Life insurance denial letters often cite an “independent medical review” as if it were a neutral second opinion. Families are told a doctor reviewed the records objectively and confirmed the insurer’s position.
What is rarely explained is who selected that doctor, who paid for the review, and what the doctor was actually asked to do.
Those details matter more than most people realize.
What insurers mean by “independent”
In life insurance claims, an independent medical review almost never means a court appointed expert or a mutually agreed physician. It usually means a doctor hired by the insurance company or one of its vendors to review records only.
The doctor does not examine the insured. They do not speak with treating physicians. They review selected records and answer specific questions posed by the insurer.
The review may be independent of the treating doctors, but it is not independent of the insurer.
Who pays the reviewing doctor
The insurance company pays for the review. Sometimes directly. Often through a third party vendor that supplies physicians for claim reviews.
Those doctors are paid for their time, and repeat work often comes from repeat assignments. That does not mean the opinion is dishonest, but it does mean the framing of the questions and the selection of records matter greatly.
Families are almost never told how much the doctor was paid or how often that doctor works for insurers.
How the review is shaped before it begins
By the time a doctor sees the file, the scope is often narrow. The insurer may ask questions such as:
Whether a condition existed before the policy
Whether symptoms should have been disclosed
Whether death was related to a prior condition
Whether treatment compliance affected the outcome
The doctor is not asked to decide coverage. They are asked to support or reject a specific narrative.
What records are included, and what records are left out, often determines the conclusion.
Why these reviews carry so much weight
Once an insurer obtains a medical opinion that supports denial, it becomes the backbone of the decision. Denial letters quote it. Appeals rely on it. Internal reviews defer to it.
Meanwhile, treating physicians are often ignored or discounted as advocates for the patient.
The imbalance is built into the process.
What beneficiaries usually do not see
Beneficiaries rarely receive the full medical review report unless they demand it. Even then, portions may be summarized rather than disclosed.
What is often missing from the denial letter is:
The full scope of records reviewed
Any limitations expressed by the reviewing doctor
Alternative explanations that were not addressed
Language that was hedged or conditional
A confident sounding summary can mask a cautious or qualified opinion.
When “independent” reviews can be challenged
These reviews are not untouchable. They can be questioned when:
The doctor reviewed incomplete records
Treating physician opinions were ignored
Assumptions were treated as facts
The review went beyond the doctor’s specialty
The insurer misstated what the doctor actually concluded
In many cases, the problem is not the doctor. It is how the opinion is used.
Why timing matters
Once an independent medical review is introduced, it shapes the entire dispute. Challenging it later becomes harder if deadlines pass and the administrative record closes.
That is why these reviews need to be examined early, not accepted as neutral simply because they are labeled independent.
If a life insurance denial relies on an independent medical review, the first question is not whether the doctor was qualified. It is who hired them, what they were asked, and what they actually said.
That is where leverage is usually found.