Legal Question in Insurance Law in Ohio

My doctor has had me off work since 1/18/10 on short term disability. MetLife of Connecticut denied my original claim. I filed an appeal. Toward the end of their 45 days for the appeal decision, they decided to refer my case to 2 of their doctors giving them another 30 days. Toward the end of that time frame they requested dictated copies from my doctor even though I had submitted actual office visit notes upon their request. My doctor sent them a bill for $125 & would havethe dictated copies sent to them. They refused to pay; I filed a complaint with the insurance commission of Ohio; they decided to pay for the dictations & gave them to another doctor to review. They now decide to deny my claim again based on the recommendation of a "doctor" whom has never spoke with or examined me. Is it legal for a doctor to make a decision based only on a few pages of questions, not reviewing my entire file or examining me?


Asked on 5/27/10, 12:42 pm

1 Answer from Attorneys
Vaseem Hadi Rendigs, Fry, Kiely & Dennis LLP

It sounds like they made the determination off of a medical file review/audit. While they can make a decision off of that, it's weak as they didn't have someone personally examine you for an IME (independent medical exam). You have no choice now but to hire an attorney and file a lawsuit for breach of contract and bad faith. Filing a complaint with the Insurance Commission won't get you anywhere. Please call me to discuss potential representation.

Vaseem S. Hadi

513-381-9216

www.rendigs.com

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Answered on 5/28/10, 6:25 am


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