Case files key to comprehensive medical board reviews

August 23, 2018
Jody Simpson
Jody Simpson, RN
Clinical Director, Disability Evaluation Services

There are many obstacles public retirement systems must overcome to ensure clinically sound medical board recommendations. Complex medical records that describe various conditions and ailments must be compiled and analyzed to make accurate recommendations. There are key elements to inform a successful medical board review, and chief among them is compiling robust, well-documented case files. If you begin the process with incomplete documentation, you run the risk of getting a partial clinical picture of the member. Not having a full clinical picture could make it difficult to achieve a fully-informed decision.

To ensure you begin the determination process with the right information as a baseline, you need to create a comprehensive medical record. To do so, assign case management responsibilities to credentialed clinicians with experience in identifying and obtaining critical medical records. You can be proactive about record development by contacting member, employer or medical treatment sources for additional information as necessary.

Once you believe you have a comprehensive medical record, you have to go one step further and dig deeper. Are there any pieces of medical information missing to inform decision-making?

Probing health and medical records is critical to create a complete clinical picture. A tireless approach to case development on the first application supports a thorough medical record, which leads to a fully supported decision.

If you need help, UMass Medical School’s Disability Evaluation Services provides comprehensive disability evaluation services to public retirement systems and state agencies. Our onsite team consists of more than 75 licensed clinical professionals who can support the medical review process.

Taking time in the beginning—to augment your team and/or to ensure complete case files— saves time in the end, and, most importantly, gives you the foundation to make the correct decision.