The deciding factor in most disability lawsuits will be the quantity and quality of medical evidence on both sides of the claim. A plaintiff typically relies on the treating physicians to support the disability claim. Even where the treating physician(s) unanimously support the claim, the insurer may: (1) disregard or discount that information, (2) require the claimant to submit to one or more independent medical examinations (IME’s), or (3) submit the claimant’s medical records for review by captive or outside medical consultants personnel. Indeed, the insurer’s claim handlers themselves may question the reliability or accuracy of the treating physicians’ diagnosis and/or medical restrictions, and/or disagree with their conclusions about disability.
Evaluating this conflicting information is a challenge for claims people, attorneys and judges alike. The task can more difficult in ERISA litigation than in other legal contexts, because there may be little, if any, opportunity to conduct medical discovery or otherwise fill in gaps in the medical evidence.