It is both ridiculous and unfortunate that properly filling out forms often matters more than all the other paperwork submitted by physicians and the context surrounding those forms. In many cases insurance companies have been able to argue that their decisions to deny benefits were reasonable because the forms treating physicians filled out were not completed perfectly.
It is both ridiculous and unfortunate that properly filling out forms often matters more than all the other paperwork submitted by physicians and the context surrounding those forms. In many cases insurance companies have been able to argue that their decisions to deny benefits were reasonable because the forms treating physicians filled out were not completed perfectly.In Carrigan v. Reliance Insurance Company, Carrigan’s doctors called him “disabled” without knowing the policy’s definition of disability. Although Carrigan’s primary care physician him as "disabled from even sedentary work," he did not set forth his definition of “disabled,” and he did document exactly what Carrigan’s limitations were or for how long.
Carrigan’s orthopedist did not give a conclusion one way or the other as to whether claimant was totally disabled. He did conclude that claimant had some physical limitations, but stated that claimant could work for a few hours a day, as long as appropriate positional changes were made.
Another of Carrigan’s doctors also failed to conclude whether Carrigan was totally disabled. At best, he confirmed that claimant suffered from chronic back pain and that his back problems could, at some point in the future, act to disable him from gainful employment. But he did not conclude that Carrigan was disabled.
Then Reliance brought in their vocational expert who concluded, using all the right forms and the right language, that Carrigan could perform his job duties.
That was all Reliance needed to prove to the court that their decision to deny benefits was reasonable and to get the court to find in their favor. Carrigan lost his benefits because Reliance could claim that without the right boxes checked and the correct language from his physicians, it was reasonable for Reliance to ignore his physicians’ statements.
This is why it is important to make sure your doctor understands what your insurance policy’s definition of disability is and knows to use the policy definition when answering questions. Bring a copy of your policy to your appointment and ask or pay for extra time with your doctor to be sure they get this right.
