Medical arbitration FAQ

Read our FAQ on medical arbitration below, and be sure to read our guidance on medical arbitration for more information. 

What is medical arbitration?

Medical arbitration is the process by which a pedagogue appeals a decision made by the DOE medical office. Members may be eligible for medical arbitration once they have been denied a Line of Duty Injury (LODI) for at least 20 consecutive days. Once you apply for arbitration, you will be added to a waiting list to see an independent medical doctor who will function as a neutral arbitrator for your case.  

When must I apply for medical arbitration? 

You must file for arbitration within 10 business days of receiving a Line of Duty Injury (LODI) denial letter from the DOE medical office. 

What does the arbitration process entail?

The DOE Medical Office will contact you to schedule an exam with an arbitrator in the  medical specialty you selected when applying. They will remind you to contact your doctor to speak with the arbitrator after your exam. 

Before the exam, the arbitrator will review all the documents you submitted and read the defense the DOE doctor wrote. Then he will examine you, speak to your doctor and then write a decision. The arbitrator has unchallenged authority to grant you all of your LODI, some of it, or none of it. Since your injury may have occurred a considerable amount of time ago, the actual examination might resemble more of a conversation. This is your opportunity to make your case directly to the arbitrator. However, he will rely primarily on the medical documentation to render a decision.

How can I decide whether or not to proceed to arbitration?

It costs $800 to proceed to arbitration, so it is a good idea to know your chances of winning. The most common reasons for a loss include the presence of a pre-existing condition, and whether your recovery was much longer than is typical. To help you make your decision, you may wish to consult with tbennett [at] uft [dot] org (Thomas Bennett), the UFT Liaison to the DOE Medical Office.

Also, if a year or more has passed and you are still out of work, you should be considering a disability retirement as the arbitrator will not grant years of LODI. In this case, call the UFT at 212-331-6311 to speak with a pension representative. 

Once I apply, how long will it be until I have been assigned a date for an exam with the arbitrator?

Currently, the wait time is approximately 18 months to two years. The wait is very long because there are so many members applying. The wait also depends on the specialist you need; orthopedic surgeons are the most common, hence the wait is longest. Wait times to see a psychiatrist or neurologist may be faster.  

How will I be informed of the date of the exam?

The invitation will arrive in your DOE email. If you lose access to your DOE account, inform the MLR [at] schools [dot] nyc [dot] gov (DOE Medical Office) right away of your new contact information. 

Can I continue to submit ongoing medical documentation as I await the exam?

Yes. Upload any pertinent updates onto the DOE’s HR Connect Portal.

Do I need to prepare for the exam?

No. Just come as you are but be ready to explain your case clearly. If you have examined your documentation carefully, you will know the strengths and weaknesses of your case. You want to emphasize the former and address the latter. 

If I apply for medical arbitration, can I change my mind later?

Yes, you can withdraw at any time. There is no penalty. You are only required to pay the $800 fee at the time of the exam. You are making no promises to continue.

Will my arbitration proceed even if I am retired or separated from service?

Yes. Just inform the MLR [at] schools [dot] nyc [dot] gov (DOE Medical Office)of your new email address.

What are my chances of success in pursuing medical arbitration?

Unfortunately, the process is structured to the advantage of the DOE. The arbitrator is tasked with answering the following question: Was the decision of the DOE doctor to deny your LODI a “reasonable” one? Since that question leaves a lot of room for interpretation, the outcome is not often what we might hope. Also, since the DOE is defending their decision to deny your LODI, they have the opportunity to write up a defense. However, you do not get to present your case in writing.

Does the DOE ever change its mind before the arbitration?

Though rare, it does happen. Therefore, it is a good idea to apply for arbitration even if you don’t pursue it further. Sometimes, the DOE will suddenly approve an entire LODI. Another possibility is that they may offer you a stipulation settlement where you agree to accept a shorter LODI approval in exchange for dropping your arbitration request. 

How will I learn whether I won my case or not?

Astonishingly, the arbitrator does not send a copy of the decision directly to you. He sends it to your doctor, the DOE Medical Office, and to tbennett [at] uft [dot] org (Thomas Bennett), the UFT Liaison to the DOE Medical Office, who will forward it to you as soon as he receives it. 

If I lose my arbitration case, can I appeal the decision?

No. The arbitrator’s decision is final. There is no other opportunity to appeal.