When illness or injury prevents an Ohio public or school employees from being able to continue performing their jobs, they are supposed to be protected by disability plans which are administered through their retirement systems—including the Ohio Public Employee Retirement System (OPERS), the School Employee Retirement System (SERS), and the School Teachers Retirement System (STRS).
Many claims will be denied upon the first submission of an application for disability retirement. Each of the retirement systems has set up a review procedure by which hired medical personnel evaluate the paper medical evidence submitted by the employee in order to make a recommendation to the retirement board to approve or deny the claim. These same hired doctors may also perform “independent medical examinations” of the claimant as part of the evaluation process.
It is no secret that the same doctors are used repeatedly by the retirement systems to make the initial recommendation regarding an applicant’s disability. Some of these doctors do hundreds of disability evaluations every year. It is also common for these hired doctors to present conclusions about an employee’s ability to return to work which are directly opposite those of the claimant’s personal physician, who is far better acquainted with the claimant and the problems caused by their medical condition.
But remember, when a disability retirement claim is denied, the employee has a right to appeal that denial. The employee must, within a limited period of time, notify the system that it wishes to appeal and is then provided a deadline to submit new information about his or her medical condition which supports approval of the claim. One of the most important parts of the appeal process is that claimants and their attorneys are entitled to obtain and review the reports written by the hired reviewing doctors. This gives the claimant’s own doctor a chance to address the issues raised by the hired doctor which so often lead to a recommendation to deny the claim.
Finally, the appeal process also provides the employee an opportunity to request a personal appearance–with your attorney–before the board prior to making its final decision on the recommendation of its medical committee. This personal appearance can be crucial if there is a need to change the impression of an employee’s case that can be created by a biased medical report.
An experienced attorney can play an important role in preparing the overall strategy for appealing a denied claim. An appeal requires relevant new medical evidence, rebuttal of the negative conclusions of hired doctors and, in most cases, a plan for appearing in person and presenting the case before those who will make the final decision on the claim. The benefits that are at stake are too important for an employee to go through that process on their own.