Making the Correct Disability Determination the First Time.

Approximately one in four Americans have a disability.1 When someone is hurt or disabled and unable to work, they need an objective evaluation of their level of injury or disability to confirm their eligibility for appropriate financial, and sometimes vocational, support.

Disability services administered by states and retirement plans may help provide disability applicants with monthly cash payments for living expenses, approve individuals for Medicaid or other insurance based on their disability, and offer access to educational and vocational opportunities. Disability determinations are completed to verify an individual’s disability status and confirm eligibility for benefits and services. This is a crucial step in the process of benefit eligibility.

Disability regulations are complex and lengthy. Organizations charged with making disability determinations must be knowledgeable in disability regulations as well have the operational expertise to process determinations efficiently. Accurate and efficient decisions are crucial as, many disability applicants are dealing with difficult situations, such as acute or terminal disabilities, which can add to an already extremely stressful and confusing process.

Ensuring access to needed clinical expertise

Organizations lack the expertise to comprehensively review and evaluate an individual’s disability. If an incorrect judgment is made or a decision is delayed, it can have longstanding and costly consequences to Medicaid agencies, public employees’ retirement systems, and the impacted applicants. 

ForHealth Consulting’s comprehensive Disability Evaluation Services enable timely and accurate disability determination. We hire our own internal team of clinicians, which includes physicians, psychologists, registered nurses, certified vocational rehabilitation counselors and other allied health professionals that are highly trained in disability determinations and provide accurate disability determinations in significantly less time than our competitors, or state or federal review teams. Our “in-house” approach to handling disability evaluations and determining disability and/or capacity to work means applicants receive decisions and potential access to benefits more quickly and organizations do not develop a backlog of cases.

Our “holistic view” approach to disability determinations is largely based on the totality of the applicant’s available medical records. By leveraging longitudinal evidence from the applicant’s own treating providers, we produce a “complete clinical picture, over a period of time” decision instead of a “snapshot/single moment in time” assessment which is generally conducted by an independent assessor with no prior clinical relationship with the member or their treatment team.

Using the comprehensive case file that has been assembled, our team makes the correct disability determination the first time.

Federal requirements are that disability determinations need to be completed within 90 days; our Medicaid evaluations are typically finished within 42-60 days when a consultative exam is not required. Our retirement system case turnaround times range between 10-30 days. For all our clients we increase cost-effectiveness and efficiency.

ForHealth Consulting has created disability determination guiding principles and best practices that maximize efficiencies and minimize costs. Our clients gain access to broad clinical and vocational expertise, enabling objective, quick, and correct decision-making that responds to members’ needs, drives down costs, and reduces waste.

Vocational rehabilitation can lead to new opportunities

Sometimes vocational rehabilitation is most appropriate for applicants undergoing disability evaluation services. This process enables people with disabilities to access, maintain, or return to employment or other useful occupations. Vocational rehabilitation can require input from various healthcare professionals and other non-medical disciplines such as disability employment advisers and career counselors.2

ForHealth Consulting’s certified vocational experts—not offered by many other determination services organizations—can assist and help assess members and agencies for vocational rehabilitation opportunities. This support can be instrumental in offering members the tools necessary to become more independent and facilitate their return to work, providing them with better income opportunities and access to other health insurance.

Our experts have developed operational guidelines and evidence-based vocational tools to assist disability applicants in a self-guided employment search.

For over 25 years, our team has provided cost-effective, accurate disability determinations in significantly less time than our competitors, or state or federal review teams. Contact us to learn how we can help with your disability determination process.