The peer-to-peer call is a tactic used by insurance companies to deny or terminate claims. When you file your disability claim, the insurance company will typically assign your claim to a doctor who they pay to review your medical records and look for ways that they can deny your claim. Next, after you have submitted your medical records, the insurance company will say that it needs more information and tell you that its doctor will be calling your treatment providers over the phone to ask your doctor a few follow-up questions. The tone of these calls is usually collegial, to put your doctor at ease, and begins with a few straightforward questions. Once the insurance company’s doctor has developed a rapport with your doctor, he or she will then start to ask questions that are crafted to elicit responses that the company can use to deny or terminate your claim. For instance, the insurance company’s doctor might ask whether there are alternative treatment options, when your doctor thinks that you will be able to go back to work, etc.
After the call, the insurance company’s doctor generally sends your doctor a written summary of their discussion. These summaries often contain statements that are inaccurate and prejudicial to your claim, but your doctor may be too busy to notice and may simply sign off on it without much thought, inadvertently hurting your claim. The best way to prevent this from happening is to have all correspondence with your medical providers be in writing and go through an attorney.
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