In the case of Work Comp, they use hired guns to deny everything--procedures, meds, the fact that a patient has a health concern at all--and unfortunately, those "reports" from docs that have never seen the patient, but only reviewed records, is then sent to Social Security. It can make approval an uphill battle. I'm sure there are other examples like this. It is important for the applicant to provide overwhelming evidence of a severe disability by clear medical documentation.