Medical retirees to undergo reexamination every 3 years
posted 01/12/06
As provided for in the Social Security Act of 1990, at least once every three-year period, MISSA shall require a medical retiree to undergo a medical re-examination by a physician appointed by MISSA. If the re-examination indicates that the medical retiree has already recovered from disability, payment of his or her disability benefits shall be discontinued.
For purposes of proper interpretation, recovery from disability shall mean the beneficiary may once again engage in the performance of the duties performed prior to the determination of the disability.
However, if MISSA’s proposed change in the interpretation of recovery is approved by the Nitijela, it will mean that the beneficiary may once again engage in any gainful employment, which may be the same or different from the last employment of the claimant before he or she became disabled.
A disability handbook, which is a simplified version of the US Social Security Disability Handbook, is now being reviewed by the MISSA Board. This handbook, being a consultative examination guide, will provide physicians and other health care professionals with a clear and comprehensive understanding of the information a health professional can furnish MISSA to help ensure sound and prompt decisions on disability claims. The handbook also incorporates numerous inputs from John Vanderburg, the Program Coordinator of the U.S. Social Security Disability program in the Pacific Region, who was invited last year by MISSA to conduct an orientation about how the U.S. disability program is administered.
MISSA is now considering the appointment of one chief medical examiner and another one as back-up (in case the chief medical examiner is not available) among the local doctors licensed to practice medicine in the Marshall Islands. The Administration has already budgeted a certain amount and will pay the medical examiner a reasonable fee on a per patient basis.
The main function of the medical examiner is to form a second opinion about the medical condition of a claimant.
Although the Administrator has the authority to approve or deny a disability claim, the recommendation of the medical examiner will still be the main basis of her decision.
One added information in the medical report that must be filled up by the attending physician and which will be reviewed thoroughly by the medical examiner, is the doctor’s opinion about what the claimant can still do despite his or her impairment. This includes the individual’s ability to perform work-related activities such as sitting, standing, walking, lifting, carrying, handling objects, hearing, speaking and traveling.
Furthermore, the claimant’s education and work history, including latest earnings and other skills will also be taken into consideration.
The main reason for this new requirement is the probability that even if the claimant is no longer capable of performing his or her latest job prior to the impairment, he or she may still have another skill (not affected by the impairment) that may be used to find another gainful employment.
A person’s work may be slightly or totally different from what he or she has been doing before the impairment began. It may also not be as hard to do and the earnings may be less as before. However, MISSA may still find that the work is gainful or substantial under its criteria. If the claimant is self-employed, MISSA will also consider the kind and value of his or her work, including participation in the management of the business, as well as the gross revenue of the business.
As most patients use the facilities of Majuro and Ebeye Hospitals for consultation, examination and laboratory/diagnostic tests, the medical report required by MISSA will still have to be prepared by their attending physicians. Medical reports from other private physicians licensed to practice medicine in the Marshall Islands and off-island licensed physicians and health care facilities will also be accepted by MISSA.
In the absence of sufficient medical evidence from the claimant’s own medical sources, the medical examiner may request further examination or test to remove his doubts or uncertainties.