Our client was a 53 year old dental hygienist who suffered a wrist injury to her dominant hand. She required multiple surgeries, including fixation devices to be installed. Her private disability insurance claim was terminated and she knew she needed help.
The private disability insurance policy insured her during the first 60 months for the ability to perform her own occupation. She was within this period of her policy.
Her claim was terminated following an examination by a doctor hired by the insurance company. Upon reviewing the report, we noted that surveillance had been obtained and given to the doctor.
The doctor, who was hired and paid by the disability insurance company, relied on this material to buttress his opinions in his report. However, he offered no description of what the surveillance observed of our client, or why it undercut her claim for benefits.
We demanded the surveillance video, noting we intended to share the examination report upon which the claim had been terminated, but that it would be manifestly unfair and a breach of the duty of good faith and fair dealing to refuse to produce this material.
Since the doctor who was being relied upon for the claim decision had the benefit of the surveillance, and even cited to as support for his position that our client was not disabled, it was appropriate for our client’s doctor to have the same array of information. Otherwise, we argued, they could attempt to reject the opinion of the treating physician, whose findings – supportive – would be dismissed as lacking the same body of information. Thus, the insurer was creating its own silo of information to ensure its support was strongest.
We also advised our client to secure upper extremity functional testing, to address specific dental specific procedures and movements to replicate what our client would be required to perform as part of her daily tasks. Through her testing failures, we were able to develop powerful evidence to utilize in support. This was objective evidence and not something a hired doctor could manipulate or distort.
Working with our client’s treating doctor, we developed a response to the examination report, where many of the supportive examination findings (which the hired doctor chose to ignore in his conclusions) were embraced, and all providers agreed. We nuanced the issues by having our client’s treating doctor truly appreciate the intense nature of our client’s vocational duties and provided the doctor with a statement from her employer addressing these vocational requirements and instruments utilized.
Putting this package together, including more detailed occupational requirement information and a statement from our client across a spectrum of issues, we also identified additional potential legal claims that we intended to bring if necessary.
Upon review and consideration of this material, and in a short period of time, the insurance company relented and agreed to pay the claim. Our client is now receiving her full monthly benefit.
