Psychiatric Disability Claims Denied without an Examination

1314903_medical_doctor.jpg Many of our clients suffer from psychiatric impairments that keep them from being able to work on a regular basis. As we see in most all of our disability cases, at some point in time the insurance company hires a psychologist or psychiatrist to review the medical records of our clients to manufacture a report finding that our client is not impaired or disabled. Significant authority provides that when dealing with psychiatric claims, the opinions of psychiatrists or psychologists who merely review written records are inherently unreliable as compared to the opinions of physicians and other health care providers who examine and treat the patient at issue. The American Psychiatric Association has instructed that the primary assessment tool for a psychiatrist evaluating an individual’s medical condition and treating those conditions is the face-to-face interview with the patient and “evaluations based solely on review of records … are inherently limited.” Westphal v. Eastman Kodak Co., 2006 WL 1720380, *5 (W.D.N.Y., June 21, 2006). The American Psychiatric Association further stated that it is “unethical for a psychiatrist to offer a professional opinion unless he or she has conducted an examination…” Id., citing “The Principals of Medical Ethics” Section 7, Paragraph 3, 2006 Edition. In Zoller v. INA Life Ins. Co. of New York and Lucent Technologies, Inc. Long Term Disability Plan for Mgmt. Employees, 2008 WL 3927462 (S.D.N.Y. 2008), the court held that “the practice [of relying on second-hand opinions of psychiatrists] seriously undermines a reviewing court’s confidence in such opinions where they appear to be, as in the instant case, unsupported and arbitrary rejections of the opinions of treating physicians.” Id. at * 14; see also Winkler v. Metropolitan Life Ins. Co., 170 Fed. Appx. 167, 168-69 (2nd Cir. 2006) (First-hand observation is especially important in the context of assessing psychiatric disabilities).

It has been noted that in disability cases involving mental illness, these cases “may be uniquely suited for diagnosis by personal examination.” Scotti v. The Prudential Welfare Benefits Plan, 2009 U.S. Dist. LEXIS 64559, at *16 (D.N.J. July 23, 2009). Courts discount the opinions of psychiatrists who have never seen the patient because unlike other medical doctors who can formulate medical opinions based upon objective clinical tests, the psychiatrist typically treats the patient’s subjective symptoms. Schwarzwaelder v. Merrill Lynch & Co., Inc., 606 F. Supp. 2d 546 (W.D. Pa. 2009), rev’d on other grounds, Merrill Lynch, Pierce, Fenner & Smith, Inc. v. Schwarzwaelder, 2012 U.S. App. LEXIS 16845 (3d Cir. Pa. Aug. 13, 2012). When a psychiatrist evaluates a patient’s mental condition, “a lot of this depends on interviewing the patient and spending time with the patient, . . . a methodology essential to understanding and treating the fears, anxieties, depression, and other subjective symptoms the patient describes.” Sheehan v. Metropolitan Life Ins. Co., 368 F. Supp. 2d 228, 254-55 (S.D.N.Y. 2005). A subjective evaluation is a requisite when a doctor is diagnosing the psychiatric state of a patient. Glunt v. Life Ins. Co. of N. Amer., 2012 U.S. Dist. LEXIS 8027 (E.D. Pa. January 24, 2012). As held by the court in Morse v. The Corning Inc. Pension Plan for Hourly Employees, U.S. Dist. LEXIS 12645 *26 (W.D.N.Y., Feb. 23, 2007):

Subtleties in the patient’s mannerisms, the nuances that are derived from her speech and gestures cannot be observed and evaluated by the non-examining physician. This is all necessary in the evaluation process and cannot be done in absentia nor by merely evaluating the treating physicians’ notes and opinions. Accordingly, it was error for MCMC to rely upon the opinions of two non-treating, non-examining doctors to the exclusion of the remaining substantial evidence in the record in finding that Morse was not disabled.

Oftentimes, disability claims are denied based on the opinion of a psychologist, psychiatrist or therapist who never examined or interviewed the person applying for disability benefits. Without the opportunity to observe an individual’s mannerisms, or the nuances derived from speech patterns or gestures, we believe the opinions of these record reviewing psychiatrists are unreliable and should not be used by the insurance companies to deny claims.

The O’Ryan Law firm has successfully represented numerous clients who suffer from psychiatric disabilities such as bipolar disorder, severe depression, and schizophrenia in proving to the insurance companies that these conditions are truly disabling. Please contact the O’Ryan Law firm if you believe that you are unable to return to work based on a psychiatric impairment.