Why would CalPERS or the County Retirement Association deny a disability / medical retirement application?
Denials are frequent. The retirement system hire defense doctors, referring to them oftentimes as “Independent Medical Examiners”, even though they are hired, paid for by and used repeatedly by the retirement system. Thus, the label “Independent” is misleading. These defense doctors are used to evaluate its members following their applications for benefits. These doctors are routinely used for the purpose of defending against claims for insurance companies, workers’ compensation carriers, and for retirement systems. Thus, the defense doctors understand that if they can deny benefits for their employers, their referrals will continue.
Therefore, it is very important that once you are evaluated by a doctor on behalf of CalPERS or the County Retirement Systems, that you take steps to get a copy of the doctor’s reporting regarding your evaluation. It will provide you with the information in most cases as to why you were denied.
Although reasons vary, many times the claims are based upon the fact that you are older, obese, or had an injury in your past, that the doctor can claim is the “real” reason you have your current disability from work despite having injuries actually occurring on the job. Other common reasons to deny claims is that your injury is not bad enough to disable you claiming you are exaggerating your injuries or are a malingerer and just want the benefit instead of working. Defense doctors also routinely state that your disability is merely based on your subjective claims of having pain, and that the objective findings cannot substantiate the pain you feel.
To most, a denial is shocking and frightening. Most employees have already been through a lengthy workers’ compensation process filled with denials and delays, and now they face more of the same. Most have been off of work for months or years. The employer has already advised them that it cannot accommodate the restrictions developed during the course of the workers’ compensation case. So how can CalPERS or the County Employees Retirement System now come to a completely different result?
Whether it is CalPERS or the County Employees Retirement System employees discover that it is an entity separate from their employer which makes its own determination many times opposite of that which was determined by the employer and the workers’ compensation system.
At the time of the denial a decision must be made whether to return to work or pursue an appeal hearing. It is beneficial for employees with disability / medical retirement rights to consult with an attorney handling such matters at the first time they believe that they will not be able to return to their prior job, but certainly once the retirement system has obtained a medical report against you, it is imperative that you get professional advice.
Jane Oatman, Esq.
FAUNCE, SINGER & OATMAN
Fighting for the Rights of Disabled Public Employees