In a previous blog post we discussed how disability insurers use independent medical examinations (IMEs) to their own advantage, despite explicit state prohibitions. In this post, we will look at another similar ban that is also part of the California Regulatory Settlement Agreement with Unum. The fourth ban in the California Order prohibits Unum from selectively using portions of medical records and IME findings to its exclusive benefit.
Disability insurance companies require claimants to send in medical records when filing for disability benefits. In addition, disability insurers may also require claimants to undergo an IME and send in the results of the IME. When these medical records come in, the disability insurer sends them over to its in-house medical team for evaluation. In-house evaluations are problematic for disability claimants: Since the in-house people are employed by the disability insurer, they often look at the medical records and IME results with an eye toward what is best for the insurer, not the claimant.
Some in-house medical teams may even “cherry pick” medical records or portions of records to say that a claimant is not disabled. An extreme example of this would be if an insured told his doctor that he was feeling better on a particular day, even though his overall condition was still quite poor and continued interfering with his daily activities. An in-house medical team could “cherry pick” the medical records by highlighting the insured’s positive statement—that he was feeling better that day—and then using the statement to conclude that the disabled insured is well enough to go back to work. The in-house team would ignore the portion of the record that indicates the insured’s overall condition is still very poor. Another example of “cherry picking” would be if an insured met with one doctor who reported that he was not disabled, and then the insured got a second opinion from another doctor who said he was disabled, the in-house medical team would only rely on the first doctor’s report and ignore the second.
Even though they are prohibited from doing so, disability insurance companies continue engaging in these unfair business practices. The California Order is an attempt to limit disability insurance bad faith; it can be used to hold disability insurers accountable for their unfair practices. But, because these activities persist, before you file a disability claim you should find a disability insurance lawyer who can make sure the disability insurance company handles your claim appropriately.