Question
What is clinical review? And what are my chances of getting continual approval during the own occupation period?
I have an own occupation period of 5 years. I have MS, injuries to my spine and a ankle crush accident which required 2 surgeries. Basically I’m a mess. I am completely unable to work my past job, (which by the way I lost this job), not to mention any other job at this point. My claim is constantly in pending status. It is now under clinical review. I’ve been on LTD for about 15 months. What are my chances of getting continual approval during the own occupation period. What documents would I need to submit to keep benefits going. I have a lawyer, but he seems a little “non-aggressive” He seems to never push LFG for approval like I, myself would and have since the claim was opened. I didn’t take on this lawyer until I was on LTD about 8 months, (Almost a year including STD). I’m not sure what I’m asking exactly but I guess I am tired of Lincoln constantly putting me in pending every month and why they keep doing it. Will they ever just leave it in pay status for at least a few months after documentation is received. I want to call them myself and push them for answers but I suppose I can’t because I now have a lawyer and he seems to be a little nonchalant. Am I wasting my time with this lawyer or is it usual to be so cool during a very crucial time in a claim? What is clinical review and what more do I need to do or give them to ensure the clinical review goes in my favor. My lawyer doesn’t seem to be giving me much to go on as far as how to ensure approval. Advice to a claimant is key for the claimant to pursue aggressively and ensure the documents are giving the insurance what they need to approve. I am an aggressive claimant and I need an aggressive lawyer. Whatever it takes to get approved, just tell me and I’ll make sure I get it, period. That’s how I work. All I get from my lawyer is maybe’s and hope so’s. For instance, he will say, “I was hoping the last documentation would have worked but maybe they will agree after your office notes are recieved”. It’s clear my documentation shows I can’t work my own occupation so let’s go, get on them and prove it! I feel like a sitting duck each month.
Answer
Linsey, as disability benefits are determined on a month to month basis an insurance company is allowed to review your claim each month. It is not common for an insurance company to approve a claim through an own occupation period regardless of the medical condition. Although the reviews are certainly annoying, there is really little that can be done to prevent an insurance company from conducting them.
