One of the most frustrating experiences for disability claimants is learning their benefits were denied based on a medical opinion from a doctor who never examined them. These decisions are often justified through what insurers call a “paper review” or “file review.” We understand how devastating it can be to have your claim denied, especially when the decision comes from someone who has never met you.
If your disability claim was denied after a paper review, you are not alone—and it does not mean your medical evidence is weak. Understanding how these reviews work, why insurers use them, and how they can be challenged is the first step toward reclaiming your benefits.
What Is a Paper Review in a Disability Claim?
A paper review happens when an insurance company hires a doctor to assess your medical records without ever meeting you, examining you, or speaking with your treating physicians.
Instead of a hands-on assessment, the reviewing doctor:
- Reads only selected medical records provided by the insurer.
- Often relies on summaries prepared by the insurance company.
- Provides a written opinion on your capacity to work.
- Frequently contradicts the conclusions of your own doctors.
This process is commonly used in both long-term disability (LTD) and short-term disability (STD) claims.
Why Do Insurance Companies Rely on Paper Reviews?
Paper reviews are appealing to insurers for one simple reason: control. They allow the insurance company to manage the narrative of your claim.
Key advantages for the insurer include:
- Cost Savings: Avoiding the expense of an in-person examination.
- Selective Evidence: Choosing which records the reviewing doctor sees.
- Familiar Doctors: Hiring doctors who frequently work for insurance companies.
- Support for Denial: Generating medical opinions that support denying or terminating benefits.
Because the reviewing doctor never sees you, crucial evidence of your condition is often lost. Subtle but critical symptoms—like observable pain, cognitive fatigue, mobility struggles, or psychological distress—are easily minimized or dismissed entirely.
Common Flaws in Paper Reviews
Paper reviews are notoriously vulnerable to serious errors and biases.
Key Strategies to Challenge Paper Reviews:
- Expose Incomplete Records: Insurers may conveniently leave out supportive reports from your file.
- Correct Mischaracterizations: Challenge descriptions of your pain or fatigue as merely “self-reported.”
- Highlight Contradictions: Point out where the review ignores or dismisses the detailed findings of your long-term treating doctors.
- Question Unrealistic Assumptions: Contest claims that you can perform a job without considering real-world demands or your specific limitations.
In many cases, the reviewing doctor lacks specialization in your medical condition and may use generic, template-based language across multiple different claims.
The “Objective Evidence” Trap
Insurers often use paper reviews to argue there is no “objective medical evidence” to support a disability. This tactic is especially common for conditions that are not diagnosed with a single test, such as:
- Chronic Pain and Fibromyalgia
- Migraines
- Long COVID
- Mental Health Conditions (e.g., Depression, Anxiety, PTSD)
- Autoimmune Disorders
These conditions rely on clinical judgment, long-term observation, and the functional impact on your life—realities that a paper reviewer can easily ignore.
Case Example: Overturning a Denial Based on a Flawed Review
A client with severe fibromyalgia was denied benefits after a paper review claimed they could perform sedentary work. The reviewer dismissed the client’s debilitating pain and fatigue as “subjective.” We successfully challenged the denial by demonstrating that the reviewer ignored years of consistent records from our client’s rheumatologist. By highlighting these inconsistencies and providing detailed functional evidence from the treating physician, we proved the paper review was unreliable and secured our client’s benefits.
Paper Review vs. Independent Medical Examination (IME)
It’s important to know that a paper review is not the same as an Independent Medical Examination (IME).
| Paper Review | Independent Medical Examination (IME) |
|---|---|
| No physical exam | In-person physical assessment |
| No patient interaction | Direct observation and conversation |
| Based on limited records | Broader clinical picture considered |
| Easier to challenge | Still contestable, but more detailed |