Why Do Doctors Let Themselves Be Compromised by Insurance Companies?

Why Do Doctors Let Themselves Be Compromised by Insurance Companies?

Schedule Your Free Consultation

My good friend and fellow trial lawyer Steven Gursten of Michigan has posted on his blog his experience with a physician hired on behalf of an insurance company to help defend an injury case. Steve called out the Michigan physician for her conduct.

I agree with Steve that it’s important to shine a spotlight on behaviors of insurance companies, defense lawyers and physicians who assist in mounting frivolous defenses to legitimate injury claims. In this post, I want to call out the questionable technique of the “paper review.” A paper or file review occurs when the defense enlists the assistance of a physician to review the medical records of an injured party to a claim or lawsuit for the purposes of securing a written opinion to diminish or criticize the claim, without ever laying eyes on the patient. This is often done in cases where the injuries cannot truly be diagnosed in the absence of a clinical assessment (meaning you need to see the patient).  Some physicians depend upon paper reviews for their income.

In a recent case of mine that was tried for over four weeks, a Connecticut physician, Anthony Alessi, M.D., an Associate Clinical Professor of Neurology and Orthopaedics at the University of Connecticut Medical School and Director, UConn NeuroSport Program, performed a paper review of my client and wrote a report indicating that she “had no objective evidence of any deficit on her neurologic exam relative to her traumatic brain injury.” Of course, Dr. Alessi was referring to an examination he did not perform, and all of my client’s physicians were convinced that she had suffered some level of brain injury.

Dr. Alessi’s report enabled the insurance company to carry the case to trial costing them [the insurance company] attorneys’ fees and other expenses, including paying Dr. Alessi (who had already been paid by me to give a deposition) as well as another expert – a neuroradiologist – to testify at trial.  Then, on the Friday evening after Dr. Alessi had testified in the afternoon as the last witness, a settlement was reached for an amount that will be many millions of dollars over my client’s life. But to reach that point, my client had to endure the great anxiety of a trial, and from her recovery, she will bear the cost of all the physicians, other healthcare providers and expert witnesses whom we brought in to testify.

This is an example of abuse of the legal system with an expert evaluation that was not credible. It supported a frivolous defense by the insurance company and made the witness look foolish in my judgment. In the end, the costs to the insurance company were far greater than they would have been had a proper examination of my client been performed and a legitimate assessment of her claim been made.

By Stewart M. Casper. Posted February 17, 2016

First posted on LinkedIn on February 12, 2016