When the ERISA administrator decides to send you to a medical examination with a doctor they have chosen, there are some things you can do to fight back. I say fight back, because in 20 years of law practice helping people with disability insurance and ERISA Disability claims, I can count on one hand the number of times the insurance company’s doctor said my client was disabled. Expect a fight if the ERISA plan insurer is sending you to to a disability medical examination.
5 Tips for Dealing with the ERISA Insurance Company’s Doctor Examination:
1. Do not go alone. Bring a friend, a spouse, a parent to watch the exam. If they will not let the person observe the exam, something is fishy. Call the insurance company before you go and confirm that they have picked a doctor that will let you bring someone with you.
2. When you call the insurer, ask them if they will allow you to video the exam. You can have a local videographer come with you. Even if they will not allow a person to join you, the video will make up for that. You want the video because, more than anything else, it will keep the doctor as honest as possible.
3. Be observant. Make mental notes about everything you see and the doctor say. Even if you end up going to an exam without a friend or someone shooting video of the exam, you may notice many things that can call into question the accuracy or honesty of the doctor. When you leave the exam, make notes about a) how long you were there, b) what the exam room looked like, c) if there were signs that the doctor does not actually treat people regularly, d) how the exam room looked, e) things on the walls….how old is the doctor, where did they go to school (Grenada? Seriously), etc., f) what the doctor asked you and comments they made, and g) how long the exam lasted.
4. Ask the doctor questions. Get them to talk to you about your condition and what they think. If they are cagey or don’t answer your questions with a straight answer, you know what you are dealing with. Make mental notes about their answer.
5. Beware of surveillance video….insurance companies that run ERISA Disability plans often schedule a private investigator to follow you to/from the disability exam. They are hoping to catch you driving all over town, shopping, or whatever they may think catches you in a lie. Look over the forms you have filed with the ERISA administrator and the statements you have given them. The ERISA insurer is tracking your movements compared to those forms and statements. The more you have given them a hard and fast limitation (“I can only sit for 10 minutes” compared to “Some days I can only sit for 10 minutes and other days I can sit for 30 minutes or so, but I can’t predict if I am going to have a good day or bad day.”)
Tucker’s Bonus Tip: My last comment in #5 about hard and fast limitations is crucial. No one has the same restrictions and limitations every day. Explain to the insurance company’s doctor things like: a) good days vs. bad days, b) unpredictable symptoms, c) side effects of medications, d) how things like pain can impact your concentration, etc. You have to give the doctor specifics and the nuance of your conditions. Often, they will not write down everything you tell them when you give them a lot of detail. Remember what you told the doctor, and read their report to see if they wrote everything down.
Attorney John Tucker has been fighting to keep his client’s ERISA disability claims from being denied for 20 years. For a free consultation about your ERISA Disability case, call (866) 282-5260.