Insurer sued over denied claims Doctor says firm misused its staff

CHATTANOOGA, Tenn. – A former doctor for UnumProvident has accused the insurer in a lawsuit of summarily denying disability claims, then using its medical staff to back up the denials.

The lawsuit alleges that Dr. Patrick McSharry, the former medical director at UnumProvident’s headquarters in Chattanooga, was fired in January after he refused to comply with the policy.

Linnea Olsen, a spokeswoman for UnumProvident, characterized the allegations as “absolutely false.” She said McSharry made his claims only after “certain job-related contentions” arose.

McSharry’s lawsuit, filed in federal court in Chattanooga, could provide ammunition for lawyers suing the disability insurer on behalf of policyholders who allege their claims were unfairly denied.

More than 60 lawyers have contacted McSharry’s lawyer, asking to interview the doctor for their cases, since the lawsuit was filed this summer.

A federal judge narrowed the depositions to cases where the evidence-gathering period was expiring, and McSharry testified in six cases earlier this month.

Much of the doctor’s testimony has been sealed from the public record. McSharry has an unlisted home phone number and could not be contacted. His lawyers did not return phone calls seeking comment.

McSharry’s lawsuit alleges that he and other doctors were hired “for the ostensible purpose of providing needed medical guidance in reaching benefit decisions.”

But the lawsuit says the doctors’ actual responsibility was “to provide language and conclusions supporting denial of claims.”

McSharry also charges that nonmedical employees and nurses made medical decisions and that doctors had to review a daily quota of claims, precluding meaningful analysis.

The doctors were not allowed to suggest additional tests, the lawsuit alleges, and were barred from helping policyholders improve their claims.

McSharry alleges that he told his supervisors he could no longer operate in good conscience under rules he believed violated federal laws. His supervisors retaliated with write-ups and warnings, eventually firing him for “disruptive behavior,” the lawsuit argues.

Olsen denied McSharry’s charges and said that if UnumProvident had a policy of denying claims, “we wouldn’t be in business.”

UnumProvident, the nation’s largest disability insurer, handled 400,000 new disability claims in 2001. In 90 percent of those cases, claims were approved and benefits paid, the spokeswoman said.

Only 0.4 percent of all claims ended up in litigation and that figure has remained fairly constant over the last few years, Olsen said