EMPLOYER & MUNICIPALITY SERVICES

The effect of employees’ disabilities on employers goes well beyond the direct cost of benefits. Disabilities in the workplace profoundly impact productivity, healthcare costs, quality of product, revenue and customer satisfaction. By embracing a comprehensive, best-practices disability management model, employers can enhance workforce productivity and financial results, and reduce healthcare costs. However, most employers do not have the resources and experience necessary to accurately assess disability, to determine whether or not rehabilitation or job modification will facilitate a return to work, or to otherwise monitor recovery.

HOW DMS HELPS EMPLOYERS

Employers depend upon DMS to thoroughly, fairly and objectively assess the functional impact of medical and psychiatric impairments and to appropriately manage disability claim outcomes, utilizing highly trained and experienced claim professionals and clinical experts to gather and interpret key information, address any inconsistencies in information and reconcile differing opinions.

DMS focuses on the importance of early and proactive involvement with every disability claim, using a team-oriented approach to ensure that benefit eligibility is accurately assessed and appropriately managed throughout the duration of the claim. In addition to necessarily interacting with the employer, employee, and the employee’s treatment provider(s), DMS claim professionals often interact with specialized clinical experts, medical consultants, vocational specialists, forensic accountants, investigation professionals and legal advisers to gain a comprehensive understanding of each claim. DMS has access to the expertise of a national network of Independent Medical Examination providers, Peer Review experts, and Functional Capacity Evaluation professionals who help in the assessment of impairment and its impact on the employee’s capacity to work.

Types of Plans DMS Services:

• STD and LTD Plans

• Federal, State and Municipal Disability Benefit Plans

• Disability Pension Retirement Plans

 

DMS Services include:

• Claim Management & Administration
• Clinical Consultative Services
• Clinical Case Management
• Occupational Rehabilitation
• Vocational Rehabilitation
• Audit Services
• Appeals Review

Claim Management and Administration Services

Services can be chosen from a menu of options, including:

• Full-service claims management
• Select complex claim review
• Resolution of disputed claims
• Benefit disbursement and tax reporting
• Advice-to-pay
• Claim performance audits
• Special investigative resources
• Independent Medical Exams, Functional Capacity Exams and Peer Reviews
• Training

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Clinical Consultative Services

DMS’ Nurse Consultants either consult with our claim professionals to provide, or directly provide, the following services:

1. Consultation and guidance regarding medical diagnosis, treatment plans, prognosis and the basis for impairment.
   
   
2. Recommendations as to when and what additional medical information would be beneficial in the assessment of the claim.
   
   
3. Direct contact with the employee’s treating physicians and other treating medical providers to clarify clinical information.
   
   
4. Assistance in other information gathering activities.
   
   
5. Recommendations as to when Independent Medical Exams (“IMEs”), Functional Capacity Evaluations (“FCEs”) and Peer Reviews may help aid in documenting the employee’s functionality. If an IME is deemed necessary, the Nurse Consultant can assist in formulating specific questions to be answered by the medical expert.

In addition, DMS consults with a nationwide network of physicians, psychologists, and physical therapists who perform IMEs, FCEs and Peer Reviews and who specialize in a wide array of professional disciplines. Many of the experts DMS recommends have participated in research and clinical studies, hold academic appointments, and have extensive forensic experience. Prior to making a referral, all IME, FCE and Peer Review experts are carefully credentialed by reviewing CV’s, board certification, licenses, malpractice coverage, work product samples and potential conflicts of interest.

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Our Clinical Case Management staff consists of Registered Nurses (RNs) who are all Certified Case Managers (CCMs). Staff members have an average of more than 25 years of clinical case management experience. Clinical Case Management Services involve ongoing contact with the employee, employer and medical providers to facilitate effective and timely medical treatment and to establish reasonable expectations regarding the duration of disability.

• Employer contact - obtain information regarding job duties and requirements, including the physical demands of the job; assist in identifying modified duty opportunities and developing specific Early Return to Work (“ERTW”) plans; provide ongoing updates and estimates regarding the employee’s medical status and duration of disability (including potential for carryover from STD to LTD).
  
  
• Employee contact – identify co-morbids and/or other factors which may impact return to work; educate the employee regarding rehabilitation resources and options.
  
  
  
• Medical Provider contact – obtain and/or clarify diagnoses, clinical status, treatment plan, duration of disability, and restrictions/limitations; inform providers of the availability of modified duty (with written documentation of individualized modified-duty work plans); communicate with providers (orally and in writing) to facilitate functionally-focused treatment plans and return-to-work releases.

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• Occupational Analysis - analysis of the job duties, physical demands, and/or work environment factors of a particular occupation within a specific labor market.
  
  
• On-site Job Analysis - analysis of the employee’s job to determine their exact job duties, physical demands and work environment factors (i.e. directing, controlling, planning activities, working alone or with others, etc.). A job analysis can help identify potential job accommodations.
  
  
• Assessment of Work Capacity – analysis of ability to work either in the employee’s own occupation or another occupation. As part of this analysis, a Functional Capacity Evaluation (“FCE”) may be required.
  
  
• Transferable Skill Analysis – analysis of the employee’s transferable training, education, work skills and experiences in light of their physical or mental limitations. This service is typically utilized when the definition of disability in a policy changes from an Own Occupation definition to an Any Occupation definition. It can also be used for rehabilitative purposes to assist in identifying appropriate and realistic vocational alternatives for an employee.

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Vocational Rehabilitation Services include:

• Ergonomic Assistance- assessment to evaluate the postural requirements and work environment of the employee’s occupation. This activity may lead to the purchase of equipment to adapt the workstation, education on proper body posture, and work schedule accommodation.
  
  
• Vocational Counseling – begins after the employee expresses an interest in returning to work in some capacity. This service may involve counseling about occupational choices and resources and helping the employee evaluate their options, and development of goals for return-to-work.
  
  
• Labor Market Research – research conducted by our Vocational Rehabilitation Specialist or by an outside vendor to determine the availability of suitable occupations, locally or nationally, as well as the earnings potential within such occupations. This service can be useful to generate information about opportunities to return to work within the employee’s own occupation or in conjunction with a Transferable Skills Analysis to determine the existence of reasonable alternative occupational opportunities.
  
  
• Job Placement Assistance – can include assistance with resume preparation, guidance on interview techniques, and generation of job leads. Our Vocational Rehabilitation Specialist assists in referring employees to a suitable outside vendor that specializes in providing this service.

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Appeals Review

• ERISA-compliant, comprehensive and independent review of adverse determinations.
  
  
• Identification of medical resources required to accurately assess benefit eligibility in accordance with ERISA standards.
  
  
• Compliance with time-sensitive ERISA and state regulatory requirements.

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