LTD Final Review

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Final Review for LTD New Hire Learning Journey

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Edad recomendada: 17 años

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Joan Murray

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LTD Final ReviewVersión en línea Final Review for LTD New Hire Learning Journey por Joan Murray 1 #1 DOD = 7/3/2018 LTD EP = 90 days M/N limit = 12 months DX = anxiety What is the LTD BBD? Written answer 2 #2 DOD = 7/3/2018 LTD EP = 90 days M/N limit = 12 months DX = anxiety What is the M/N Maximum Benefit Date? Written answer 3 #3 Assuming that the claimant enrolled in coverage on their DOH, is the EDOC the ER provided correct? a Yes b No c d 4 #4 What is the numerical value for the pre-ex provision? Written answer 5 #5 Based on the Effective date of coverage you determined in question #3, is this employee subject to the pre-ex investigation? Choose one or more answers a Yes b No c d 6 #6 Based on the effective date of coverage you determined in question #3, what is the pre-ex period? (xx/xx/xxxx-xx/xx/xxxx) Written answer 7 #7 (Complete questions 3-6 first) 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) Written answer 8 #8 (Complete questions 3-7 first)Could the claimant meet the second chance treatment free provision? Choose one or more answers a Yes b No c d 9 #9 (Complete questions 3-8 first)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 #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 6/1/2026. A clinical review was received on 4/1/2024 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 UPDATE AO JUN 2026 b NP MAY 2024 c UPDATE OO AUG 2024 d DENY OO APR 2024 11 #11 What is the LTD benefit begin date? Written answer 12 #12 What is the maximum benefit date at the time of approval? Written answer 13 #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? a Diagnosis Code 2 b Diagnosis code 1 c Disability type d Maximum benefit date

LTD Final ReviewVersión en línea

Final Review for LTD New Hire Learning Journey

por Joan Murray

#1 DOD = 7/3/2018 LTD EP = 90 days M/N limit = 12 months DX = anxiety What is the LTD BBD?

Written answer

#2 DOD = 7/3/2018 LTD EP = 90 days M/N limit = 12 months DX = anxiety What is the M/N Maximum Benefit Date?

Written answer

#3 Assuming that the claimant enrolled in coverage on their DOH, is the EDOC the ER provided correct?

Yes

#4 What is the numerical value for the pre-ex provision?

Written answer

#5 Based on the Effective date of coverage you determined in question #3, is this employee subject to the pre-ex investigation?

Choose one or more answers

Yes

#6 Based on the effective date of coverage you determined in question #3, what is the pre-ex period? (xx/xx/xxxx-xx/xx/xxxx)

Written answer

#7 (Complete questions 3-6 first) 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)

Written answer

#8 (Complete questions 3-7 first)Could the claimant meet the second chance treatment free provision?

Choose one or more answers

Yes

#9 (Complete questions 3-8 first)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.

No, the condition falls within the pre-ex period

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 6/1/2026. A clinical review was received on 4/1/2024 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

UPDATE AO JUN 2026

NP MAY 2024

UPDATE OO AUG 2024

DENY OO APR 2024

#11 What is the LTD benefit begin date?

Written answer

#12 What is the maximum benefit date at the time of approval?

Written answer

#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?

Diagnosis Code 2

Diagnosis code 1

Disability type

Maximum benefit date

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LTD Final ReviewVersión en línea

por Joan Murray

#1 DOD = 7/3/2018 LTD EP = 90 days M/N limit = 12 months DX = anxiety What is the LTD BBD?

Written answer

#2 DOD = 7/3/2018 LTD EP = 90 days M/N limit = 12 months DX = anxiety What is the M/N Maximum Benefit Date?

Written answer

#3 Assuming that the claimant enrolled in coverage on their DOH, is the EDOC the ER provided correct?

#4 What is the numerical value for the pre-ex provision?

Written answer

#5 Based on the Effective date of coverage you determined in question #3, is this employee subject to the pre-ex investigation?

Choose one or more answers

#6 Based on the effective date of coverage you determined in question #3, what is the pre-ex period? (xx/xx/xxxx-xx/xx/xxxx)

Written answer

#7 (Complete questions 3-6 first) 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)

Written answer

#8 (Complete questions 3-7 first)Could the claimant meet the second chance treatment free provision?

Choose one or more answers

#11 What is the LTD benefit begin date?

Written answer

#12 What is the maximum benefit date at the time of approval?

Written answer

#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?