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Traverse City, Michigan

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Tim Smith
Tim Smith
Attorney • 231-946-0700

Insurance Company Doctors

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I think it’s important for attorneys to keep track of the different trial and appellate judges they appear in front of. It helps attorneys to give "counsel" to their clients. If you have an understanding about how a particular judge stands on a particular issue, it gives you a better ability to advise and counsel your client as to how their particular legal issue may fare in the courts of this state. So, it has been with a watchful eye that I have followed the beginning of the career of the newest Michigan Appellate Judge, the Honorable Jane M. Beckering.

In one of her first decisions since being appointed to the Court of Appeals by Governor Granholm, Judge Beckering appeared with fellow Michigan Court of Appeals Judges Henry Saad and Kathleen Jansen. The case entitled Spencer v. State Farm Mutual Auto Insurance Company. dealt with State Farm’s denial of certain medical benefits claimed to be due and owning to Ms. Spencer.

In Michigan, we have a no-fault auto insurance system which requires an auto insurer to pay for medical treatment related to injuries caused by the insured’s use of a motor vehicle. In this case, Plaintiff was injured in an automobile accident. Her treating physicians felt that the treatment and physical therapy that she was receiving were due to the injuries sustained in the accident. State Farm sent their insured to an insurance company doctor who, after a cursory examination, reported that her medical condition could not be related to the car accident. Based solely upon the opinion of their own doctor, State Farm terminated her benefits.

Judge Beckering, in affirming a long line of case law here in Michigan held that it is absolutely improper for an insurer to deny coverage when the insurance doctor’s opinion conflicts with and is contrary to the medical evidence from the treating physicians. Judge Beckering found that the Defendant’s claims adjuster made no effort to reconcile the conflicting medical information which caused the denial of benefits to be legally unreasonable and justified an award of penalty attorneys fees and costs against State Farm in this auto accident claim.

It shouldn’t be a surprise that insurance companies utilize the services of these insurance company doctors to justify decisions to terminate benefits of their insureds. The insurance company doctor or defense doctor has become a standard tool for insurance companies to utilize in attempting to terminate their insured’s benefits.

The insurance doctor industry has become quite a cash cow for those medical practitioners willing to engage in an area of practice typically looked at by other doctors as a task for those who are unable to make a living in private practice. In fact, there are a number of insurance doctors in this state that make hundreds of thousands of dollars per year performing these one time exams at the request of insurance companies.

Not surprisingly, many of them have questionable academic backgrounds, a private practice which produces many malpractice claims and, in some cases, even criminal convictions.

Tune in to my next post as I discuss some of Michigan’s more notorious insurance doctors.