat or to pay the light bill or to buy school lunches. Son knowing that you'd figure the insurance company's doctor should be meticulous in taking the history conducting his examination of the patient and in ordering tests to confirm the medical findings. So what did this doctor do? In this case no physical examination of the patient had been made. Now granted I've not read the reports or seen what this doctor read and don't know this doctor but the report by GMA speaks for itself and says a lot about the claims denial process.

So Tucker or his attorney clearly frustrated contacted GMA and Chris Como gets involved with air time. At that point the insurance adjuster approved the claim and the insurance company began paying Charles Tucker, who really is just one of the little guys.

Here is what is troubling about this case. I'm glad GMA did what they did bringing light to what would otherwise just be one more of the little guys, who pays for insurance, becomes a disabled person and then is unfairly denied coverage when they need it the most; but what about all the others? GMA can't expose every situation. That means many of these claims just get swept under the rug.

If this is you fight back. Don't give up. Ask questions, write letters and then find a lawyer who is willing to assist you. You are not alone.

ABC GMA video link.

Originally posted at InjuryBoard by Steve Lombardi

Full post as published by Des Moines Personal Injury Lawyer on March 04, 2009 (boomark / email).