MFPD hires firm to review disability cases
July 13, 2005 - The Mehlville Fire Protection District Board of Directors recently hired a company to review the cases of five employees granted disability benefits over the past five years.
Board members voted 2-1 with Secretary Dan Ottoline Sr. opposed to hire Medical Services Management, a Missouri-based managed care company, to determine if employees who were declared disabled by the board in the past five years still can be considered disabled.
"The situation we contacted you about is over the last five years, I believe roughly five employees were granted disability, and as I spoke to these gentlemen about before, I think it's good to look now and explore the veracity of the claims, as well as overviewing the whole pension plan," board Chair-man Aaron Hilmer told a Medical Services Management case manager at the June 20 Pension Committee meeting.
The district provides benefits to eight disabled employees. From 2003 to 2005, the district will have paid nearly $950,000 in benefit payments to current disability recipients.
The district hired Medical Services Management to evaluate the five employees who were disabled over the past five years. If the company's review determines an employee is no longer disabled, then the district could end the benefit payments of that former employee.
"If any of those come back not disabled, then I'm going to make a motion to open up all of the disability cases," Hilmer told the Call.
Barbara Cullen, a case manager for Medical Services Management, said her company works for several fire districts in the area.
"And to reassure the other firefighters who are here, we have a great relationships with the firefighters in all the districts, Cullen said. "This is not a threatening situation, it's an advocacy position, and I'm a nurse first."
The board also voted 2-1 with Ottoline opposed to approve an amendment that would remove disability benefits from the pension plan for injuries that occurred after July 1. Under the amendment, disability benefits would be covered by the Standard Insurance Co., a change the board unanimously approved in early June.
However, St. Louis County Circuit Judge Barbara Ann Crancer granted a temporary restraining order prohibiting enactment of the amendment until July 15 when a hearing will be conducted on a lawsuit filed by Mehlville Local 1889 of the International Association of Fire Fighters. The lawsuit seeks to prohibit the board from implementing the contract with Standard Insurance.
The district's disability plan states, "The Pension Committee may require proof of continued disability from time to time, but not more frequently than once every six months."
Hilmer told the Call that when he reviewed the files on each of the disabled employees, he found no documentation that showed any follow up on the disability cases.
"It's not a witch hunt," Hilmer told the Call. "It's just doing our due diligence. The Board of Directors are trustees of the pension plan."
Cullen told board members at the meeting that reviewing disability plans is a common practice.
"And many times with a lot of districts, at the first and second year anniversary of being declared disabled, they will have someone re-examine them, and that's not unusual, and it's very beneficial because sometimes during that period of time people have gone on with further rehabilitation and are able to return to their job," Cullen said at the meeting.
Medical Services Management will review the medical documentation of each disabled employee. If the case manager determines the disabled employee still is disabled, then the case manager would recommend to the board that the medical review stop there. However, if the case manager determines that it's possible the disabled employee has reached a non-disabled level condition of health, then the company will recommend to the board that the district pay to have the employee visit a physician for an independent medical evaluation.
The disabled employee will be accompanied by the case manager to the physician appointments.
"We summarize the patient's medical history for the physician and provide it to them before the appointment, along with all the MRIs or radiographs that have been taken so that when the patient goes, the physician knows exactly what was going on previously, and it's usually a win-win situation," Cullen said.
Under Missouri law, an employer has the right to select the doctor an employee sees for treatment in workers' compensation cases. So, the board would have the final say in which doctors the disabled employees visit and how many doctors they see. Cullen said her company has a list of physicians who will provide an unbiased opinion and will offer quality care for the disabled employees.
"If it's something that you're questioning, and we think that only one doctor would be necessary, we could get them to an occupational health doctor," Cullen told the board. "You dictate what you want. If they need three more doctors to examine them, we'll set that up. I will tell you, we do not use a lot of the docs — the support-comp docs. We believe in using really quality physicians, who know and understand that injury. So if it's a shoulder injury, we're going to get them to someone who specializes in shoulder injuries. It's very important that the patient member, employee, be seen by someone who specializes in the field where their injury occurred."
Hilmer told the Call that he will base his vote on how to handle each disability case based on what the company recommends.
"I think the Board of Directors will be an afterthought," Hilmer said. "I think the real decision making will be the case manager, the doctors, and our lawyer."
For the initial medical review of each disabled employee's case, the company charges $85 per hour, and the average total cost for a case is $170. The district also will have to pay for the physician appointment if the independent medical evaluation is necessary. The company negotiates with physicians and therapy facilities for the cost of the medical evaluation, so costs vary.
However, Cullen gave the example of one occupational medicine physician who charged $600 for a new disability evaluation and documentation. Any follow-up disability determination then would cost $400.
Ottoline opposed hiring the company, saying the district has its own disability review system that requires a disabled em-ployee to see three board-approved physicians when the employee first becomes disabled.
"I don't see much sense in saving money by taking away from one person and then paying another person to do something we do ordinarily ourselves," Ottoline said.