Looking for Inconsistencies in Physician’s Statements: A Case Study
When you go to file a disability insurance claim, you will be required to submit evidence, usually including a statement signed by your treating physician, of your disability. What many don’t realize is that insurance companies will often require updated statements from treating physicians, and may even reach out to your physician directly with additional questions. What happens if your physician doesn’t fill out the form correctly, or somehow indicates you can return to work when you really can’t?
One such example of this is the case of Curiale v. Hartford.[1] Mr. Curiale was a vice president at Bear Sterns when he was injured in a motor vehicle accident and suffered head, shoulder and back injuries. As a result of his injuries, Mr. Curiale was no longer to perform sedentary work. He saw several physicians, many who completed physician’s statements that were submitted to Hartford.
One of Mr. Curiale’s doctors was a Dr Francis, who confirmed Mr. Curiale’s herniated discs and spondylolisthesis and noted several limitations including Mr. Curiale’s inability to bend at the waist, kneel, crouch or reach above his shoulder. On one physician’s statement, Dr. Francis opined that the limitations were expected to last for a year, but he also indicated on the form that there was an expected return to work date of six months. Hartford keyed in on this statement and sent a follow up letter to Dr. Francis. On this follow-up form, Hartford provided the definition of sedentary work and asked if Dr. Francis agreed that Mr. Curiale could perform such work on a full-time basis. Dr. Francis placed an x on the line indicating that he agreed with this statement. In a subsequent APS form, Dr. Francis opined on Mr. Curiale’s limitations again, indicating that they had improved. Based in part on this statement, Hartford terminated benefits.
However, Mr. Curiale underwent a functional capacity evaluation (FCE) which found that he would be unable to return to work in a sedentary position. When they received this FCE, Hartford again reached out to Dr. Francis. Dr. Francis indicated that Mr. Curiale’s functionality as represented on his previous APS did not remain “valid and accurate” and he indicated that he deferred to the expertise of the FCE clinician. However, Hartford still chose to uphold its denial of the claim.
The Court noted that the denial of benefits was triggered by comments by Dr. Francis that were subsequently withdrawn. Given this retraction, the court found that “the longitudinal medical record supports a finding of disability” and they found in favor of Mr. Curiale; however, not before the parties had had to engage in costly litigation. This case highlights how insurance companies will often cherry-pick statements from medical records and/or physician statements in order to find a basis to deny a claim—even in the face of other records or statements that consistently back up a finding of disability.
If you feel that your insurance company is looking to deny your claim based on an incomplete review of your medical records or physician’s statements, please feel free to reach out to one of our attorneys directly.
Every claim is unique and the discussion above is only a limited summary of the court’s ruling in this case. If you are concerned that your insurer is not evaluating your claim under the proper standard, an experienced disability insurance attorney can help you assess the situation and determine what options, if any, are available.
[1] Curiale v. Hartford Life and Accident Ins. Co., No. 2:21-cv-54, 2022 WL 2063261 (D. Vt. June 8, 2022).
