Wolf In Sheep’s Clothing = Peer Review Physicians
Sure, they are doctors, talk the same medical language, and may be an active member of your local medical association or board certified in your specialty. BUT they aren’t about the same thing you are. You work for your patient’s best interests. They don’t. They are peer review physicians working for large financial institutions called insurance companies that employ a whole department of well-paid disability insurance lawyers. That’s what you and we are up against when battling for the disability insurance benefits your patients and our clients deserve.
Whenever you have a conversation with a peer review physician you would act in your patient’s best interests if you always took contemporaneous notes of those conversations. Just like the FBI, contemporaneous notes protect both you and your patients.
Here’s a good example when our client’s treating physician called their bluff. This could have impacted this patient and is just one of the hundreds I’ve dealt with through the years.
Our client, Jim Foster – a fictitious name to protect his identity – worked as a warehouse/sanitation worker at a distribution center cleaning and changing batteries, lifting garbage cans, sweeping, and mopping. He stopped working and filed for disability with CIGNA due to hand tremors and falls due to his leg giving way.
CIGNA denied Jim’s claim based on a peer-to-peer conversation with his neurologist, who felt Jim was able to do his job. However, the peer review physician failed to note that Jim’s neurologist had cautioned him not to drive or operate dangerous equipment when drowsy and deferred to Jim’s rheumatologist for an opinion on his other medical conditions.
Our law firm helped Jim win his case by obtaining the neurologist’s notes, as well as those of Jim’s rheumatologist and a letter from his primary care physician noting Jim was disabled due to leg, back and knee injuries. The peer review physician had represented himself as “working with the Henry Law Firm.” However, when Jim’s rheumatologist returned the peer reviewer’s phone call, the peer reviewer became evasive when asked for his credentials and Jim’s rheumatologist rightfully refused to provide any information.
It would appear that the peer reviewer was not objectively seeking information to provide an independent opinion regarding Jim’s functionality, but rather his peer-to-peer contact was an attempt to convince the treating providers to agree with his opinion. Failing to do so, he simply reported that there was no contact with the provider. Presented with this evidence thanks to the assistance and cooperation of Jim’s treating physicians, CIGNA reversed course and paid Jim his rightfully deserved benefits. Case Closed.
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