Arrow Legal Solutions Group, PC

Common Tactics Used by Insurance Companies to Misrepresent Physician Statements

First, often insurance long-term disability providers engage in
practices that are opaque, dismissive, and sometimes misleading.

They do this by providing forms for treating medical providers that inadequately document a patient’s restrictions and limitations. For instance, they often do not allow medical providers to describe restrictions and limitations that preclude full-time competitive employment.

For example, waxing and waning symptoms can create a medical record in which it is noted that at times patients function well and at other times are completely dysfunctional.

Also, insurance companies disregard a patient’s baseline and hereby interpret phrases such as “doing well,” “shows improvement,” etc. as indicative of functional health and the capacity to work.

Because insurance companies do not go out of their way to solicit complete information that would compel them to grant benefits, they often do not ask information about a disability’s effect upon absences, punctuality, workplace errors and productivity. Instead, their forms are often inadequate, vague, and incomplete.

These forms deceive both patients and their physicians into believing that a full picture of a patient’s actual disability is being provided to the insurance company and considered by it.

Second, insurance companies often use language, terms, and phrases that are poorly understood by medical providers. Those terms include “constantly,” “frequently,” and “occasionally.”

Occasionally can mean as little as a few times during the day to up
to one third of the day. That is often not explained. Insurance companies are inexact in distinguishing the differences between full-time competitive work vs. part-time or subsidized work.

They do this by eliciting responses from treating physicians in which the treating physician may be thinking that they are indicating that their patient can do some work but are not suggesting they can work full time in a competitive employment
setting.

Within that ambiguity, insurance companies often conclude, based upon the treating physician’s input that a patient can work in full-time competitive employment when that opinion was not intended by the physician. They also fail to indicate that competitive work often requires reliability that precludes absences.

Medical providers, who may work in industries that allow significant accommodations for illnesses and other absences, may not be aware that most industries in the United States do not tolerate absences of two or more per month and sometimes even 1.5 absences per month–especially during initial-hire probationary periods that a lot of disabled persons cannot complete.

Third, insurance companies often improperly and misleadingly suggest that the term “objective evidence” excludes that evidence that can be derived from a patient’s signs and symptoms that the medical provider observes during examinations.

They also at times misleadingly suggest that once a medical condition is established through “objective evidence” that subjective symptoms cannot be considered or that a physician cannot consider their own extensive experience when opining upon a patient’s limitations and restrictions.

Lastly, insurance companies often do not seek clarification when a written or an oral question is asked of a medical provider and the question is vague and/or the response given is ambiguous.

In such situations they will usually infer a meaning that is most supportive of their denial of benefits.

In short, it is the insurance company’s nature to look for any and all ways to deny coverage and preserve profits instead of going out of its way to evaluate a claim in a transparent, equitable and fair manner.

Jury Service in Salt Lake County - A Jury By Slot Machine

I received notice in June that I can be called as a juror in the Salt Lake City Justice Court. Below are some of the questions I was asked so that fellow attorneys could decide whether or not I could be challenged for cause or they could use their peremptory challenges to eliminate my participation.

What that means is if a juror reveals a bias that is incompatible with serving as a juror, upon a challenge for cause, they will be automatically disqualified. Or if simply a party believes that they do not want myself or some other person as a jury member, based upon the answers we give to the court’s questions, each side can use one of their three peremptory challenges to disqualify them. Then the remaining jurors that are the appropriate number for the type of case serve to hear the evidence. That means that instead of getting a jury of “peers,” you get a jury of slot machine symbols. So it is a jury selected by a system akin to a “one armed bandit.”

If we really wanted juries of our “peers,” then after the challenges for cause were addressed, each side would pick the juror of their choice instead of having them selected through an arbitrary and random process of attrition. There are apocryphal and nonscientific opinions that this would somehow not work and lead to a lot of hung juries. To the contrary, it would be far superior to our current system and would lead to jury verdicts that better reflected the thought process of the most capable and would thereby produce more just and fair verdicts.

As part of the process of the selection, I was asked if I “strongly agree, agree, neutral, disagree, strongly disagree,” to the following questions (loosely speaking there is not a correct or right answer, but legally there is based upon specific legal principles that are a hallmark of our legal system):

Unfair treatment of underprivileged groups and classes is the chief cause of crime.

No one should be convicted of a crime on the basis of circumstantial evidence, no matter how strong such evidence is.

Wiretapping by anyone or for any reason should be completely illegal.

Because of the oppression and persecution minority group members suffer, they deserve leniency and special treatment in the courts.

A society with true freedom and equality for all would have very little crime.*

When there is a "hung" jury in a criminal case, the defendant should always be freed and the indictment dismissed.

Too many obviously guilty persons escape punishment because of legal technicalities.

Evidence illegally obtained should be admissible in court if such evidence is the only way of obtaining a conviction.

Any person who resists arrest commits a crime.

Defendants in a criminal case should be required to take the witness stand.

Accused persons should be required to take lie-detector tests.

Police should be allowed to arrest and question suspicious looking persons to determine whether they have been up to something illegal.

The law coddles criminals to the detriment of society.

Upstanding citizens have nothing to fear from the police.

Search warrants should clearly specify the person or things to be seized.

A defendant in a criminal case should not be required to prove their innocence beyond a reasonable doubt.

When determining a person's guilt or innocence, the existence of a prior arrest record should not be considered.

Citizens need to be protected against excess police power as well as against criminals.

It is better for society that several guilty individuals be freed than one innocent one wrongfully imprisoned.

It is moral and ethical for a lawyer to represent a defendant in a criminal case even when he/she believes his/her client is guilty.

The freedom of society is endangered as much by zealous law enforcement as by the acts of individual criminals.

In the long run, liberty is more important than order.

People who have been charged with a crime are typically guilty of committing that crime.

So what are the “correct” answers that would be consistent with specific legal principles that are a hallmark of our legal system?:

Unfair treatment of underprivileged groups and classes is the chief cause of crime.

Answer: there is no right or wrong answer to this question because it is a philosophical one, and your answer would largely demonstrate whether you are sympathetic to those charged with crimes or would tend to favor the prosecution.

No one should be convicted of a crime on the basis of circumstantial evidence, no matter how strong such evidence is.

Answer: circumstantial evidence can sustain any civil or criminal verdict so long as it complies with the specific burden of proof.

Wiretapping by anyone or for any reason should be completely illegal.

Answer: pursuant to specific laws that must be followed by law enforcement wiretapping is legal and the judge would determine whether or not evidence derived from wiretapping is admitted into evidence and it would be improper for a juror to disagree with the judge’s decision.

Because of the oppression and persecution minority group members suffer, they deserve leniency and special treatment in the courts.

Answer: pursuant to constitutional principles and other laws, it would be improper to either favor or disfavor a minority group based upon their minority status.

A society with true freedom and equality for all would have very little crime.

Answer: there is no right or wrong answer to this question because it is a philosophical one that is not subject to proof, and your answer may or may not cause either side to use a peremptory challenge against you.

When there is a "hung" jury in a criminal case, the defendant should always be freed and the indictment dismissed.

Answer: such opinion would be incompatible with the law but in practice there is no right or wrong answer to this question because it is a philosophical one that would never be addressed by a juror because they don’t decide whether or not after a hung jury the prosecution proceeds to a second trial. However, your answer would largely demonstrate whether you are sympathetic to those charged with crimes or would tend to favor the prosecution.

Too many obviously guilty persons escape punishment because of legal technicalities.

Answer: there is no right or wrong answer to this question because it is a philosophical one that is not subject to proof, and your answer would largely demonstrate whether you are sympathetic to those charged with crimes or would tend to favor the prosecution.

Evidence illegally obtained should be admissible in court if such evidence is the only way of obtaining a conviction.

Answer: pursuant to constitutional and legal principles illegally obtained evidence is not admissible regardless of what evidence is needed to obtain a conviction. A contrary answer would subject you to dismissal for cause.

Any person who resists arrest commits a crime.

Answer: pursuant to legal requirements that set forth elements of every crime, a person is not necessarily a criminal for resisting arrest. The prosecution would still have to prove all elements of the crime beyond a reasonable doubt. Categorically agreeing with the statement would cause you to be dismissed for cause.

Defendants in a criminal case should be required to take the witness stand.

Answer: pursuant to the United States and Utah Constitutions a criminal defendant cannot be compelled to take the witness stand and to agree that they should be compelled would cause you to be dismissed for cause. This is for good reason. We do a bad job of teaching why we have certain constitutional principles in the United States. It needs to be understood that if a person can be compelled to testify, it would corrupt that system of justice and would invariably justifies a sundry coercive tactics leading up to and including torture.

Accused persons should be required to take lie-detector tests.

Answer: the answer immediately above applies here also. Forcing a person to take a lie-detector test is a form of coercion. Moreover such tests are unreliable and inconclusive. They are simply a tool that can be administered when a criminal defendant voluntarily and freely agrees to take such a test.

Police should be allowed to arrest and question suspicious looking persons to determine whether they have been up to something illegal.

Answer: pursuant to the United States and Utah Constitutions law enforcement are barred from such tactics and agreeing with this idea is contrary to those constitutions and you would be dismissed for cause.

The law coddles criminals to the detriment of society.

Answer: there is no right or wrong answer to this question because it is a philosophical one that is not subject to proof and a person could reasonably have the opinion that our laws are to strict or are too lenient. Your answer would largely demonstrate whether you are sympathetic to those charged with crimes or would tend to favor the prosecution.

Upstanding citizens have nothing to fear from the police.

Answer: there is no right or wrong answer to this question because it is a philosophical one that is not subject to proof and a person could reasonably have this opinion, and your answer would largely demonstrate whether you are sympathetic to those charged with crimes or would tend to favor the prosecution. On the other hand, a strong opinion one way or the other could subject you to be dismissed for cause if the facts of the particular case made your opinion incompatible with adhering to proper jury instructions in the event it concerned a defendant’s right to remain silent or there was evidence of a defendant actually being fearful. This is because such fear is not necessarily indicative of guilt.

Search warrants should clearly specify the person or things to be seized.

Answer: pursuant to the United States and Utah Constitutions generally search warrants are required to provide such specifications. However, simply having an opinion to what degree detail is required in a search warrant would not necessarily cause you to be dismissed for cause. If not, your response would be used to determine how a party should exercise their peremptory challenge.

A defendant in a criminal case should not be required to prove their innocence beyond a reasonable doubt.

Answer: this is a trick and poorly worded question. Pursuant to the United States and Utah Constitutions only the prosecution is required to prove guilt beyond a reasonable doubt. A criminal defendant cannot be compelled to do so or even to prove their innocence in any other manner. I am hard-pressed to say how this question would work to qualify or disqualify a potential juror.

When determining a person's guilt or innocence, the existence of a prior arrest record should not be considered.

Answer: pursuant to legal principles a prior arrest record would rarely if ever be allowed into evidence to determine guilt or innocence. But a judge would make this decision. If a judge allowed such evidence to be introduced, then a juror could consider it for its probative value.

Citizens need to be protected against excess police power as well as against criminals.

Answer: pursuant to the United States and Utah Constitutions and other laws, this is a true statement. Strongly disagreeing with this statement could possibly subject a potential juror to a challenge for cause.

It is better for society that several guilty individuals be freed than one innocent one wrongfully imprisoned.

Answer: The United States and Utah Constitutions enshrine this principle. However, a potential juror could reasonably agree or disagree with this principle. The question would be whether or not they have an entrenched bias that would cause them to favor one side or the other and thereby subject them to a challenge for cause.

It is moral and ethical for a lawyer to represent a defendant in a criminal case even when he/she believes his/her client is guilty.

Answer: The United States and Utah Constitutions enshrine this principle. Believing otherwise would subject a juror for dismissal for cause. To assure that the government does not exercise improper authority in prosecuting someone, it is indispensable to the system of justice that criminal defendants have access to the same zealous representation and advocacy that the government to deploys.

The freedom of society is endangered as much by zealous law enforcement as by the acts of individual criminals.

Answer: while generally this is considered to be a true statement, the interpretation of “zealous,” suggests that there could reasonably be a difference of opinion and no right or wrong answer to this question because it is a philosophical one that is not subject to proof. The answer to this question would guide the parties on whether or not to use a peremptory challenge depending upon the potential juror’s answer.

In the long run, liberty is more important than order.

Answer: there is no right or wrong answer to this question because it is a philosophical one that is not subject to proof and a person could reasonably have this opinion. But agreeing that this is true would most likely signal that the potential juror would tend to favor the defense and not prosecution.

People who have been charged with a crime are typically guilty of committing that crime.

Answer: theoretically there is no right or wrong answer to this question because it is a philosophical one that is not subject to proof and a person could reasonably have the opinion that this is true or untrue. The fact is depending upon the particular government and its policing and justice system, there could be a high or low degree of charges of criminality that bear little or a great deal to the underlying guilt or innocence of the person’s charge. But a potential juror manifesting a strong opinion that this is true would probably be dismissed for cause.

Loren M Lambert,© 7/11/2025