Continuing disability proof

How do we run the continuing disability review on its date, chase updated medical evidence and claimant statements, and decide continuation or closure on the ERISA clock?

Open the review from the claim's own calendar and chase on a clock. Callvu opens each continuing review on the date the claim's plan sets (the definition change from own occupation to any occupation, the periodic proof date, a return-to-work indicator), lists the proof required by the policy (the attending physician statement, the claimant's statement of activities and income, records and authorizations, a functional capacity or independent exam where the examiner orders one), chases each from the claimant and the physician through links, reads and checks it, routes the decision to the claims examiner in the Decision Desk with the medical and vocational review, generates the continuation or the termination letter with the ERISA content, and writes the decision and the next review date to the claims system.

In scopeComplex: multi-party handoffsCallvu moves: chase and verify, decide, write back

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Last updated November 7, 2026.

The problem today

The claimant's benefits stopped because a form went to the physician's old fax number, and the termination letter did not say what was missing.

Today, without Callvu

A disability claim in payment must be proved again on a schedule: a physician's update, the claimant's statement, sometimes an exam. The request is a form mailed to the claimant, who gives it to a doctor's office that faxes it back, or does not. When the proof is late, the examiner terminates for failure to provide proof, and the appeal that follows costs more than the benefit.

For a group plan, the ERISA claims procedure rules treat a termination of benefits in payment as an adverse benefit determination: the claimant must receive the specific reasons, the plan provisions relied on, a description of the additional material needed and why, the internal rules relied on, and the appeal rights, with the review decided within the rule's periods. The policy sets the proof required and the definition of disability at each stage. Each item on the proof list has a party who owes it and a date it is due.

Benefits in payment should stop only on evidence, never on a missing fax.

How it runs

From the requestto the system of record.

A review date on a disability claim arrives (a periodic proof date, the own-occupation to any-occupation change, a return-to-work indicator). Callvu opens the review on the claim.

Claimant: Completes the statement of activities and income, signs updated authorizations and attends an exam where ordered.
Attending physician: Completes the attending physician statement and provides records through a link.
Claims examiner: Decides continuation or termination in the Decision Desk with the medical and vocational review.
Callvu: Opens the review, lists the proof, chases each party, checks, routes, generates the letter and writes back.

Open the review and list the proof
The claim's plan (own occupation or any occupation at this date, the maximum benefit period, the offsets to confirm), the diagnosis and the last proof set the list: the attending physician statement with restrictions and limitations, the claimant's statement of activities, income and other benefits, updated authorizations, and an independent medical exam or functional capacity evaluation where the examiner orders it.
Chase and verify
Each item is requested from its party through a link with its due date (the physician's office receives the statement to complete online, the claimant completes theirs on a phone), read on arrival (the restrictions, the dates, the signatures), checked against the definition at this stage and the prior proof, and reminders run to the claimant and the office until complete; a nurse or vocational review is attached where the carrier's guidelines call for it.
Decide
The claims examiner decides in the Decision Desk with the proof, the medical and vocational review and the plan's definition, and only the allowed outcomes: continue with the next review date, continue under the changed definition, terminate with the specific reasons, or request named additional material with the period to provide it.
Notify and write back
The continuation or termination letter is generated from the decision with the ERISA content (reasons, plan provisions, material needed, rules relied on, the appeal right and period), the decision, the letter and the next review date are written to the claims system, and benefit payments continue or stop from the decision's effective date.

Where it ends: Every review opened on its date, the proof came from the physician and the claimant on a clock, and a termination rests on evidence with a letter that says why and what would change it. The Decision Trace shows the proof list, the checks and the decision; the Audit Trace shows each request, upload, review and the letter with their times.

Runtime enforcement

What is enforcedwhile the work runs.

The regulations preloaded in Callvu Studio and the bank's own policies, applied as steps that run, not lines in a binder. A step that breaks a rule does not run, so a completed run was compliant.

Regulations

ERISA claims procedure rules (group): Under 29 CFR 2560.503-1 a reduction or termination of disability benefits in payment is an adverse benefit determination: the notice must give the specific reasons, the plan provisions, a description of any additional material needed and why, the internal rules, guidelines or protocols relied on, a discussion of any disagreement with the treating physician or Social Security determination, and the appeal procedures; the claimant has at least 180 days to appeal, and the plan decides the appeal within 45 days (extendable once by 45 days for special circumstances), with the 2018 disability claims amendments requiring independence of the decision makers and access to the claim file.
The policy's proof of continuing disability and definition of disability provisions: The policy sets when proof is due, the change from own occupation to any occupation (commonly after 24 months), the offsets for other income, the maximum benefit period and the right to require an exam at the carrier's expense; the review list is built from these provisions.
HIPAA authorization (45 CFR 164.508) and state disability claim rules: Medical records require a current HIPAA authorization; several states set additional notice and timing rules for individual disability policies, applied by the policy's state.

Company policies

Reviews open from the claim's own dates, never from a diary someone must remember.
Each proof item is requested from the party that owes it, through a link, with reminders.
A termination requires evidence and a letter with the ERISA content, generated from the decision.
The claims system holds the decision, the letter and the next review date.

Controls

Review opened on the claim's calendar.
Proof list from the policy's provisions and the stage.
Chases to the physician and the claimant with reading and checks.
Decision Desk decision with required outcomes.
ERISA letter generation.
Claims system write with the next date.

Clocks and deadlines

ERISA claims procedure rules (group) appeal: At least 180 days for the claimant to appeal; the appeal decided within 45 days, extendable once by 45 days.
Proof due date: The policy's period from the request, with reminders before it.
Next review: Set by the decision and the policy's schedule.

Documents and checks

The attending physician statement and records
The claimant's statement and authorizations
The exam or evaluation where ordered
The medical and vocational review
The decision, the letter and the claims system record

In the Decision Trace

The proof list and the stage's definition.
Each item's check.
The decision, the reasons and the examiner.

In the Audit Trace

Each request and upload with time.
The letter with time.
The write and the payment change.

The handoff

Between the front doorand the back office.

The front door

The claimant on their phone and the physician's office through its own link; no forms by mail or fax.

The back office

The examiner decides on complete proof with the reviews attached; the letter is generated from the decision.

The Decision Desk

Every review goes to the claims examiner in the Decision Desk with the proof and the reviews, and only continue, continue under the changed definition, terminate with reasons, or request named material with a period.

Proof

In scope.Proof at scale, not one process at a time.

The kind of process Callvu runs in production for customers in this industry. Ask for a reference on this exact process. The results below are the industry's published proof; each claim code links to its record on agents.callvu.com.

Phoenix put more than 100 processes live in under 3 months.

Across Callvu customers

More than 1,000 processes are live across Callvu customers.

Across Callvu customers

Questions

What buyers ask next,answered plainly.

When does a review open?

On the claim's own dates: the periodic proof date, the change in the definition of disability, or a return-to-work indicator, without a manual diary.

What must a termination letter say?

The specific reasons, the plan provisions, the material needed and why, the rules relied on and the appeal rights, as the ERISA claims procedure rules require for a group plan.

How does the physician provide the statement?

Through a link to the office, completed online and read on arrival, with reminders until it is complete.

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