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Runfox Communication Consultants

 

P.O.Box 1443

Darlinghusrt NSW 1300

Ph 02 9011 7277

Mob 0429 007 059

ABN 92 111 597 598

john.harrison@runfox.com.au

De-medicalising Psyche claims

In this seminar you will learn how to avoid swamping a claim with multiple Psychiatric and Psychological reports. You will learn how to use Claims Management expertise and experience to reclaim the Claims Management territory from partisan medical reports

. Fraudulent Psyche claims are expensive (perhaps $ 3.5 billion annually in Australia, based upon US experience).

. Specific Psychiatric diagnoses do not imply a specific functional disability.

. Psychiatric and Psychological opinions are inexact, generally conflicting and may not contribute to the management of the claim.

. Psyche opinions favourable to Insurer often extend the claim, not shorten it.

. Claims personnel are encouraged to quantify the disability and de-medicalise the claim.

 

“The total cost of health insurance fraud in the United States (including untruthful claims by patients and medical personnel) was more than $59 billion in 1995” David Bienenfeld, MD, Vice-Chair, Program Director, Professor, Department of Psychiatry, Wright State University School of Medicine.

The U.S. Supreme Court has remarked, "Psychiatrists disagree widely and frequently about what constitutes mental illness, on the appropriate diagnosis to be attached to a given behavior and symptoms, [and] on cure and treatment."(45) Ake v. Oklahoma, 470 U.S. 68 (1985).