MEDICAL/LEGAL COOPERATION: What Medical And Social Service Providers Need To Know About The Social Security Disability Process
View Article “Should This Patient Apply?” 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.
At the law firm of Jeffrey A. Rabin & Associates, Ltd., located in Des Plaines, Illinois, many of our clients have been entrusted to us through referrals from our medical and social service colleagues. We truly appreciate these referrals because a referral is, on some fundamental level, a mark of trust by one professional in the competence of another.
During the course of our long and mutually advantageous association with our colleagues, we have discovered that while we share some common goals regarding our mutual clients, sometimes our perspectives are vastly different.
Our efforts with Social Security Disability Insurance claims help by providing Medicaid and Medicare eligibility for patients; lessening some of the financial stressors that hinder treatment and recovery; and by providing access to private vocational rehabilitation services once a claim is approved.
The primary goal of every physician is to successfully diagnose and treat people with illnesses and conditions. Patients, of course, seek doctors who can provide treatment and cures, hopefully allowing them to return to their daily routines. So, initially, doctors and patients set a course for the same destination.
Unfortunately, no matter how accurate the diagnosis or treatment, it is impossible to cure everyone. Some patients will become disabled and, therefore, unable to function in the workforce doing even basic work on a sustained basis. When this occurs, the person may be forced to apply for Social Security Disability benefits .
The Social Security Act
The Social Security Act requires anyone applying for Social Security benefits to furnish “medical” proof of his or her total disability. This disability must produce symptoms that are so severe that they inhibit the person’s ability to perform any type of substantial gainful work activity for at least 12 months. Therefore, the focus is on the medical proof related to the ability to function, not the diagnosis.
Proof Comes From The Treating Doctors
This requirement of medical proof in order for a disabled person to obtain Social Security Disability benefits can cause a subtle shift in the relationship between doctor and patient, or between social service provider and client. Whereas in the past both parties were cooperating in reaching the goal of returning the patient to complete health, now there is an added component that can complicate the doctor-patient or social service provider-client relationship.
Necessary Evidence For Social Security Disability Claims
This added component is the need for specific, documented evidence of the patient’s disability.
Difficulty arises in regard to this particular type of documentation for two primary reasons:
- The patient does not fully describe his or her symptoms or complaints.
- The doctor/social service provider is looking for signs of improvement in the patient’s condition.
Consequently, the office notes may not contain the types of evidence the Social Security Disability reviewer is seeking.
Another factor that enters into the equation is the extra time required to create the extensive office documentation that is necessary to supply the Social Security Administration with the type of evidence it requires before awarding benefits.
Doctors and social service providers are busy professionals with a limited amount of time to allocate to each individual patient. The additional tasks involved in completing reports, filling out forms and other requirements can make it increasingly difficult for the doctor or social service providers to comply. Some professionals even feel that it is taking time away from patient/client care, which they believe is their first obligation.
We understand the burden that disability claims place on medical staff and professionals. We work to be responsive, understanding of your time limitations, and always available for questions and discussions by meeting, telephone and email.
By making sure that our clients understand the importance of ongoing medical care, we help maintain strong physician-patient relationships and communication. By assuming responsibility for the Social Security issues, we free up case managers and social workers for other critical needs facing their clients.
Your Patient Needs Your Cooperation
While we realize all the factors that can create a negative impact on the doctor-patient, social service provider-client relationship, and the increased burden it places on the professional’s time and resources, your patient sincerely needs your help and cooperation.
Without the factual information and evidentiary proof only you as a professional can provide, your patient may be faced with severe financial and insurance jeopardy. This can ultimately impede any progress he or she might make in regard to the injury or illness.
Support For Medical And Social Service Professionals
Jeff Rabin and his associate attorneys annually conduct several dozen free in-service trainings for hospitals, physicians, social service agencies, community groups, government agencies and others who have an interest in this area of law. Called “Social Security Disability: Change and Confusion” the presentation explains the law, the application and appeal process and how to return to work after a claim is approved in clear language and in an entertaining manner.
In addition, each month we produce a newsletter for medical and social service professionals on Social Security Disability issues. Your agency or organization can be placed on our mailing list by selecting the topics you wish to receive. This page contains a list of our earlier newsletters and you can click the link to request copies.
If you have any questions or if you think we can be of any assistance with regard to the requirements of your patients who are applying for Social Security Disability benefits, do not hesitate to contact our office at your convenience.