Opinion ID: 70646
Heading Depth: 4
Heading Rank: 2

Heading: Possible Bias by Reviewing Physicians

Text: McDonald argues that because the three reviewing physicians are employed by agencies that contract with Hartford, the physicians were biased in favor of Hartford; therefore, Hartford abused its discretion in relying on their opinions. McDonald points to several federal district court cases that note a potential conflict of interest on the part of UDC, the organization that employs Drs. Turner and Pick, because of its “significant and ongoing relationship” with Hartford. See, e.g., Caplan v. CNA Fin. Corp., 544 F. Supp. 2d 984, 991–92 (N.D. Cal. 2008) (reviewing Hartford’s denial of claim with “skepticism” because structural conflict of interest accompanied by “reliance on UDC, a company which Hartford knows benefits financially from doing repeat business with it”). McDonald notes that Drs. Turner and Pick have been criticized by district courts for deficient reviews in similar cases. Hicklin v. Hartford Life & Accident Ins. Co., No. CV06-4543, 2007 WL 4729856, at –8,  (C.D. Cal. Dec. 12, 2007) (criticizing Hartford for “ignor[ing] the obvious, comb[ing] the record and [taking] selective evidence out of context as a pretext to deny” a claim, detailing misstatements and omissions by Dr. Turner, and describing Dr. Pick’s review as 16 Case: 09-30381 Document: 00511007186 Page: 17 Date Filed: 01/19/2010 No. 09-30381 “deficient”). Hartford, in turn, cites several district court cases affirming Hartford’s claim decisions that relied on opinions of UDC physicians. See, e.g., Singley v. Hartford Life & Accident Ins. Co., 497 F. Supp. 2d 807, 812 n.9 (S.D. Miss. 2007) (upholding Hartford’s denial of claim even though Hartford used reviewing physicians from UDC, including Dr. Turner); Dowdy v. Hartford Life & Accident Ins. Co., 458 F. Supp. 2d 289, 296 n.9 (S.D. Miss. 2006) (same). While the Fifth Circuit has yet to discuss in great detail the impact of potential physician bias on the ERISA standard of review, we have briefly dismissed similar arguments in the past. For example, in Sweatman v. Commercial Union Insurance Co., 39 F.3d at 601 n.14, we considered and rejected the argument that reviewing physicians were biased, based solely on their employment with a contracting agency. In that case, the physicians reviewed twenty to thirty files per month for a contracting agency, but the claimant pointed to no evidence to show that the physicians were financially dependent upon the agency or the plan administrator. Id. We noted that “the only way for [plan administrators] to meet [the claimant’s] standard for impartiality would be to seek physicians willing to volunteer their time to review the medical files of disability claimants.” Id. The Seventh Circuit recently examined a similar issue when a claimant argued that de novo review—rather than abuse of discretion—was warranted because the plan administrator used in-house doctors for its file reviews. Davis v. Unum Life Ins. Co. of Am., 444 F.3d 569, 575–76 (7th Cir. 2006). The Seventh Circuit held that absent evidence of “any specific incentive [for the in-house doctors] to derail [a] claim,” such as giving the doctors “some specific stake in the outcome of [a] case,” the theoretical argument that “in-house doctors have an inherent conflict in every case” is insufficient to change the standard of review. Id. Here, McDonald does not appear to have pursued discovery on this issue, nor has she presented the type of specific evidence of bias that would show abuse 17 Case: 09-30381 Document: 00511007186 Page: 18 Date Filed: 01/19/2010 No. 09-30381 of discretion or justify a change in the standard of review. While she points to the conclusions of district courts and cites evidence presented in other cases, the record before us contains no documentary or testimonial evidence regarding the financial relationship between Hartford, UDC, and the individual physicians. Furthermore, McDonald does not present any evidence showing an incentive for the doctors to undermine her case in particular. McDonald’s attempts to provide specific evidence of bias fail to rise past the level of conclusory allegations; the district court did not err in finding that Hartford did not abuse its discretion on this point.