Credentialing & Privileging

Reviewing physician's opinion evidence in ERISA case

Credentialing Resource Center Connection, March 29, 2007

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A federal court in Alabama affirmed a lower court's grant of summary judgment to an employer denying a disability claim under the Employee Retirement Income Security Act of 1974 (ERISA). 

 

The plaintiff's treating physician is of the opinion that she is disabled and entitled to benefits. The insurer's reviewing physician examined the plaintiff's treatment records and opined that the insurer's denial of disability benefits was correct. Both reports were presented as evidence in the plaintiff's lawsuit to compel the insurer to pay her disability benefits. The lower court granted summary judgment to the employer.



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