Thursday, February 10, 2005

Disability concepts

As someone who is experienced in analyzing disabilty claims, I would like to share some observations:

  • As mentioned before, don't assume that being an advocate for the patient means advocating for being out of work and for payment of a disability claim. Frequently, the discipline of schedule, regular physical activity and social interaction are more beneficial to your patient. For example, getting up and eating meals at the same time every day are a big part of being employed and also a big part of managing diabetes.
  • As I mentioned in my discussion of this article, be as specific as possible. I will post some verbiage you may find useful. I know that I had no clue how to write restrictions before I started this job.
  • Try to address specific functional capacity issues. Avoid commenting on work capacity or whether your patient can go to work. It is not usually helpful, to the insurer or to your patient, to say "No work" or "Can't work." Even worse is "can't do anything."
  • The job tasks your patient describes to you may not be specifically required for that occupation, especially for another employer. This is why I recommend you avoid making the vocational decision yourself, unless you happen to have some expertise in vocational analysis.
  • Realize that there may be contractual reasons for denial of a claim. Perhaps there is a pre-existing condition clause or your patient was not covered by the policy on the date of disability. I even saw one claim where the employee had not even purchased the coverage and still filed a claim. No matter how impaired he may have been, he was not eligible for benefits.

More to come.