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Insurers Rely on Doctors Whose Judgments Have Been Criticized by Courts

In dozens of cases ProPublica reviewed, judges found that some doctors working for these companies engaged in “selective readings” of medical evidence and “shut their eyes” to medical opinions opposing their conclusions.

They wanted to know why United Healthcare had denied coverage for a 15-year-old girl named Emily Dwyer, whose anorexia had taken such a toll on her body that she had arrived at a residential treatment facility wearing her 8-year-old sister’s jeans. King said many of his cases end in settlements — with confidentiality clauses that prevent the parties from disclosing the terms — in large part because families want to avoid the uncertainty of going to court and a process that often lasts several years. They faulted the Employee Retirement Income Security Act, which governs many insurance claims in court, for not allowing for punitive damages, the sort that can rise into the millions of dollars and deter companies from bad conduct.

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