Should This Patient Apply?

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The most perplexing question for many social service professionals is whether to suggest to a patient/client (we’ll use “patient”) to apply for Social Security Disability benefits. Many doctors face the same dilemma when a patient announces that he or she has applied for benefits and requires the physician’s support that she is totally disabled.During our discussions with doctors and case managers it seems that the perceived disincentive to return to work cause many to hesitate to suggest application for Social Security assistance. In addition, many have been involved in more contested workers’ compensation and personal injury claims and are hesitant to get involved in litigation again.Obviously SSDI and SSI benefits are not appropriate for every patient — in fact our office does not help most of the people who call for assistance because it does not appear that they qualify for these programs. However, these programs are intended to help those patients who are just unable to continue to maintain full-time work activity. When trying to decide whether to assist a patient, we suggest the following considerations:

Do You Believe That This Patient Cannot Sustain Work Eight Hours A Day, Five Days A Week?

For most patients, work is defined by SSA for disability purposes as full-time activity, eight hours a day, five days a week. If a patient cannot sustain this activity at a competitive level then application for disability may be appropriate.

Also, the medical problems which cause total disability must have lasted, or be expected to last, at this level of severity, for at least 12 months, or result in death within 12 months.

SSA will require medical evidence to support this opinion. Therefore, the next issue is:

Are The Treating Doctors Able To Support The Inability To Work?

These are medical claims — benefits are not awarded without medical proof from treating specialists who provide medical support for the inability to function. The clinical findings, test results and the written opinions of the treating physicians are the key to any disability claim. No opinion regarding the severity of a medical problem will be given great weight without supportive medical findings.

The focus always begins on “objective” medical evidence — those findings, signs and symptoms that are demonstrable by medical testing and examination.

Impairments that cannot be supported objectively, i.e. fibromyalgia, chronic fatigue syndrome, reflex sympathetic dystrophy, are more difficult so SSA will require sustained period of treatment allowing for a longitudinal view of the symptoms and findings from the treating doctors. The focus in these cases will be on the consistency of the subjective symptoms over a period of time and whatever supportive findings can be found in the office notes. For example, in Fibromyalgia claims, repeated findings of the requisite number of tender points will be important; in Chronic Fatigue Syndrome claims notes regarding elevated temperatures, severe fatigue, myalgias, and pharyngitis will all be considered; Reflex Sympathetic Dystrophy claims will, in addition to the complaints of pain, look for findings hair loss in the affected area, change in skin texture and sensitivity to touch will all be supportive findings.

In all of these cases, the types of medication prescribed will be considered — SSA will view patients treated with narcotics as suffering from more severe pain problems than those treated with the less powerful analgesics.

SSA’s reply to the real issue of lack of insurance and lack of access to the health care system is a simple acknowledgement that the patient has failed to prove eligibility.

Finally, doctors will not be required to come to court. The ALJ hearings are considered nonadversarial and the judges are allowed to consider narrative reports with supportive clinic records and therefore do not require court testimony or depositions.

Remember That SSDI And SSI Are Not ‘Life Sentences’

These programs are not intended to support patients for the rest of their working lives. People who are approved generally are going to receive 30 percent of less of their prior work earnings. SSA will check on almost every patient periodically with Continuing Disability Reviews to determine whether there has been sufficient medical improvement to allow a return to work. Many people have their benefits terminated because of medical improvement. People are allowed to return to work on these programs.

SSDI And SSI Provide Vocational Rehabilitation Programs

Many people who are totally disabled will improve enough over time to allow them to return to work. However, some may not be able to return to the type of work they have done in the past.

The “Ticket to Work” program administered by the Social Security Administration provides free vocational rehabilitation opportunities to persons who have already been approved for SSDI and/or SSI benefits. This training is often broader than that provided by state vocational rehabilitation providers. Access to vocational rehabilitation under the Ticket to Work can open new possibilities for persons who are suffering from serious medical impairments.

CONCLUSION

Physicians and case managers should view Social Security’s Disability programs as an adjunct to their treatment programs. SSDI and SSI provide minimal financial support, health insurance assistance via Medicare and/or Medicaid, and return to work vocational training. As opposed to being a disincentive to work, these programs can support a patient during treatment — especially after the loss of health insurance — and assistance when medical care has provided sufficient medical improvement to allow a return to the workforce.

For other questions, or to confidentially discuss a patient’s situation, feel free to contact the staff at Jeffrey A. Rabin & Associates, Ltd., by either calling our toll-free number, 888-529-0600 and asking for Jeff; or emailing us at jeff@rabinsslaw.com. Our law practice focuses exclusively in the representation of disabled individuals nationwide seeking Social Security Disability Insurance and Supplemental Security Income benefits.