Often, when reviewing a claimant’s eligibility for benefits, an insurance company will attempt to contact the claimant’s treating physician via a “peer-to-peer” telephone call. In these instances, an in-house physician or nurse reviewer will contact a treating physician in order to “clarify” a claimant’s functionality. However, more times than not, these calls will end up harming a claim.
This happened to one of our clients, who retained our firm after her claim had been terminated by CIGNA. When reviewing her eligibility for benefits, CIGNA contacted one of our client’s health care providers to ask his opinion as to her disability. However, this doctor was not our client’s primary physician, was not treating her for her disabling conditions, and in fact, had not evaluated her in over a year. As a result, this doctor claimed that our client was not disabled and was more than capable of returning to work, and even suggested that CIGNA refer her claim for special investigation. Needless to say, within a few months of this conversation, our client’s disability claim was terminated.
For this reason, we act as a mediator to closely monitor all contact the insurance company has with our clients’ treating providers. Even if your treating physician is supportive of your disability, their statements are often twisted or taken out of context by the insurance company in order to support an adverse benefit determination. Thus, we highly recommend limiting all correspondence with your treating providers to written requests, as well as limiting which providers the insurance company is authorized to contact.
If you have concerns about your long term disability insurance claim, at any stage of the claims process, call our office and learn how we can help. Call us at 1-877-LTD-CLAIM (1-877-583-2524).