When you begin to experience medical symptoms you can identify as causing poor performance at work on a consistent basis, it’s a good idea before leaving the job to seek consultation from a qualified physician with appropriate credentials to evaluate what’s wrong.
Although you may have already sought medical treatment resulting in one or more diagnoses, discussions about disability with treating physicians are essential prior to actually leaving work. One of the worst things employees can do is “not show up” for work without having a treating physician document the inability to work.
A “best practice” for patients is to provide physicians with a copy of their job description and discuss item-by-item difficulties with specific job tasks referred to as “material and substantial duties.” Claimants may be unable to perform some, but not all of their duties, while others may find it impossible to perform any duties expected of them by their employers.
Unfortunately, today’s reality is that patients are expected to be “in and out of medical consultation in fifteen minutes” leaving very little time for disability conversations with their doctors. However, patients can arrange for “extended office visits”, alerting physicians of a patient’s need for a longer consultation.
Physicians are not “mind readers” and appreciate patients who share their physical and mental limitations while working. A job description and an honest conversation allows your physician to objectively gauge the severity of a diagnosis in combination with what you are realistically able to do on the job such as:
- Are you having problems sustaining a full 8-hour a day or 40-hour workweek?
- Do you have severe levels of pain while at work requiring frequent breaks?
- Do you find yourself frequently confused, unable to remember, or unable to think clearly enough to make important decisions?
- Are you receiving poor performance reviews because you can’t do your job, or is your employer complaining about attendance?
- Are you having difficulties getting along with your co-workers or problems interacting on a social level?
- Do you experience high levels of pain during the work day?
- Are you harsh or abrasive when dealing with customers?
- Are you frequently absent from work and quickly use up sick leave?
- Have you requested FMLA leave more than once in a given year?
- Have you had to ask your employer for work-at-home accommodations or special workstation equipment?
- Are you so fatigued at work that you fall asleep or find it hard to stay awake?
- Are you placing yourself or others at risk because you drive yourself to and from work?
Using your job description as a guide, discuss with your doctors all of the difficulties you’ve had at work and why you find it harder and harder to continue performing the “material and substantial “duties of your job or occupation. Explain to your physicians how many sick days you’ve had in the last month and how often you’ve had to leave work early for medical reasons and why.
For the most part, physicians are supportive when patients take the time to fully explain why they are unable to sustain or perform consistent work. At the same time, physicians have little regard for patients who show up in the office insisting he/she support their disability and basically “do what the patient says.”
“I can’t take it anymore, doc, my boss is really giving me a hard time, and I need to go out on disability. Please sign my paperwork.”
Approaching a treating physician in this way probably won’t get you his/her support for a disability claim. Physicians much prefer to make medical diagnoses and disability decisions independently. Walking into a physician’s office with a list of self-diagnosed impairments is not the way to speak to physicians about disability leave.
“Dr. Brown, I’ve tried very hard to remain at work, but I’m finding it more and more difficult to lift those legal boxes and files without having pain for several hours. My job description requires me to lift up to 50 pounds frequently and my back just won’t let me do that anymore. I’m in pain all the time.”
Dr. Brown most likely will order a set of MRIs or x-rays and pinpoint the herniated or bulging disc causing you to have so much pain. Afterward, he may recommend a period of disability because it is supported by objective evidence or because there is a longstanding history to support the impairment. Disability determination is always related to the patient’s inability to perform his/her job and is supported by a series of objective tests, medical history, and/or clinical observation. To ignore the occupational side of disability could be disastrous to anu claim.
Although there are many impairments that are NOT diagnosed as a result of objective evidence, physicians are permitted to base their opinions from “clinical analysis and consultations” in the past. This is why it is extremely important for employees to seek medical treatment early rather than later when it becomes evident a work leave is necessary.
For some, the decision to apply for disability is the result of a long history of managing impairments for the sole purpose of remaining at work and keeping their jobs. However, insurers, looking for “triggers” to challenge disability claims ask, “What changed? You’ve been working with your symptoms for many years. Why are you submitting a claim now?”
The “what changed defense” is easy enough to explain since nearly all disabled persons do all they can to remain at work until, due to medical necessity, it is no longer possible to work. Sometimes there is no specific “trigger” to filing a disability claim except a long history working with medical impairments that are no longer manageable.
Mental health and self-reported disabilities are much more difficult to diagnose and support for disability since there is no objective evidence such as lab or MRI results to back-up any diagnoses made. Mental health treatment providers, for example, rely on histories of consultation, observation, and reported behavior to make their diagnoses. This is referred to as “clinical proof of claim” and is just as credible as “objective evidence” in supporting disability claims.
Psychologists and other therapists generally do not sign disability paperwork for new patients. Therefore, when it becomes obvious depression and anxiety, or other mental health issues are disrupting and preventing work, or regular attendance at work, treatment should begin right away to establish a history in case it becomes necessary to leave work in the future.
“Dr. Brown, I’ve been working for nearly 10 years now with my back pain and I’m finally ready to retire. I just can’t do it anymore. I want to retire. Will you support my disability claim?”
“I can’t work any longer with my migraines, doc, besides my employer is laying me off and I have too much stress. I want to go out on disability. Can you help me?”
Unfortunately, the above statements are very common mistakes made by employees with medical impairments who have struggled to remain on the job for many years. It is important to realize disability insurance is NOT retirement or unemployment income, but replacement income for medical disability only. As a result, a typical notation in the patient notes such as, “John is having difficulty at work, and he wants to retire. I agree” is a sure guarantee of a dead-in-the-water disability claim.
Insureds and claimants should never associate or use the word “retirement” when discussing disability with a physician since once written in the patient notes, insurers may allege he/she went out of work, not because they were medically impaired, but because retirement seemed a better option. Such patient notes aren’t going to be helpful to support medical disability when read by disability insurers looking to deny claims.
Another common error made by claimants is the presumption that a diagnosis is equal to a disability. For example, Marjorie was recently diagnosed with Type II Diabetes Mellitus with an A1C of 11%. Alarmed and scared by the initial lab reports, Marjorie started crying and requested her physician sign paperwork supporting short-term disability. While her physician gave in and took her out of work for a month, it is unlikely (barring any serious complications) her disability insurer will approve an STD claim for Type II Diabetes without more serious complications involving uncontrolled glucose levels, neuropathy or some degree of blindness.
Physicians actually have more authority than they think they do when certifying medical disability – it’s the paperwork they are opposed to. Most physician caseloads include up to thirty percent “disabled” individuals whether it’s for worker’s compensation, social security, or private disability.
Filling out paperwork is not cost-effective, and utilizes the physician’s office administrative staff, office machines and phones, as well as his/her own time in attempting to determine how to “fill in the boxes” on various forms from different agencies and insurers.
Although physicians generally have more experience in filling out paperwork for workman’s compensation and social security, private disability insurance forms are somewhat unique and require very specific documented “restrictions and limitations.” All good intentions aside, most physicians are unskilled in writing disability restrictions and limitations and wish the “problem” of disability paperwork would just go away.
Early discussions with your physician are essential prior to leaving work since it is extremely important to develop written histories of medical consultation and treatment prior to walking off the job. Disability insurers will request copies of patient notes to ensure claimants have sought appropriate medical treatment prior to approving the payment of any disability claim.
Remember, only physicians can determine disability status, therefore, key information to filing initial applications is included in the patient notes, i.e. the date of disability, diagnosis and treatment plan. The “date of disability” (DOD) is extremely important since it is the date which begins the Elimination Period, and determines the first benefit payment date.
The date of disability, or more specifically, the date your physician restricts you from working is extremely important to any disability claim and should be clearly documented in the patient notes. It makes perfect sense that since your physician is the only person who can “take you out of work” he/she should also be the person who determines when disability begins.
Most insurance companies will use either the day after your last day worked, or your first date of treatment as the date of disability. However, “dates of disability” (DOD) should be established and documented in patient notes by treating physicians before submitting any claim to the insurance company. If not, the insurance company will determine dates of disability claimants may not agree with.
The lessons here in this post are to realize that private disability claims are not “entitlements” to automatic benefits, but require claimants to meet certain conditions of impairment that prevent work certified by one or more physicians.
Only qualified physicians can take claimants out of work and only physicians can release patients to return to the workplace. Leaving work on disability the proper way, supported by qualified physicians is the first primary action claimants make to support claims in a credible way.
All of the above also applies to Individual Income Replacement policies since consultations with physicians remain the same.
Medically preparing for a disability claim is just as important as the impairment itself. Excluding a catastrophic event, such as a heart attack, a disability claim should be prepared and well thought out before making application.
If you are having difficulty in making application for disability benefits and need to speak with an expert please feel free to give me a call.
DCS is a national consulting organization that provides expert claims management services to those with private insurance. I offer free initial consultation and I’m happy to discuss how you can become a DCS client.
If you need assistance with filling out your update forms or questionnaires, please feel free to give me a call. I offer reasonable per hour fees in addition to full management assistance.
If you are interested in becoming a DCS client, please feel free to visit my website at: http://www.disabilityclaimssolutions.com
- Telephone: (207) 793-4593
- Fax: (207) 274-2331
Detailed information about DCS, Inc. can also be viewed on this blog by clicking the “Consulting Services” Tab from the Lindanee’s BlogHome Page.