Legal Briefs from Matt Cohen
The following are past questions and answers from Matt Cohen on this topic.
Do students with Sensory Processing Disorders have rights under Section 504 and IDEA?
My son is 10 years old and in 4th grade. He was just diagnosed with a Sensory Processing Disorder, being severe with touch and visual. I live in a very small community with a small school and very little funding. Would this type of disability be covered under section 504 or IDEA?
I am trying to find a way to get the help my son needs in order to succeed in school. However the school keeps telling me they don't have funding and can't bring in specialists. They say that this disability is not a federally recognized learning disability under the federal guidelines. I should mention that I can't trust the schools opinion a lot because for years they have told me my son does not have a problem other than "laziness and disrespect." Therefore, they can't assist us. I am trying to figure out if I can "force" them to bring in help under the federal guidelines or just try to get them to accommodate my son as much as possible.
A concerned and frustrated parent
The IDEA doesn't specifically reference Sensory Processing Disorder as a listed disability. However, many children with Sensory Processing Disorders may be appropriately made eligible for special education under the special education category of Other Health Impairment, due to a medical condition which causes limited strength, vitality or alertness, including limited alertness to educational tasks due to heightened alertness to environmental stimuli. I have successfully argued in many cases that sensory processing disorders may fall either under the category of Learning Disability, if they affect processing of information, or under OHI, if they affect the ability to attend, focus, behave, etc.
Even if your child does not meet criteria for an IEP under the IDEA, a sensory processing disorder may qualify for protections under Section 504 as a physical or mental impairment which substantially limits one or more major life activities, including thinking, learning, working, etc. It would be helpful if the clinicians who diagnosed your child could provide detailed information about the ways that the disorder impact your child's functioning at school, as well as provide you with articles or research that you could share with the school staff to help to educate them about the disorder and to persuade them to take it seriously.
What do you do if your insurance company will not pay for a test related to a disability?
My son has been tested and diagnosed with CAPD. However, the doctor who did the testing tells us the report she completes with the information as to what needs to be done for my son is a separate cost of $400. My insurance company will not pay for it. I have verified with my insurance company that they will not pay for it because it was not included in the overall testing cost. How can a doctor do testing and charge for the report in such a manner that it is not covered by insurance?
Any advice you can give me would be appreciated! Thank you!
You should review your insurance policy and benefits book to make sure that the insurance company's interpretation is correct. You may consider appealing their position to your state insurance commission. On the other hand, if your doctor did not inform you of the extra charge for the report, you may also have a legitimate complaint with them, particularly if they were aware that the results would be needed by the school district. This could be pursued through the state licensing agency or the clinician's professional association.