Opinion ID: 148924
Heading Depth: 3
Heading Rank: 1

Heading: Bias of Medical Consultants

Text: Rizzi claims the frequency with which Hartford engages the services of MAG and UDC provide these companies with “an incentive to make a finding of ‘not disabled’ in order to save their employers money and to preserve their own consulting arrangements.” Black & Decker Disability Plan v. Nord, 538 U.S. 822, 832 (2003) (quotations omitted).18 Therefore, we should accord little, if any, weight to their doctors’ opinions. 18 Rizzi fails to note the Nord case considered a wholly separate question from the one raised in this case -- whether a personal physician is entitled to greater deference than a non-treating physician; the Court concluded he is not. Nord, 538 U.S. 831. Nonetheless, the Court even-handedly countered the quote relied upon by Rizzi, - 18 - To support her allegations of bias by UDC and MAG physicians, Rizzi relies on Caplan v. CNA Financial Corp., et al., 544 F. Supp.2d 984 (N.D. Cal. 2008).19 In Caplan, the plaintiff applied for long-term benefits pursuant to a benefits plan administered by Hartford (who was also a named defendant in the case). He had suffered a lumbar spine injury and an injury to the ulnar nerve in his right arm in 1998. Id. at 986. In 1999 or early 2000 he began working for CNA and in 2003 injured his cervical spine and began experiencing problems with his hands. Id. After attempting several methods of accommodation and engaging in numerous consultations with physicians, Caplan applied for long-term disability benefits. Id. at 987. Hartford denied his claim and subsequent appeal based solely on a UDC physician’s opinions. Id. at 989. In seeking to overturn Hartford’s denial of benefits, Caplan claimed not only that the relationship between Hartford and the UDC physician called into question the physician’s trustworthiness, but also that the physician’s medical opinion was itself unreasonable. To support his argument, Caplan provided admissible evidence showing UDC obtained nearly seventy-five percent of its revenue from Hartford’s claim reviews and had reduced its hourly rates for Hartford-related work from $300 an hour to $225 as part recognizing a claimant’s treating physician also has the potential for bias. Id. at 832 (“And if a consultant engaged by a plan may have an ‘incentive’ to make a finding of ‘not disabled,’ so a treating physician, in a close case, may favor a finding of ‘disabled.’”). 19 Before the district court, Rizzi cited 41 cases where Hartford reportedly employed the services of MAG or UDC arguing this “shows a strong and ongoing relationship between Hartford and each medical consultant.” (Appellant’s App., Vol. I at 40.) The cases are currently between three and eight years old and are not cited on appeal. We do not consider them. - 19 - of a “volume discount type arrangement.” Id. UDC’s gross revenue had increased between 50 and 100 percent after it signed its contract to provide services to Hartford; Hartford had paid UDC more than $13 million between 2002 and 2008 for consulting services. Id. He also presented evidence that the physician who reviewed his claim had performed chart reviews for UDC “producing 217 evaluations for 202 Hartford claimants between January 1, 2005, and September 30, 2007 . . . . [and] of these 202 claimants, he found that 193 of them were capable of working full-time in some type of position under appropriate restrictions.” Id. at 990. The court found Caplan had shown “UDC ha[d] an incentive to provide [Hartford] with reports that will increase the chances that Hartford will return to UDC in the future.” Id. at 991. This bias led the court to view Hartford’s benefit decisions “with commensurate skepticism” and caused it “serious doubt [as to] the neutrality of [Hartford’s] decision-making process.” Id. at 992. The court also expressed significant concern over the unreasonableness of the reviewing physician’s conclusions and his personal history with Hartford. Rizzi demands similar skepticism of Drs. Dibble and Siegel because Hartford regularly contracts with their employers. While we do not quarrel with the result reached by the California district court, we cannot presume bias on the part of UDC based upon facts presented to another court more than two years ago (much less on the part of MAG which was not involved in Caplan).20 Rizzi identifies no admissible evidence of a significant financial incentive by 20 These facts are not in the record and Rizzi has not asked us to take judicial notice of them as evidence of the relationship between Hartford and UDC. Even if - 20 - MAG or UDC to decide claims in Hartford’s favor. Even more telling, Rizzi presents no evidence of an inherent bias or unreasonableness by Dr. Dibble or Dr. Siegel. The skepticism expressed in Caplan was due in large part to the physician’s individual history with Hartford and the unreasonableness of his conclusions. That physician “discounted a wealth of evidence” supporting Caplan’s claim including the results of “multiple MRIs” and objective functional capacity tests. Id. at 992. General accusations of bias against Dr. Dibble and Dr. Siegel do not provide a reason to doubt what otherwise appear to be competent and reasonable opinions. See Sweatman v. Commercial Union Ins. Co., 39 F.3d 594, 601 n.14 (5th Cir. 1994) (rejecting a similar sweeping argument of bias based solely upon a consultant’s employment with an agency which contracts regularly with a plan administrator). Drs. Dibble and Siegel independently noted Rizzi’s numerous medical examinations failed to identify any objective signs of disability -– a conclusion Rizzi does not challenge. Rather, Rizzi’s disability claim (and her physicians’ diagnoses) relied solely upon her subjective complaints of pain. The surveillance evidence showed Rizzi performing a variety of daily activities for significant periods of time without any indications of pain, distress, or difficulty. Drs. Dibble and Siegel each considered and addressed all subjective and requested our ability to take judicial notice of the claimed facts is questionable. “Judicial notice is appropriate where a matter is verifiable with certainty. It replaces the evidentiary procedure that would otherwise be necessary to establish adjudicative facts that are generally known or capable of accurate and ready determination by resort to reliable sources.” York v. Am. Tel. & Tel. Co., 95 F.3d 948, 958 (10th Cir. 1996) (citation and quotations omitted). These facts do not appear to be readily verifiable by public records or reliable sources, particularly because much may have changed in the time since they were admitted as evidence. - 21 - objective evidence in the record and separately arrived at the same conclusion. Hartford did not abuse its discretion in relying on their opinions simply because they are employed by MAG and UDC, respectively. Our cases recognize the hiring of independent physicians (defining “independent” as not including “[a plan administrator’s] own on-site physicians and nurses”) to review a medical file actually decreases the importance of a plan administrator’s inherent conflict of interest because they are not directly employed by the administrator. Holcomb, 578 F.3d at 1193; see, e.g., Loughray v. Hartford Group Life Ins. Co., No. 07-1189, 2010 WL 618032, at  (10th Cir. Feb. 23, 2010) (unpublished) (no abuse of discretion in relying on one outside physician against whom no evidence was presented undermining his independence).21 This is not to say that any hiring of an outside physician to review a claim of disability will automatically entitle a plan administrator to greater deference. Rizzi presented no evidence to suggest the medical opinions of Drs. Dibble or Siegel were suspect or that a significant fiscal relationship existed between Hartford and the doctors or their employers. We have no reason to depart from our previous holdings. Hartford’s reliance on independent physicians to review her benefits claim was not unreasonable or an abuse of its discretion.