Mansell, Engel & Cole

Sometimes a legitimate fear: MDs who always support insurers

The reality for some insurance policyholders in Oklahoma and elsewhere with serious injuries or illnesses is that they can't catch a fair break at the doctor's office.

And that has nothing to do with typically bothersome things linked with medical visits, such as the inevitable waiting involved or bill statements that later arrive that take some real courage to open.

A recent article citing a disturbing insurance-related issue points to an altogether different concern that can grossly undermine fairness and safety in medical matters relevant to policyholders. That is the employment of doctors "who routinely provide favorable reports allowing insurers to deny benefits to those injured."

The aforementioned report cites regulators' and courts' "growing scrutiny" of such insurers in the context of benefits denied for on-the-job accidents and injuries. Claimants have also pointed to bad-faith denial-linked conduct in health claims unrelated to work.

How sad is that? We submit at Mansell, Engel & Cole that the callous nature of such a practice and anticipated outcome must jolt even the most cynical of people. It certainly turns the Hippocratic Oath's admonition to doctors to "do no harm" on its head.

One recently reported case cites the travails of a woman injured at work who subsequently had to cease her employment to have multiple surgeries fusing vertebrae in her neck.

The doctor the insurer required the woman to see had reportedly "never once … appeared for anyone other than an insurance company."

His findings predictability concluded that the claimant's injuries were preexisting and not work-related.

Ultimately, the woman reached a settlement with the insurer (an arm of national insurer AIG) through an administrative action filed with the U.S. Department of Labor.

And now she is suing the insurer in that wake of that agreement, alleging violation of the DOL's mandate that the company pay past and future medical expenses. Among other things, the lawsuit charges the insurer with bad faith for hiring a biased physician who it knew would "conduct an adverse medical examination."

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