Which physician has the final word?

In this California case heard before the U.S. Supreme Court, the AMA filed a friend-of-the-court brief defending treating doctors' roles in workers' compensation cases.

By Tanya Albert, AMNews staff. May 5, 2003.

If a disability insurance plan's physician and a treating physician come to opposite conclusions on whether a patient is disabled, which doctor should have to justify his or her conclusion?

The U.S. Supreme Court in April heard arguments from the two sides in The Black & Decker Disability Plan v. Kenneth L. Nord on how to answer that question. The patient who sued the disability plan argued that the company's physician should have to give reasons why he disagreed with the doctors who treated Nord on an ongoing basis.

"It's more about who has the better information: the treating physician or the company physician," said Lawrence D. Rohlfing, a Santa Fe Springs, Calif., attorney representing Nord. "To have an insurance company and large corporation simply disregard what a treating physician says invades ... the patient-physician relationship."

Also, physicians for the company could have a conflict of interest when they evaluate the patient, the American Medical Association says in a friend-of-the-court brief it filed in the case. If the company's physician can't give substantial reasons to why he or she disagrees with the treating physician's conclusion it "should serve as a warning to fiduciaries that their decisions may be based on improper incentives," the AMA says.

Black and Decker and the Dept. of Labor disagree with those arguments. They say it is wrong to assume that the treating physician, whom an employee chooses, is inherently more responsible and more competent than a specialist reviewing the case.