Doctors and other medical professionals are the main care providers for seriously disabled patients. But just as a physician turns to lab technicians, imaging experts, nurses and others perform related services, physicians ought to turn for help in certain cases to the legal profession. Nowhere is this truer, or more neglected, than dealing with patents suffering long-term disabilities.
There is a tragedy in this country that stems from the denial of government benefits for the severely disabled. Under a Social Security program that awards benefits to long-term disabled and seriously ill people, incapable of working on a sustained basis, including monthly income (as much as $2,000 for a family) and health insurance, these benefits often become the difference between living with some measure of dignity and despair. Yet only about 30 percent of the people who apply for such benefits are approved at the first step of the process.
This high rate of denial is tragic because as many as half of those denied ultimately will be approved upon appeal. Yet the backlog of cases so burdens the Social Security Administration that appeals can take as long as two and often times three years.
During this long delay, many severely disabled people have little if any money to live on - and even in the best of cases a great deal less than what they would have normally. These patients may be suffering chronic illnesses or the ravages of a horrible disease, or possibly the residuals of a catastrophic injury. What they share is an almost total loss of function as it relates to their ability to work. Having lost their usual income, they now face what looms as an interminable delay in receiving the benefits.
Moreover, while many companies' long term disability plans pay as much as 2/3 of the wage base, they, nevertheless, make continuing eligibility contingent on qualifying for Social Security Disability. Once in pay status for social security, Medicare coverage is then provided after benefits are paid for 24 months. Given these circumstances, the two-year gap in getting approved for SSD can have horrendous financial psychological and emotional consequences for a patient saddled with mortgage payments, medical expenses, utilities, children's school costs and just putting food on the table.
The denial of SSD benefits also creates animosity between doctor and patient. The patient, already confused on how the system works, often confronts his treating physician asking why the doctor did not support the claim for disability. The physician then wonders what more he or she could have possibly done to avoid this confrontation. The doctor gave the SSA information they wanted; what more could be asked?
This horrible situation, in most instances, stems from the physician being totally unfamiliar with the guidelines social security uses in deciding who qualifies for benefits. In many cases, initial guidance and assistance to the patient and the health care professional could avoid most of these problems as well as quicken the decision-making process. Ignorance is the disease, education and counseling the cures.
It is urges that your patient obtains competent legal assistance even before he applies for benefits. Though most ATTORNEYS do not accept cases until the claim has been denied at least twice, a limited number encourage legal input at the time of the initial application. How the application is completed, how the medical evidence is developed and what questions to ask the health care provider can be the difference between a claim being allowed within a six to eight month period and one that can take longer than two years.
If more physicians were familiar with how the Social Security Administration utilizes the age, education and skill level of the patient - along with the medical evidence - many more patients would be approved for disability benefits much sooner. Yet few, if any, doctors can keep up with the often arcane, sometimes outdated medical standards that could qualify a patient. The application process involves the completion of no less than six different multi-page forms, ranging in size from five to 20 pages. Even after one qualifies on the medical requirements, the non-medical issues must then be investigated before benefits start and medical coverage begins.
It's crucial to remember that when a Social Security examiner sends a questionnaire to a doctor to complete, the examiner is seeking specific clinical and laboratory data that can allow a finding of severe disability that precludes gainful work. SSA is not interested in the physician's own opinion and conclusion unless supported by the medical evidence. Understanding how the medical signs, symptoms and test data impact on the issue of the patient's ability to function on a sustained basis is the key to understanding how a claim is decided.
Many, perhaps the great majority of health care professionals, don't understand this distinction. When confronted with completing a form by the SSA on behalf of a patient, brief answers and short summaries along the lines of "I find this patient to be permanently and totally disabled" are used. Unfortunately, the statement means nothing to a SSA examiner or reviewing physician unless supported by detailed medical data that meets specific SSA standards.
Our experience in this world of law tell us that probably 90 percent of even board-certified doctors in a given specialty won't know what medically qualifies a patient for disability benefits. It is not their job to know. The treating professional is there to diagnose and then to successfully treat the patient. Struggling with legal forms is not and should not be a part of the task.
The best solution is for the physician to encourage a patient to get competent legal help immediately. There are ATTORNEYS who gladly answer questions and give basic guidance, answering as many questions the patient, or for that matter, the physician or his support staff may have. Only when services are needed and representation starts are charges incurred, and even then those charges are on a contingency basis - there is no charge unless the claim is successful and the benefits are awarded.
Our plea to physicians - let us help you help your patients. Allowing a competent social security attorney to guide both you and your patient throughout this complicated contradictory and confusing system can result in not only an award of benefits, but receiving those benefits sooner than ordinarily expected in the majority of cases.
Applying for Benefits - What to tell your Patient
It would be easy to simply give your patient the 800 phone number of SSA and tell the patient to call. In many cases that would be sufficient. However, the person you get on the other end of the line at SSA, or the individual you deal with in one of the field offices does not necessarily mean competence. Misinformation is not uncommon. However, there are some simple rul3s to go by. Foremost, what ever your patient does, make sure he does it in writing. There can be no benefits without a written and signed application. This is quite critical in SSI claims because often benefits are lost because the patient was given information that was incorrect and no application was taken. If there is any doubt, always tell the patient to err on the side of safety and file a written application, making sure to get an acknowledged copy from SSA. SSI disability cannot be paid any sooner than the month, following the month, the written application is made. Do it in writing (the application), and get it in writing (acknowledgement by SSA an application has been filed).