What’s a peer review on an LTD claim?

On Behalf of | Aug 31, 2023 | ERISA Disability Benefits

Trying to get a long-term disability (LTD) claim approved can feel like you’re trying to work your way through a maze of rules, paperwork and medical assessments – and there’s no guarantee that you’ll even be treated fairly.

One of the most common causes of denials in LTD claims is the “peer review” process.

One doctor judges another doctor’s work

Successfully obtaining LTD benefits generally depends on providing substantial medical evidence in support of your claim, so you might assume that your primary care provider’s (PCP’s) opinion of your condition and ability to work would count for a lot.

Unfortunately, insurance companies often question a PCP’s objectivity. There’s an assumption that a longstanding physician-patient relationship can create an emotional connection that erodes the physician’s professional detachment, causing them to overlook information that contradicts the patient’s assertions about their disabilities.

In other words, the insurance company doesn’t trust your doctor’s opinion. Their solution is to have a supposedly independent physician review just your medical records and – without ever having met you – make a recommendation about your case.

There are numerous problems with the peer review process, not the least of which is the fact that doctors who make their living that way may be reluctant to bite the hands that feed them by being too “pro-patient.” The fact that there’s no in-person exam can also leave them with limited context about a patient’s overall medical history, personal circumstances and the full scope of their disabilities. Finally, peer reviewers can be influenced by their own personal biases about certain patients or medical conditions.

If your LTD claim was denied after a peer review, don’t give up. Learning more about your legal options can help you assert your rights and obtain the benefits you deserve.