When you’re hurt or you’re sick, you expect your long-term disability (LTD) policy to cover you. After all, your doctor has agreed that you’re not currently able to work, and that’s why you have the policy in the first place, right?
A lot of people who file long-term disability claims are shocked to discover that their applications are denied after a medical review by a doctor who has never even examined them. It happens all the time.
Peer reviews are often used to deny benefits
Your doctor is the person you see all the time for your medical issues, and they know you. That might naturally lead you to believe that your doctor’s opinion has significant weight when it comes to your LTD claim – but the opposite may actually be true.
Long-term disability providers sometimes think that primary care physicians may be too “pro-patient,” especially when they have a long-established relationship with a particular claimant. Because of this, they often order what’s called a “peer review” of long-term disability applicants’ medical records.
Unlike independent medical exams where you actually meet the doctor being asked to weigh in on your condition, peer reviews are done entirely by looking at your medical records. A “peer review” is basically a fancy term that equates to having one doctor check another doctor’s work.
The physician doing the peer review may be an employee of the insurance company handling the LTD claim, or is being paid indirectly by the insurance company, so there’s not even a pretense that they’re a neutral party – but they still have the power to provide an opinion that supports denial your claim.
It’s often possible to aggressively challenge such denials based on the idea that these “hired guns” may have outdated medical knowledge, lack the appropriate training to really understand your condition or simply ignored anything that didn’t fit with their preconceived opinions.
You generally only have a limited ability to appeal a long-term disability denial. While there are a lot of things you can handle on your own without legal guidance, this shouldn’t be one of them.