DOD = 7/3/2018 LTD EP = 90 days M/N limit = 12 months DX = anxiety What is the LTD BBD?
2.
DOD = 7/3/2018 LTD EP = 90 days M/N limit = 12 months DX = anxiety What is the M/N Maximum Benefit Date?
3.
Assuming that the claimant enrolled in coverage on their DOH, is the EDOC the ER provided correct?
A.
Yes
B.
No
4.
What is the numerical value for the pre-ex provision?
5.
Based on the Effective date of coverage you determined, is this employee subject to the pre-ex investigation?
A.
Yes
B.
No
6.
Based on the effective date of coverage you determined, what is the pre-ex period? (xx/xx/xxxx-xx/xx/xxxx)
7.
Between what dates would we investigate to determine if the employee was treatment free to meet the second chance provision? (xx/xx/xxxx-xx/xx/xxxx)
8.
Could the claimant meet the second chance treatment free provision?
A.
Yes
B.
No
9.
Based on the following medical information, can we pay benefits? Both back pain & the broken leg are disabling. The broken leg occurred when the claimant was hospitalized on 02/01/20 and occurred in a car accident. The claimant has had office visits for the back pain on 11/01/19; 11/13/19; 12/03/19; and 01/15/19.
A.
No, the condition falls within the pre-ex period
B.
Yes, but only for the broken leg
10.
Determine which action plan header would be the most appropriate based on the below scenario: The claimant is out of work due to arthritis. The claim is approved during the Own Occ period and the Change of Definition Date is 6/1/2022. A clinical review was received on 4/1/2020 and supports less than sedentary restrictions for 4 months while the claimant recovers from surgery. The claimant is currently in Physical therapy and sees their doctor monthly
A.
RTW AO JUN 2022
B.
NP MAY 2020
C.
RTW OO AUG 2020
D.
DENY OO APR 2020
11.
What is the LTD benefit begin date?
12.
What is the maximum benefit date at the time of approval?
13.
After benefits have been paid for 4 months, the EE is diagnosed with osteoarthritis, which is found to be disabling along with the anxiety and depression. Based on the new diagnosis, what fields would you update in SystemOne at month 4?
