Disability Management: Rules, rules, and more rules

When it comes to patients facing serious disability — whether in or out of the workplace — carriers face a bewildering array of regulatory rules that vary from state to state and are constantly being changed.— all of these place special demand

At ICS, we have the expertise to guide you in your efforts to comply with the regulatory demands of Medicare, ERISA, FMLA, ADA, COBRA, and others.

Medicare Set-Asides (MSA)

When a Medicare Set-Aside is required, ICS will help you identify a Medical Allocation Amount — a monetary settlement to be applied to future treatment.

There is a lot at stake, since even slight inaccuracies can have huge financial consequences. In the face of such pressure, we’ll take a systematic approach to an evaluation, including:

  • Complete Legal Review — Our Medicare Settlement Specialists review all legal requirements and arrive at an opinion they can then defend
  • Comprehensive Review of Medical Records — Our Certified Nurse Life Care Planners document the type and frequency of medical services, detailing each service path
  • Review of Payment History — Our Life Care Planners and Bill Review Specialists go over all payments for the previous 2-3 years, seeking to identify any prior annual medical costs
  •  Identify Physician Recommendations for Future Care — In an effort to clarify recommendations for treatment in the future, we review all ongoing care assessments, whether they come from treating providers, independent medical exams, or second opinion exams
  • Standards of Care — We can help you identify costs for projected items and services that are covered by Medicare.

Integrated Disability Management

Disability claims inevitably give rise to a number of crucial questions:

Is the claimant totally or partially disabled? Is the claimant permanently disabled? Has the claimant reached maximum medical improvement? Is claimant capable of returning to work at full duty? Is the claimant capable of performing accommodated work?

We can help you resolve these questions with an eye toward managing your risk, controlling your costs, and increasing productivity.

Our integrated disability services are provided by a nationwide panel of board-certified physicians and certified vocational and nurse specialists.

These services include:

  • Medical File Review
  • Panel Examination and Review
  • Labor Market Surveys Nationwide
  •  Independent Medical Examination
  • Litigation Support
  • Vocational Rehabilitation
  • ERISA claim administration
  • Return to work coordination
  • Acute or progressive illness evaluation
  • Ergonomic assessments and recommendations
  • Evaluation of the influence of pre-existing             
  • Conditions on disability
  • Evaluation of restrictions and limitations
  • Evaluation of disability claims  for which mental health or chemical dependency treatment are the primary interventions

FMLA (Family Leave Medical Act)

In helping you administer disability claims, we take on the daunting task of figuring out just which law — FMLA, ADA, COBRA, Workers’ Compensation — takes precedence.

In the case of an FMLA-qualifying event, we’ll help you determine, among other things:

  • How care is maintained during FMLA leave
  • Whether the claimant’s condition is considered a disability under ADA
  • The employer’s duties regarding reasonable accommodation
  • Whether the employer must allow the claimant to return to his/her original job or its equivalent
  • Whether there is a COBRA-qualifying event, and whether it falls during or after the 12-week FMLA leave
  • Whether the employer is permitted to receive medical information about the injury under the HIPAA privacy rules