Disability Medical Determinations and Claim Services

The vendor is required to provide and handle various aspects of disability management, including evaluating disability claims, ensuring compliance with relevant laws and regulations, and managing ongoing cases effectively.
-Disability program maintains contact with members who are applicants as well as employers, medical providers, worker’s compensation, attorneys, and other interested parties regarding the disability process and case management. Disability team members are required to gather pertinent medical records from the member as well as any relevant incident reports from the employer and decisions from workers compensation and insurance carriers.
-Disability claim management:
•Initial claim intake and processing for member’s records which can include:
oCompleted and signed disability application.
oEmployee’s job functions and requirements.
oEmployment records and applicable incident reports regarding the alleged illness or injury.
oWorker’s compensation records and applicable decisions.
oMedical records.
oOther records and other materials as requested.
oMay also request a fit for duty exam prior to making any appointments with the agency on a case-by-case basis.
oMay also contract with an independent physician for a medical review prior to or after the case is reviewed by agency on a case-by-case basis.
•Medical and vocational analysis and evaluations:
oRequest and review additional medical documentation to make an initial determination if medical evidence suggests the reported illness or injury qualifies for the requested disability as listed on the application.
oProvide analysis, then compile prompt, clear, concise, written reports from medical records to special service death and disability bureau chief.
oSchedule appointments with the university of hospitals and clinics medical board for a disability evaluation.
oReview medical board decision and make a recommendation to the special service death and disability bureau chief regarding the award of disability.
•Adjudication and determination of disability status:
oReview appeals and prepare documentation.
oAttend required hearings as an expert witness.
•Ongoing case management and periodic reviews of continued disability status for approved claims including:
oCollection of tax documents of special service members who are in pay status.
oThen reviewing those accounts for any monetary offsets that may need to occur.
oCollection of disability award letters from social security on all regular class members to determine if they still meet the criteria for state disability.
-Contract Period/Term: 3 years