What is a Disability Claim Review?

When an individual submits a disability claim through their employer or a group disability plan, there’s often a lot at stake - not just for the claimant, but for the organization handling the request. At Managed Medical Review Organization, Inc. (“MMRO”) our role is to provide clarity, objectivity, and clinical accuracy through the disability claim review process.

But what exactly does that process involve?

Understanding Disability Claim Review

A disability claim review is a structured, evidence-based process used to determine whether a claimant is medically eligible for disability benefits under the terms of their specific plan. It’s not a judgment or assumption. It’s a clinical evaluation grounded in facts, medical evidence, and supported by licensed medical experts.

• Gathering Medical Evidence
  We begin by collecting all relevant medical documentation submitted by the claimant, including:

  • Information from the application

  • Attending physician statements

  • Records from recent and relevant medical history (e.g., specialist visits, hospital stays, diagnostic tests, treatment plans)

• Clinical Review by Experts
  Our experienced registered nurses review the file and ensure that all pertinent information is included and clearly understood. Then, board-certified physician reviewers (specialists in relevant fields) evaluate the medical evidence in relation to the condition under review.

• Matching Medical Evidence to Functional Ability
  The core of a disability review lies in answering a key question:
  Does the medical evidence support that the claimant is unable to work their own job, or any job, based on the plan’s requirements?
  Depending on whether the standard is “own occupation” or “any occupation,” our review is tailored to the client’s policy and guidelines.

• Delivering an Expert Determination
  MMRO provides the client with an expert, clinically sound, and objective determination that is delivered in a professional, timely, and defensible format. This supports consistent decision-making, reduces risk, and improves trust in the process.

Why It Matters

Disability claims are often complex, emotional, and highly detailed. Our mission is to ensure that every case is reviewed fairly, thoroughly, and without bias. We help employers, insurers, and third-party administrators make informed decisions by providing:

• Independent medical expertise

• Clear and defensible clinical rationale

• Support for regulatory and compliance standards

• Confidence in every claim decision

The MMRO Difference

Our clients benefit not only from our robust clinical process but from a partner who understands the importance of timeliness, transparency, and trust. With registered nurses and board-certified physician reviewers working hand in hand, MMRO ensures every review is comprehensive, collaborative, and clinically accurate.

When accuracy matters, trust the experts.
That’s the MMRO Difference in every disability claim review we deliver.

Want to learn more about how MMRO supports your organization with expert clinical reviews? Contact us today or explore our services on LinkedIn using #TheMMRODifference.