What is a long-term disability medical consultant review, and what can I expect?
You’ve arrived home from your doctor visit and you check the mail and find that you have a letter from your long-term disability insurance company. The letter explains that the long-term disability carrier is in the process of conducting a medical consultant review of your claim. Your benefits have not been interrupted; however, the disability insurance carrier has reached out to your treating physicians to request medical records. The letter also states that their medical consultant may attempt to contact your physicians to discuss your claim.
This type of letter often prompts a person to immediately rush to their computer and begin punching search terms into Google, “long-term disability insurance medical review”, “disability insurance medical consultant”, “disability insurance denial following medical consultant review”, etc.
Should they be this concerned? Well, one can certainly understand why they would be. A quick search of the internet will prompt dozens of horror stories describing case after case where an insured’s long-term disability benefits were terminated or denied following a records review by a medical consultant.
What is a medical consultant review, and does it always lead to a denial of long-term disability benefits? First, a medical consultant review is just what it sounds like. A medical consultant review is conducted either by an in-house physician or nurse for the disability insurance carrier, or a physician or nurse contracted through a third-party company to conduct a review of your claim and medical records. The good news? Well, the good news is that a medical consultant review does not always lead to a termination of benefits or a denial of your long-term disability claim. Unfortunately however, it is certainly possible that it may.
Rarely does a disability insurance company decide to approve or deny a long-term disability claim without first having the records and other material reviewed by either an in-house medical consultant or third-party physician consultant. Furthermore, during the course of an approved long-term disability claim it is not uncommon for a disability insurance carrier to conduct a medical consultant review periodically, or conduct one if a change in the definition of disability is approaching.
The long-term disability carrier will begin by requesting and compiling your medical records. This is the part that is actually somewhat within the insured’s control, in the sense that the insured can ensure that their records are complete and accurate by frequently gathering and reviewing them. One mistake or typo in the medical records can mean the difference between receiving your monthly disability benefits or receiving a termination of claim letter.
As the medical records are compiled and gathered, the disability insurance carrier may also hire a private investigator to conduct video surveillance of the insured, so that the medical consultant can observe the insured’s mobility, behavior, and activity, as well as assess the veracity and consistency of their activity with their reported restrictions and limitations.
After the medical records and other information are received, the medical consultant begins their review. They begin by looking for immediate reasons for termination or denial, such as: gaps in medical treatment, non-compliance with prescription medication, to name a few. If it’s not apparent there are any significant gaps in medical treatment and the insured has been complaint with the doctor’s treatment plan then the consultant’s review will shift to the details of the doctor’s notes and records. The consultant is looking for specific areas in the records and notes that discuss the insured’s symptoms and how they correlate with the imposed and claimed restrictions and limitations.
What gives rise to the most concern is when the medical consultant contacts the treating physician to discuss and question them concerning the long-term disability claim. If your physician is not sufficiently familiar with your case, or worse, does not want to cooperate and will not support your long-term disability claim, the medical consultant and the long-term disability carrier can effortlessly obtain the justification needed to terminate or deny your benefits.
It is important to frequently and openly discuss your symptoms, restrictions and limitations with your treating physicians. It is imperative that your physicians are familiar with your complaints and symptoms and why, as a result of them, you are unable to work in your occupation, or in some cases, any gainful occupation.
Lastly, if a claimant receives a letter from their long-term disability insurance carrier informing them that the disability carrier has referred their claim to a medical consultant, the claimant can reach out to a long-term disability insurance attorney to discuss their options and what preemptive measures, if any, can be taken to avoid an interruption or denial of their long-term disability claim.
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Showing 8 of 660 Reviews
Lincoln Financial
Uses every dirty trick in the book
It’s next to impossible to get $ out of them without a lawyer. They use plenty of intimidation and unfair tactics. They don’t want to pay. And yet, their CEO made 13 m... read more >
Unum
Unum is evil
On 11/3/2021 I got shot by my boyfriend and my spinalcord got hit, paralyzing me from the neck down and accepting Unum benefits was the worst decision I ever made. I sued ... read more >
Lincoln Financial
Every month I get paid on a different date
I will start by saying that my experience is not as horrible as others, like the folks who have valid claims but get nothing from Lincoln. I feel for you and hope to god y... read more >
MetLife
They will do anything to not approve your claim
MetLife’s handling of my short-term disability claim has been incredibly frustrating and stressful. I followed all the necessary steps prior to my surgery, providing the... read more >
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Sedgwick
Don't trust them, they like to play games
They suck the life out of people that need help. They falsely advertise for helping people that they care. Sorry to tell you it's all about money, they do not care for any... read more >
New York Life
Lyme Disease Disability Claim Denial
I have had repeat claims for genuine medical leave and they have repeatedly been denied by NY Life. I have even been diagnosed with Lyme and going through treatments and t... read more >
New York Life
Disappointed with NY Life Disability Excuses
I am beyond disappointed with NY Life Disability Insurance’s handling of my father’s claim. My father, a 66-year-old man who has suffered two strokes and continues to ... read more >
New York Life
New York Life is a joke!
This company sucks when it comes to disability claims. They are slow at processing stuff, then they always say they didn't recieve the doctors information. You spend your ... read more >
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Seven Surgeries and The Standard Still Denies Disability Insurance Benefits
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Our goal is to get your application for disability insurance benefits approved. Applying for disability insurance benefits can be a difficult process and the information you provide is critical. Most disability insurance companies look at your application in hopes of finding a reason to deny your claim. Your disability company will ask you to complete numerous forms, interview you, request lots of information, speak with your doctors and possibly request to have you examined by their hired gun doctor.
Through our experience of having helped thousands of disability insurance claimants, our disability insurance lawyers will guide you through the entire application process and give you the best chance to get your disability claim approved the first time.
Submit A Strong Appeal Package
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Preparing a strong disability appeal package is an art that requires you to understand how the courts interpret your disability policy language, ERISA regulations / laws, and how to strategically present evidence in support of your definition of disability. We encourage you to contact any of our long-term disability attorneys for a free immediate review of your disability denial.
Sue Your Disability Company
98% of the disability insurance lawsuits filed by our law firm have resulted in either the payment of benefits or a lump-sum settlement agreement. Our disability insurance attorneys have filed ERISA governed and private policy long term disability insurance lawsuits against every major disability insurance company in state and federal courts nationwide and we love fighting for the little guy against the multi-billion dollar insurance company giants.
We have recovered hundreds of millions of dollars for our clients and we would like the opportunity to provide you with a free review of your disability benefit denial. There are many complex factors in a disability benefit lawsuit and the legal battle to win long term disability benefits can be fierce.
Prevent A Disability Benefit Denial
Approval of long-term disability is a continuous process as every disability insurance company will evaluate your eligibility for benefits on a monthly basis. You can never let your guard down and assume that your disability company will continue to pay your benefits for as long as you think you need them.
Our disability insurance law firm offers a reasonable flat fee monthly claim handling service in which we handle every aspect of your long-term disability claim and do whatever it takes to make sure you are paid every month.
Negotiate a Lump-Sum Settlement
Let's discuss if a lump-sum settlement or buyout of your disability insurance claim is both available and makes financial sense for you. Our disability insurance lawyers have negotiated more than five-hundred million dollars in disability insurance buyouts and we know how to get you a maximum settlement. A disability insurance company is not required to offer a buyout and not every disability company offers them.
Questions About Hiring Us
Who are Dell Disability Lawyers?
We are disability insurance attorneys that know how to get your short or long term disability benefits paid. As a nationwide law firm we have helped thousands of disability insurance claimants throughout the United States to collect hundreds of millions of dollars of disability insurance benefits from every major disability insurance company.
Our attorneys have been able to either get our clients paid monthly disability benefits or obtain a one-time lump-sum settlement in more than 98% of our cases. Our disability insurance lawyers have seen it all when it comes to disability insurance claims and we know exactly what it takes for your disability claim to be approved.
We offer disability insurance attorney representation nationwide and we welcome you to contact any of our LTD lawyers for a free immediate review of your disability claim. We also invite you to visit and subscribe to our YouTube channel where we have more than 900 videos and regularly provide tips to help protect your disability benefits.
Who do you help?
Our disability insurance attorneys help individuals that have either purchased a long term disability insurance policy from an insurance company or obtained short or long term disability insurance coverage as a benefit from their employer. We have helped individuals in almost every type of occupation with monthly disability benefit payments ranging from $1,500 to $50,000.
Our clients include all types of employees ranging from retail associates, sales representatives, government employees, police officers, teachers, janitors, nurses, pilots, truck drivers, financial advisors, doctors, dentists, veterinarians, lawyers, consultants, IT professionals, engineers, professional athletes, business owners, and high level executives.
A strong understanding and presentation of the duties of your occupation is essential for securing disability insurance benefits.
Do you work in my state?
Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability insurance lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.
What are your fees?
Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.
The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.
In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.
Do I have to come to your office to work with your law firm?
No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via phone, email, fax, or video conferencing sessions. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.
How can I contact you?
When you call us during normal business hours you will immediately speak with a disability insurance attorney. We can be reached at 800-698-9159 or by email. Lawyers and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.