On a list of occupations ranked by difficulty and stress, doctors would appear near the top, along with astronauts, firefighters and, the mother of them all, junior high school teachers. Similarly, the nature of ranked lists means that for every outstanding doctor, there is a… let’s say “less outstanding doctor.”

Insurance providers employ teams of doctors who review long-term disability claims and then give their opinions on the merits of those claims. Not all of these people are the caliber of doctor you’d want prescribing you with crucial medications or hovering above your abdomen with a scalpel. In some cases, these doctors have absolutely no experience with the medical conditions they’re reviewing, which is how the case below, seemingly a slam-dunk disability claim, was needlessly denied and ended up in court.

They forgot to consider cognitive demands

In Wessberg v. Unum Life Ins. Co. of Am., the plaintiff, an attorney, was diagnosed with bilateral invasive breast cancer, requiring radiation, chemotherapy, and surgeries. Unum Life initially approved her long-term disability claim, but 16 months later they terminated her benefits, based on her oncologist’s report that her physical condition had improved.

Attorneys reading this will see the first flaw in this decision. Practicing law isn’t a physical occupation; it’s almost entirely cognitive. Unum had not considered notes from the plaintiff’s mental health provider, reporting that she was “experiencing disabling cognitive symptoms, including fatigue, dizziness, concentration issues, and fainting.” It doesn’t take a doctor to deduce that these are disqualifying symptoms for even trivial legal work.

The doctors were utterly unqualified

The court went on to note the fact that both of Unum’s reviewing doctors had considerable legitimacy issues. These issues included:

  • Neither of the two doctors had treated a patient in more than a decade.
  • Other courts had found the doctors to be not credible.
  • Neither doctor had experience in oncology or cognitive disabilities.

These hair-raising points, plus several administrative failures by Unum, brought a swift end to Unum’s defense.

The takeaways

We’re programed from an early age to regard doctors as infallible. As we grow older, we slowly realize that doctors make mistakes like the rest of us. Even with that understanding, we still tend to accept doctors’ opinions.

We’re also programmed to believe that juggernaut insurance companies have the best doctors and, even if they make an obvious mistake, their lawyers will snuff out any legal challenges. If nothing else, the case described above should overcome those perceptions.

Doctors working for insurance providers rarely have your best interests in mind. They are there to save the company money at every opportunity. With that top-line mandate, and their job security in the balance, it’s not surprising that these doctors will sometimes try to sneak a questionable or flat-out fictional judgement past applicants, knowing that only a small percentage of people will appeal their decisions.

Appeals matter more than most people realize. If you believe you have been wrongly denied long-term benefits, it’s absolutely worth your time to consult a lawyer.