Discouraging Doctors from Speaking Up Against Insurer Abuse of Their Patients: Dr. McConnell vs. Coventry
Getting fair treatment for a workers’ compensation injury is often a difficult process requiring many parties to consistently act in the best interest of the injured worker. The complicated relationship between doctors, patients, and insurance companies grew even more muddled following the ruling of a Texas appellate court last week. The Dallas appeals court affirmed the district court’s dismissal on summary judgement of the legal case brought by Dr. John McConnell, a respected orthopedic surgeon, against the companies Liberty Mutual Insurance Co. and Coventry Health Care. Dr, McConnell claimed that his health care provider contract was terminated after he spoke out against wrongful conduct of Liberty Mutual in delay/deny/dispute of critically needed care for his patients.
Dr. McConnell initially filed his case against these two companies alleging that Coventry kicked him out of their workers’ comp healthcare provider network following complaints about him from Liberty Mutual made to Coventry. The complaints Liberty Mutual made to Coventry allege that Dr. McConnell was acting unprofessionally when he documented concerns about the effect of Liberty Mutual’s actions on his patients in his patient records. Dr. McConnell’s noting in his record that Liberty Mutual would “act in bad faith” through partaking in a “3-D (delay/deny/dispute) business strategy” was claimed as “unprofessional by Coventry. Dr. McConnell began noting these issues in patient files following multiple instances in which he found Liberty Mutual would create significant delays in prescribed medical treatment.. Dr. McConnell claimed that at the instigation of Liberty Mutual, Coventry had the doctor removed as a physician in their network.
Doctors face economic and ethical decisions in cases in which they are treating workers’ comp claims. Their first priority is helping their injured patients, but they are often limited by the process of dealing with insurance providers and the unnecessary burdens placed by insurer conduct with different goals. The ruling of the Appeals Court to uphold the summary judgment against Dr. McConnell only further limits the ability for doctors to act as allies to their patients. The reality is that Dr.McConnell’s actions to help his patients severely damaged his economic well-being.
The journalists at Workcompcentral.com followed the story for their readers, including Michael Patrick Doyle’s read on the case:., “It’s outrageous that a doctor’s attempt to document the harm being done by an insurer to his patient can become a basis for wreaking economic devastation on the doctor.” Mike Doyle shared the concerns of many that this looked like a “very harmful targeting of a doctor” who was willing to try to help patients get the care the doctor thought they needed, and the defendants have “made a really terrible example out of him to scare off other doctors.”
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