The process outlined below conveys the typical applicant’s experience. Please note, some steps may be omitted or repeated depending on the circumstances. For example, for an applicant in the end stages of a terminal condition, MainePERS may work directly with the applicant’s Oncologist in order to expedite the application and render an outside Medical Review Service Provider opinion unnecessary.
Intake – When you call to inquire about applying for Disability Retirement, a Disability Specialist will guide you through an intake process. During the intake you will be provided, in detail, with the eligibility requirements of the program. These conversations usually last around an hour in length. The Specialist will ensure you understand the application process, the next steps to be taken and offer you an opportunity to explain some of the hardships you are facing.
Receipt of Application – Once the intake is completed, if you indicate you are ready to apply for benefits, MainePERS will mail you an application. If you contribute to Social Security as well as MainePERS for the same employment position, you must provide proof of filing for Social Security disability before MainePERS can accept your application for disability retirement. If you are applying for disability retirement for any conditions that are the result of, or exacerbated by your job, you must provide proof of filing for Workers Compensation. You do not have to have received a decision from Social Security or Workers Compensation prior to filing an application.
New Application Interview – Upon receipt of your application, your case will be assigned to a Disability Specialist who will be your contact throughout the application process. The Specialist will review the contents of your application and conduct an interview to gather information regarding your most recent position, the difficulties you are facing and ask questions they may have regarding the application itself. You will have the opportunity to ask any questions you may have.
Compilation of Medical Evidence – As part of the disability application, you will be asked to provide a list of healthcare providers with whom you have received treatment for the conditions on which you’re applying. MainePERS will request documentation from these healthcare providers.
Employer Interview – In addition to the medical evidence provided by your healthcare provider(s), Specialists and support staff request documentation from your employer, worker’s compensation (when applicable), staff responsible for processing ADA accommodations (when applicable) and any other sources deemed necessary through the application and interview process. Disability Specialists also schedule interviews with your employer to discuss job performance, any reasonable accommodations provided or available, further explanation of essential job functions and any other pertinent information.
Pre-Medical Review – After MainePERS has received all of initial medical evidence and completed the interviews outlined above, the Disability Specialist will call you to review the evidence received and to determine if the information you intend to submit is complete. This is an opportunity for you to identify whether there is any important information missing prior to your case being assessed for eligibility.
Submission to Medical Review Service Provider –MainePERS contracts with a Medical Review Service Provider (MRSP) who provides medical opinions regarding the applicable conditions, limitations caused by those conditions and whether or not any limitations are expected to be permanent. The MRSP receives a copy of the file compiled by MainePERS and relies on experienced healthcare professionals to make their assessment.
Observation – Upon receipt and review of the report from the MRSP, the assigned Specialist will speak with you regarding the findings. A letter outlining the detail of this conversation, as well as a copy of the report from the MRSP, will be provided to you.
Record Supplementation – After the observation, you may choose to supplement the documentation previously provided to MainePERS. Examples of supplementation include undergoing suggested treatment, consulting with treating healthcare providers regarding the observation and MRSP report or seeing a new healthcare provider. Additional medical evidence is often compiled during this phase.
2nd Review by the Medical Review Service Provider – Once you are satisfied with the content of your record, the updated record is sent to the MRSP for a second review.
Independent Medical Examination (IME) – If it is determined that you do not meet one or more of the eligibility criteria once the second submittal to the MRSP has occurred, you will have the option to be scheduled for an IME. MainePERS may also opt to schedule an IME if results from the MRSP report are inconclusive. The healthcare professionals who perform IMEs are outside contractors. You and MainePERS must agree that the healthcare professional suggested is acceptable prior to the IME being scheduled. You may choose to waive the right to an IME.
Decision Issued – Several levels of internal review are performed prior to a decision being rendered. Decisions are communicated over the phone as well as in writing.
Hold – At any point in the process above, you may request that your application be placed on hold for 30, 60 or 90 days. Multiple holds may be requested. Holds provide you with the opportunity to pursue further treatment, consult with a healthcare professional regarding the specifics of your case or take additional time to think about the options available to you without worrying about the status of your case.