PSERS Primary Care Physician - NDC (750632)

Minimum Qualifications

Must hold a valid license from and be in good standing with the Pennsylvania State Board of Medicine.

Must be able to review disability annuity applications and attendant medical records and other documentation, testify, consult and provide other professional services as requested at 5 N. 5th Street, Harrisburg, Pennsylvania (“PSERS’ Office”) between the hours of 7:30 a.m. and 4:30 p.m. Estimated number of hours services may be required monthly is approximately 13 (130 hours annually). Any recommendation not to approve an application or to continue a disability annuity shall include a written explanation of the reason for such recommendation.

Must have the ability to review disability annuity applications and attendant medical records and other documentation via PSERS’ electronic imaging system.

Must be able to review disability applications and attendant medical records and other documentation and make recommendations to PSERS on a weekly basis or on a less frequent basis as determined by PSERS.

Must be able to attend and testify at administrative hearings scheduled by PSERS at PSERS’ Office or at another location as agreed by PSERS and the medical examiner.

Role Description:

Objectives:

The Public School Employees’ Retirement System (“PSERS”) administers a large public pension plan that provides disability annuities to members who are physically or mentally incapable of performing the duties for which they are employed. The Public School Employees’ Retirement Code, PSERS’ enabling legislation, mandates that the Public School Employees’ Retirement Board (the “Board”) contract for the services of a medical examiner and such other professional personnel as it deems advisable. The primary role of a medical examiner is to review applications for disability annuities and the medical records and other documentation submitted in support thereof. To fulfill that mandate, PSERS is seeking to contract with three general medical practitioners and one psychiatrist to perform the duties of a medical examiner.

Nature and Scope of the Services:
The medical examiner shall review disability annuity applications and attendant medical records and other documentation and recommend whether or not PSERS should find the applicant to be disabled. If the medical examiner recommends PSERS find the applicant to be disabled, the medical examiner also shall recommend whether such disability should be found to be temporary or permanent and if the member was disabled on their last day of work. Upon subsequent review of a temporary disability annuitant’s status, the medical examiner shall recommend whether PSERS should find that the annuitant continues to be disabled. If recommending that PSERS find that the annuitant continues to be disabled, the medical examiner also shall recommend whether PSERS should find that the disability continues to be temporary or has become permanent. The medical examiner may be required to testify on behalf of PSERS at administrative hearings of applicants who appeal PSERS’ findings.

From time to time, as requested by PSERS, the medical examiner will consult with PSERS staff, testify and perform other professional services in connection with matters other than disability annuity application reviews and recommendations.

Tasks
1.Review and Recommendation.
The medical examiner will review disability applications and attendant medical records and other documentation, including job descriptions, and, with regard to each application, make a recommendation on each of the following points:
a. Whether or not to approve the application; and, if so,
b. Whether such disability should be approved on a temporary or permanent basis; and
c. The date on which the applicant became disabled.

If the medical examiner recommends that PSERS not find the applicant to be disabled based on a physical disability, the medical examiner may recommend that the application and attendant documentation be reviewed by another PSERS medical examiner who is a mental healthcare practitioner.

If the medical examiner determines that it is not possible to make any or all of the requisite determinations due to a lack of documentation, he or she shall so notify PSERS staff that additional documentation is needed and provide specific information as to what documentation is required.

If PSERS has previously found the applicant to be temporarily disabled, in advance of the expiration of the temporary disability period, the medical examiner will review any current medical records and other documentation the annuitant submits in support of a finding of a continued disability and make a recommendation on both of the following points:
a. Whether the prior approval should be continued; and, if so,
b. Whether the disability should be approved on a temporary or permanent basis.
If the medical examiner recommends that PSERS discontinue the disability annuity, he or she shall explain the basis for the recommendation.

In any case in which the medical examiner recommends that PSERS deny a disability application or discontinue a disability annuity, PSERS may request another medical examiner to review the same the application and attendant documentation and may base its determination on the recommendation of either or both medical examiners.

The medical examiner shall make all required recommendations, explanations and notifications in writing and with as much specificity as possible.

PSERS anticipates that, collectively, the medical examiners will devote not more than 312 hours annually to reviewing initial and continuing disability annuity applications.

2.Attendance and Testimony at Administrative Hearings.
Applicants who PSERS determines not to have a disability because they are not physically or mentally incapable of performing the duties for which they are employed may appeal to the Board and have a right to an administrative hearing before an independent hearing examiner.

If based on the recommendation of a medical examiner, PSERS denies a disability application or discontinues a disability annuity, and the applicant appeals such denial, the medical examiner must be available to attend and testify at the administrative hearing.

PSERS anticipates the medical examiners, collectively, will testify at one or two administrative hearings annually.
3.Other Professional Services.

From time-to-time, as requested by PSERS, the medical examiner will consult with PSERS staff, testify and perform other professional services in connection with matters other than disability annuity applications. Such matters include, but are not limited to cases involving member capacity to engage in retirement transactions.

PSERS anticipates that, collectively, the medical examiners will provide professional services in approximately 6 matters not related to disability annuity applications annually.

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