Law Offices of Lawrence Mann
259 Oak Street, San Francisco, CA 94102
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Do You Have a Psychiatric Disability and Have Disability Insurance? Please Be Advised of the Following:

Psychiatric Disability Claims in San Francisco

Disability insurance carriers target for benefit termination psychiatric condition disability claims.

Unlike a broken bone on x-ray, psychiatric disorders often do not have “objective” findings (independently observable) apart from the patient history (where the patient says what is wrong). These claims are terminated, despite the fact that there is no legal requirement of “objective” evidence of disability. Also, disability insurance carriers have a proven history of targeting for termination high end claims (high monthly benefit payments, over $5,000 per month).

Disability insurance carriers often claim that there is no psychiatric disorder. Instead, the insured merely is a “malingerer,” has “burnout,” and has made a “personal choice” to stop work. For example, a major disability insurance company claimed that a hospital emergency department medical doctor with post traumatic stress disorder (PTSD), bipolar I, depression and anxiety (who repeatedly confused his patients and who was hiding out in other patient rooms during “code blues” while the code blue patients died, with the disabled doctor terrified to return to emergency department work out of fear he would kill more of his patients), merely had become tired of being an emergency room doctor.

Although one major disability insurance carrier in 2003 was ordered by the National Association of Insurance Commissioners, and California State Insurance Commissioner in 2005 to stop misusing the Insurance Medical Examination (IME) process, that IME misuse has continued. Insurance carriers know who the “friendly” doctors are who typically will support the insurance company’s position. You have the right to protest referral to a biased doctor.

Other insurance company tricks:

  1. Require the IME doctors to rely on earlier reports that the insurance company knows are incomplete or inaccurate.
  2. Cover-up positive psychiatric test results, not disclosing the results to the IME doctors or even to the insurance company “specialist” who denies the claim (insurance companies lock away these test results, and do not place them in the claims file).
  3. Not allow the IME doctors to comment on whether there is disability as defined under the controlling state law.
  4. Not informing the IME doctors of the state law total disability standard (typically easier to qualify as totally disabled, as opposed to the more difficult total disability definition found in the insurance policy [which is replaced by the state law definition by operation of the law]).
  5. Misuse of covert, aggressive surveillance, when there is no basis to order the surveillance, and misusing the results.
  6. Misuse of data received from the insured (e.g., misinterpreting the insured doctor’s billing codes, to create an argument that a surgeon’s duties really were those of a non-surgeon because his billings showed office consultations with patients considering surgery).
  7. Mischaracterizing the insured’s occupation or its duties to the IME doctors.
  8. Not requiring additional psychological tests (standard psychological practice when a diagnosis is in dispute), when initial testing revealed a psychiatric disorder, but the insurance company still questioned the diagnosis.
  9. Communicating to the insured an unreasonably low settlement offer, and target the claim for denial if the insured refuses the low ball offer.

Your disability insurance policy may have a short benefit period for psychatric disorders (e.g., payments only for two years if psychiatrically disabled, with exceptions). If you also are disabled from a non-psychiatric disability (co-morbidity; e.g., you have a bad back in addition to your psychiatric condition), your disability insurance company may try and exclude you under the psychiatric condition limitation. That is bad faith, and exposes the insurance company to punitive damages.

Knowing the right questions to ask your doctors, rather than relying on the often biased paperwork provided by your insurance company, can be one of your attorney's most valuable contributions.