An insurance company may elect to have your long-term disability claim analyzed by a “peer review” physician, who could potentially challenge the opinions given by your primary healthcare providers. But what exactly is a peer review report in the context of a long-term disability claim?
Unlike an Independent Medical Examination, this is a document-based evaluation wherein the reviewing physician will only examine the contents of your claim file, eliminating the need for you to wait to schedule a physical appointment. The process does require time, as the reviewing doctor needs to go through your file, compose their report, and submit their findings to the insurance company.
Peer-to-Peer Communication
Your insurance company might initiate “peer-to-peer” communications between the reviewing doctors and your healthcare providers. This usually takes the form of a letter to your physician(s) asking whether they concur with the reviewing doctor’s appraisal. In some cases, the peer-review doctor may call your treating physician. The insurance company will establish a specific deadline for a response, and your claim will remain pending until a reply is received or the deadline has passed.
Though many claimants desire a quick decision on their appeal, it’s crucial to take the time to challenge any unfavorable evidence that arises during the peer review process. If your case advances to litigation, remember that the judge will only examine the evidence in your claim file; any new evidence will not be considered.
Legal Assistance for Long Term Disability Insurance Claim Denials
While the Ortiz Law Firm is headquartered in Florida, we provide legal services for claimants across the United States. If you believe your long-term disability claim has been unjustly denied or terminated, we invite you to contact us. We specialize in long-term disability appeals and lawsuits. Call us at (888) 321-8131 to schedule your free case evaluation. We can help assess your claim and advise on the next steps in the process.
