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How a ‘doctor shopping’ accusation can derail your LTD insurance claim

On Behalf of | Jul 21, 2023 | Long Term Disability Claim Denial

Not all doctors are created equal. Getting a diagnosis for a disabling condition could require you to visit more than one physician. Some conditions are rare and difficult to diagnose correctly. Other times, you might get examined by a doctor who lacks the experience, attention to detail or compassion necessary to make the right diagnosis.

Either way, many seriously ill or debilitated people in Fresno must visit more than one doctor before finding out exactly what their medical issue is. In fact, it can take three, four or even more examinations from different doctors before you finally find out what the problem is. But what to you is a quest to get the correct diagnosis so you can get effective treatment might look to your long-term disability insurance provider like doctor shopping.

What is ‘doctor shopping’?

Doctor shopping is when a person sees doctor after doctor regarding the same health concern until they get the diagnosis they want. It is common practice among people struggling with addiction to opioids or other prescription drugs. In the LTD insurance context, it means searching for a doctor who agrees that you are disabled when you really are not. And your LTD insurer could use a claim of doctor shopping to deny your claim.

An excuse to deny a disability insurance claim

The adjuster who reviews your claim will likely notice in your medical records that multiple physicians examined you prior to your claim. Instead of assuming you were searching for a diagnosis in good faith, the adjuster could decide that you were doctor shopping until you found one who told you that you are disabled. They might then use that as the basis for rejecting your claim that you have a qualifying disabling condition under your policy’s terms.

An accusation of doctor shopping can harm your rightful claim for LTD benefits. But you do not have to accept a denied claim on this basis. An attorney who works in disability insurance law can advise you of your rights, including the right to appeal.