A paper review is where the long-term disability insurance company doesn’t even bother having their own medical professional perform a personal examination, but instead rejects your case based on the documentation you provide. This type of review is fairly common for physical impairments. The LTD company sends your medical records to one of their chosen doctors for a review and that doctor provides a run-down of your medical along with a statement about your functional ability that allows the insurer to say that you can work.
A typical example is where you provide an MRI report showing significant degenerative disc disease along with supporting medical information about your pain and treatment. Your doctor does not note any specific limitations as a result of your condition. You submit the records believing it proves that you are disabled from your occupation.
Most courts state that there is absolutely no law in place requiring the insurer to conduct a personal exam. In short, courts say using a paper review does not make a disability insurance company’s decision wrong and does not prove it was arbitrary or capricious. Courts even allow disability insurance companies to utilize physicians who are not even experts in disease process they are reviewing – like having a pediatrician comment on an adult’s orthopedic claim.
It is very likely that your disability insurance company will have a “paper review” done in your case. This paper review is something that the courts will likely uphold as supporting the LTD insurance company’s decision.
Because of this, you need to make sure you get as much evidence to support your claim as possible BEFORE even starting the filing process or DURING your appeal. The stronger and clearer you can make your case, the more difficulty the long-term disability insurer will have denying you. You need to get important evidence in the file before the paper review takes place – like accurate job descriptions, clear medical opinion evidence, and possibly clear vocational evidence.
A knowledgeable and experienced long-term disability attorney can help you develop and find evidence to support your claim. This can go a long way in court in proving that your insurer’s decision to deny should be overturned.
If you have questions about your long-term disability claim, call disability attorney Loyd Bourgeois at 985-240-9773.
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