1. Facilitating Claims Establishing capacity level FOR INTERNAL USE ONLY
REAL Disability Story
Facilitating Claims
Establishing capacity level
Disability Claim Manager
Nurse and Physician
Team Lead and Technical Specialist
Rehabilitation Specialist
Taking a Holistic View
Understand client’s plan design
Understand employment and personal circumstances
Assessing Claims
Analyze medical aspects
Evaluate physical and functional capacity
Validating Decisions
Understand contractual provisions
Apply provisions to specific situations
Defining Employability
Assess physical and cognitive demands
Assess future employability
The goal of the Facilitated Claim Discussion is to establish a claimant’s capacity level. These discussions leverage the expertise of the Disability Claim Manager, a nurse and/or a physician, a Team Lead or technical specialist, and a vocational rehabilitation specialist. Each professional has a special role.
Disability Claim Managers have overall responsibility for management of the claim. They ensure that all necessary information is obtained, and maintain a dialog with the employee. Their assessment of the employee adds a holistic view to the discussion. They have knowledge of the plan design—and they know the employee’s employment and personal circumstances.
The clinical assessment is provided by members of our Clinical Team. The goal of our clinical review is to evaluate the medical data, verify and clarify the diagnosis, identify the appropriate duration, and determine the need for additional medical documentation. Lastly, it’s to establish future interventions based on the medical situation.
Critical to every discussion is a contractual assessment, which validates the claim decision.
The Team Lead or Technical Specialist is well versed in the contractual provisions—and on how to appropriately apply those provisions to specific claim circumstances.
As we mentioned earlier, the Vocational Rehabilitation Specialist has a dual role. First to assess the claim situation from a vocational standpoint at the “any occupation” review point—what are the physical and cognitive demands of the occupation? Then, from a rehabilitation standpoint—what is the employee’s specific future employability situation? Are they a candidate for Prudential’s rehabilitation program? Are workplace accommodations needed? Or, are other return to work services more appropriate, like job placement or job training?
Let’s take a look at capacity levels now…
FOR INTERNAL USE ONLY

2. Facilitating Claims Establishing capacity level FOR INTERNAL USE ONLY
REAL Disability Story
Facilitating Claims
Establishing capacity level
Disability Claim Manager
Nurse and Physician
Team Lead and Technical Specialist
Rehabilitation Specialist
The goal of the Facilitated Claim Discussion is to establish a claimant’s capacity level. These discussions leverage the expertise of the Disability Claim Manager, a nurse and/or a physician, a Team Lead or technical specialist, and a vocational rehabilitation specialist. Each professional has a special role.
Disability Claim Managers have overall responsibility for management of the claim. They ensure that all necessary information is obtained, and maintain a dialog with the employee. Their assessment of the employee adds a holistic view to the discussion. They have knowledge of the plan design—and they know the employee’s employment and personal circumstances.
The clinical assessment is provided by members of our Clinical Team. The goal of our clinical review is to evaluate the medical data, verify and clarify the diagnosis, identify the appropriate duration, and determine the need for additional medical documentation. Lastly, it’s to establish future interventions based on the medical situation.
Critical to every discussion is a contractual assessment, which validates the claim decision.
The Team Lead or Technical Specialist is well versed in the contractual provisions—and on how to appropriately apply those provisions to specific claim circumstances.
As we mentioned earlier, the Vocational Rehabilitation Specialist has a dual role. First to assess the claim situation from a vocational standpoint at the “any occupation” review point—what are the physical and cognitive demands of the occupation? Then, from a rehabilitation standpoint—what is the employee’s specific future employability situation? Are they a candidate for Prudential’s rehabilitation program? Are workplace accommodations needed? Or, are other return to work services more appropriate, like job placement or job training?
Let’s take a look at capacity levels now…
FOR INTERNAL USE ONLY

3. Facilitating Claims Establishing capacity level FOR INTERNAL USE ONLY
REAL Disability Story
Facilitating Claims
Establishing capacity level
Disability Claim Manager
Nurse and Physician
Team Lead and Technical Specialist
Rehabilitation Specialist
Taking a Holistic View
Assessing Claims
Validating Decisions
Defining Employability
The goal of the Facilitated Claim Discussion is to establish a claimant’s capacity level. These discussions leverage the expertise of the Disability Claim Manager, a nurse and/or a physician, a Team Lead or technical specialist, and a vocational rehabilitation specialist. Each professional has a special role.
Disability Claim Managers have overall responsibility for management of the claim. They ensure that all necessary information is obtained, and maintain a dialog with the employee. Their assessment of the employee adds a holistic view to the discussion. They have knowledge of the plan design—and they know the employee’s employment and personal circumstances.
The clinical assessment is provided by members of our Clinical Team. The goal of our clinical review is to evaluate the medical data, verify and clarify the diagnosis, identify the appropriate duration, and determine the need for additional medical documentation. Lastly, it’s to establish future interventions based on the medical situation.
Critical to every discussion is a contractual assessment, which validates the claim decision.
The Team Lead or Technical Specialist is well versed in the contractual provisions—and on how to appropriately apply those provisions to specific claim circumstances.
As we mentioned earlier, the Vocational Rehabilitation Specialist has a dual role. First to assess the claim situation from a vocational standpoint at the “any occupation” review point—what are the physical and cognitive demands of the occupation? Then, from a rehabilitation standpoint—what is the employee’s specific future employability situation? Are they a candidate for Prudential’s rehabilitation program? Are workplace accommodations needed? Or, are other return to work services more appropriate, like job placement or job training?
Let’s take a look at capacity levels now…
FOR INTERNAL USE ONLY

4. Facilitating Claims Establishing capacity level FOR INTERNAL USE ONLY
REAL Disability Story
Facilitating Claims
Establishing capacity level
Disability Claim Manager
Nurse and Physician
Team Lead and Technical Specialist
Rehabilitation Specialist
Taking a Holistic View
Understand client’s plan design
Understand employment and personal circumstances
Assessing Claims
Validating Decisions
Defining Employability
The goal of the Facilitated Claim Discussion is to establish a claimant’s capacity level. These discussions leverage the expertise of the Disability Claim Manager, a nurse and/or a physician, a Team Lead or technical specialist, and a vocational rehabilitation specialist. Each professional has a special role.
Disability Claim Managers have overall responsibility for management of the claim. They ensure that all necessary information is obtained, and maintain a dialog with the employee. Their assessment of the employee adds a holistic view to the discussion. They have knowledge of the plan design—and they know the employee’s employment and personal circumstances.
The clinical assessment is provided by members of our Clinical Team. The goal of our clinical review is to evaluate the medical data, verify and clarify the diagnosis, identify the appropriate duration, and determine the need for additional medical documentation. Lastly, it’s to establish future interventions based on the medical situation.
Critical to every discussion is a contractual assessment, which validates the claim decision.
The Team Lead or Technical Specialist is well versed in the contractual provisions—and on how to appropriately apply those provisions to specific claim circumstances.
As we mentioned earlier, the Vocational Rehabilitation Specialist has a dual role. First to assess the claim situation from a vocational standpoint at the “any occupation” review point—what are the physical and cognitive demands of the occupation? Then, from a rehabilitation standpoint—what is the employee’s specific future employability situation? Are they a candidate for Prudential’s rehabilitation program? Are workplace accommodations needed? Or, are other return to work services more appropriate, like job placement or job training?
Let’s take a look at capacity levels now…
FOR INTERNAL USE ONLY

5. Facilitating Claims Establishing capacity level FOR INTERNAL USE ONLY
REAL Disability Story
Facilitating Claims
Establishing capacity level
Disability Claim Manager
Nurse and Physician
Team Lead and Technical Specialist
Rehabilitation Specialist
Taking a Holistic View
Understand client’s plan design
Understand employment and personal circumstances
Assessing Claims
Analyze medical aspects
Evaluate physical and functional capacity
Validating Decisions
Defining Employability
The goal of the Facilitated Claim Discussion is to establish a claimant’s capacity level. These discussions leverage the expertise of the Disability Claim Manager, a nurse and/or a physician, a Team Lead or technical specialist, and a vocational rehabilitation specialist. Each professional has a special role.
Disability Claim Managers have overall responsibility for management of the claim. They ensure that all necessary information is obtained, and maintain a dialog with the employee. Their assessment of the employee adds a holistic view to the discussion. They have knowledge of the plan design—and they know the employee’s employment and personal circumstances.
The clinical assessment is provided by members of our Clinical Team. The goal of our clinical review is to evaluate the medical data, verify and clarify the diagnosis, identify the appropriate duration, and determine the need for additional medical documentation. Lastly, it’s to establish future interventions based on the medical situation.
Critical to every discussion is a contractual assessment, which validates the claim decision.
The Team Lead or Technical Specialist is well versed in the contractual provisions—and on how to appropriately apply those provisions to specific claim circumstances.
As we mentioned earlier, the Vocational Rehabilitation Specialist has a dual role. First to assess the claim situation from a vocational standpoint at the “any occupation” review point—what are the physical and cognitive demands of the occupation? Then, from a rehabilitation standpoint—what is the employee’s specific future employability situation? Are they a candidate for Prudential’s rehabilitation program? Are workplace accommodations needed? Or, are other return to work services more appropriate, like job placement or job training?
Let’s take a look at capacity levels now…
FOR INTERNAL USE ONLY