Talking to Your Doctor About Your Disability Case
For Social Security disability (SSDI) claims, as well as for long-term disability under ERISA (employer-sponsored group disability) plans, the benefits-decision is frequently based on the documentation that your doctor puts in your medical record.
The Social Security Administration (SSA), as well as private insurance carriers, are sticklers for details when they review your medical records. The more objective the documentation is of your diagnosis and disability in the medical records they receive from your doctor(s), the better chance you will have of getting your disability benefits approved at the administrative level.
While you, as a patient, cannot directly control what information your doctor puts into your medical record, there are a few important "tips" that you can follow to help you to "guide" your doctor in adequately documenting your disability.
- Avoid Conclusory Statements or Opinions and Try to Document the Factual Basis of Your Disability.
When speaking to your doctor, describe the factual basis of your disability, rather than simply stating that you are disabled. You must give specific reasons to your doctor that explain why you should be awarded disability benefits. For example, if your back hurts and you cannot sit for 6 hours or more in an 8-hour workday, tell your doctor that the most you can sit is less than 6 hours. If you have knee pain and are unable to stand or walk for 2 hours or more in an 8-hour workday, make sure you tell your doctor precisely that. If you are unable to lift or carry 10 lbs or more, explain that to your doctor. Or, if you are unable to concentrate and are unable to do your work or "stay on task" because of migraine headaches,describe those limitations to your doctor. You must tell your doctor the exact functional limitations that you have, so that he/she can document that information in your medical record.
It's not enough for you to tell your doctor that you believe you are disabled, and it's not enough for your doctor to say in the medical records that you are "unable to perform gainful employment." The Social Security Administration (SSA) or an insurance carrier, in reviewing your disability claim, will likely consider this to be a "conclusory" statement, wihtout factual support, and give little credence to it. In addition, the SSA may consider a conclusory opinion from your doctor on whether you are disabled to be an issue reserved to the Commissioner pursuant to 20 CFR §404.1527(e) and SSR 96-5, and that it is not up to your doctor to determine whether you are disabled. It's up to the SSA.
What's worse, the SSA may interpret such an opinion from your doctor as reflecting advocacy rather than objectivity, and use that against you in its benefits decision.
- If You Have Pain, Describe Your Pain Objectively on a 1-10 Scale.
It's best to describe the severity of your pain to your doctor on a 1-10 scale, where "1" is minimal or no pain, and "10" is the kind of pain that takes you to the Emergency Room. Doctors are used to using this kind of pain scale, and it's a more objective way of documenting pain, which is a purely subjective matter.
- You Have the Right to Look at Your Medical Records.
Under HIPAA ("Health Insurance Portability and Accountability Act), you have the right to review your medical records. That's something you should take advantage of and do on a regular basis to make certain that your doctor is documenting your disability in a detailed and accurate way. Doctors may not like it, but that's your right under federal law, and you can tactfully request it. You also have the right to amend your medcial records if you see something that's not accurate and that should be amended. Amending the medical record does not mean that a doctor can change what he/she has already entered into your chart. That's not allowed. However, what the doctor can do is to add a statement to clarify the entry he/she has made in your chart. And if needed, that's what you should ask for.
- Find a Doctor That You Can Work With and Who Will Support Your Disability Claim.
Not all doctors will be willing to help you with your disability claim. Be sure to find one that will.