Patient is Denied Disability by Insurance Company

Joseph O'Neill

Written by
— Updated on October 10, 2017

Health Insurance Expert WitnessThis disability services case takes place in Iowa and involves a female patient who has been denied long term disability by her insurance company. The patient had multiple medical issues including cancer, chronic intestinal disorders, hormone imbalances, glaucoma, and an undiagnosed condition that has manifested a wide range of physical and psychological issues. Despite her inability to work, her insurance company has denied her long-term benefits of disability payments. In order to establish her need for these payments, a medical expert was called upon to perform an independent medical examination of the patient.

Question(s) For Expert Witness

  • 1. Do you routinely treat patients similar to the one described in the case?
  • 2. Have you ever had a patient develop the outcome described in the case?
  • 3. Please discuss your background in evaluating disability claims and working with insurance companies.
  • 4. Have you ever served as an expert witness on a case similar to the one described above?

Expert Witness Response E-022714

My practice is mainly occupational medicine, however I do see these types of problems when I conduct Social Security Comprehensive Examinations for Disability. I have certainly seem comorbid conditions like these. I am not sure what you mean by “undiagnosed condition”, but that kind of throws up a red flag that there might be some other things going on. I have conducted disability evaluations for private insurance, workers compensation, Social Security for 20 years. I have done file reviews for LTD insurance carriers such as Prudential. I have been an expert on a number of disability cases. I cant recall an exact situation like this but certainly have experience with cancer, orthopedic issues, diabetes, hypothyroidism, etc.

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