Employees who have disabilities often turn to their group health insurance plan to provide or at least assist with funding. If you have been denied on the first round
Double-check to see if you provided all the required medical documentation and appropriates forms. If a form was filled out incompletely or incorrectly, the insurance company may not voluntarily notify you.
Assuming your paperwork was correct, you can ask for an administrative review by a staff physician or nurse. However, keep in mind that a general physician employed by an insurance company may not necessarily be knowledgeable about these devices and how they can assist you in staying healthy or employed. Do not be afraid to ask that a specialist in rehabilitation medicine review the claim.
Remember that there is always a chance for full or partial funding if the policy coverage does not specifically exclude a device or piece of assistive equipment. It is not uncommon for the claimant to eventually learn that he or she is better informed than the personnel with the group health plan.
Worker’s Compensation Claims
If a disability occurs through a work-related accident or illness, you may ask your employer’s Workers’ Compensation insurance carrier to pay for needed assistive technology devices and services. Be aware that Workers’ Compensation carriers want to settle the claim as soon as possible. Don't be too hasty! Wait until you know the full extent of the injury or disability, what kind of assistive technology is needed and for how long.
Be sure to let the insurance personnel know that you will not settle the claim or sign any waivers or release forms until there is sufficient medical evidence that the disability is permanent and unchanging.
If there is an attorney involved, make sure he or she understands why you may need specific assistive devices and the terminology associated with the devices.
Ask questions and take time to understand how your Workers’ Compensation benefits are structured.
If you apply for funding from a state agency and are told that you do not qualify for assistance or if the particular device does not qualify, you may appeal this initial decision. All government agencies have internal appeal procedures, and you can have your claim reviewed by mid-level management or, eventually, an agency director.
In considering an appeal, you should ask the following:
Question: How does this device enable me to enter employment, receive vocational training, live more independently or otherwise improve my functioning in society?
Answer: You undoubtedly built a case for this for this earlier when you first approached the source, but you need to look for ways to strengthen your request. You can construct an appeal if you can demonstrate how the device will help you; be sure to include benefits to your health and well-being. For example, stating that a speech generating device will allow you to communicate with your doctor and ask for specific help during an emergency.
Question: Do the agency’s guidelines specifically exclude the device or has it been funded in some cases before?
Answer: If an agency has funded a device in the past, thereby setting a precedent, it will be more difficult to deny your appeal.
Question: Do you meet the agency’s financial requirements and other criteria?
Answer: If it is obvious that you do not meet their criteria, an appeal would be fruitless. On the other hand, if you can provide evidence that disputes someone’s determination of your eligibility, it will greatly improve your chances.
Minnesota Special Education Mediation provides conflict resolution assistance for students, schools, parents and agencies. Parents and school staff can use a mediation session or a facilitated Individualized Education Program, Individualized Family Service Plan and Individual Interagency Intervention Plan meeting to address issues of concern. Mediated agreements are a highly successful way of solving problems in schools because people are more satisfied with and follow through better on agreements they help create. The Department of Education pays mediator fees when issues to be resolved are the same as at a conciliation conference or a due process hearing.
Area of Government Representatives
One more options to consider is to contact your local elected officials concerning your complaint or disagreement. These officials depend upon you for your support and will almost always check into your situation to see if your complaint is legitimate. If they feel it is, they may attempt to rectify it for you or at least get you another hearing with the agency. You should contact state legislators or local officials if the issue involves a state agency.
If you have been through the appeal process with a federal agency or program and still have not received authorization for funding, you may want to consider contacting your United States Senators and Representatives for assistance. Federal agencies or programs include the Social Security Administration, Medicare and the Department of Veteran Affairs.
If you have totally exhausted the appeal process and still are getting told “no,” Minnesota Disability Law center (MDLC) offers two state programs specifically to support your interests when you are having problems with some state agencies.
The Client Assistance Program (CAP) will pursue your interest if you are in conflict with state rehabilitation agencies.
Protection and Advocacy (P&A) protects the rights of and advocates for persons with disabilities in disagreements with state agencies, private insurance companies and others.
MDLC’s mission is to advance the dignity, self-determination and equality of individuals with disabilities. MDLC works to promote, expand, and protect the human and legal rights of persons with disabilities through the provision of information, training, advocacy and legal representation.
To learn more about MDLC programs visit Minnesota Disability Law Center or contact:
Minnesota Disability Law Center
430 First Avenue North, Suite 300
Minneapolis, MN 55401-1780