How To Talk with your Physician about Supporting your Disability Claim by Scott E. Davis, Disability Attorney April 17, 2001 Well, it happened again this week. What am I referring to? The all too familiar story of a treating physician who does not support a patient’s claim for disability benefits. This usually comes as a complete shock to the patient who thought the physician was in their corner. (In this article I use physician interchangeably to mean medical physicians, psychiatrists, psychologists or podiatrists). I am aware of this problem because I often talk with treating physicians about a client’s disability claim. The client has told me they are certain the physician supports their claim. I am always surprised when the physician does not support the claim or does not “want to be involved in the claim.” To be sure, the physician’s response of “not wanting to be involved” is the same as not supporting your claim. In this article I will discuss why is it critical to have the support of your treating physicians and hopefully how to obtain it. Tip #1 The Support of a Treating Physician is Often Critical to Claim Approval In a social security disability (SSA) claim, federal law gives the greatest weight to the opinions of treating physicians. If SSA has your physician’s opinion that you are unable to work, you should have a strong case. If you do not have your physician’s support, or they are “silent” on the issue of your disability, your claim will likely be compromised. This is not to say cannot win your case, but the mountain you must climb will be steeper without a physician’s support. The fact that SSA gives the greatest weight to your treating physician’s opinion is critical because one of SSA’s physicians (who may have only reviewed your records) will usually conclude that you are able to work. If confronted with differing opinions, federal law requires SSA or a judge to give greater weight to your physician’s opinion because they know your medical condition best. Thus, if your physician has told SSA you are unable to work, SSA should use that opinion and approve your claim. If your physician does not want to be involved in your disability case, or will not complete a form, this is the same as not supporting your claim. Why? Because you can bet SSA has an opinion in your file from its own physician that you can work. Without your physician’s opinion, SSA will use its own physician’s opinion (even if they have never seen you!) to deny your claim. Thus, if your physician has told you he/she does not support your claim, or does complete disability forms, you have a real problem that needs to be addressed as soon as possible. Tip #2 When to Talk with Your Physician About Supporting Your Disability Claim Remember the old adage, “Keep it Simple Stupid!” Let this adage guide your conversation with your physician. First, you should talk with them about supporting your claim only after you have been evaluated by them 3 or 4 times, or after you feel they know your condition well. Never talk with a physician about your claim after the first or even second visit. Why? Your first priority in the relationship should be for treatment that allows you to return to work. The physician will be very reluctant to support your disability claim if they believe you are motivated by disability benefits rather than getting better. The physician will be more willing to support your claim after they have treated you for a period of time without meaningful results. Tip #3 How to Talk with Your Physician About Supporting Your Disability Claim With all due respect to the medical community, many physicians do not know how SSA defines disability. The problem is most physicians think they know who is and is not disabled. I know this to be true because I have personally spoken with hundreds of physicians whose definition of disability was completely different than SSA’s. In almost every case, the physician’s definition of disability is much stricter and harder to meet than SSA’s definition! Invariably, the treating physician concludes the patient is not disabled using their definition and will not support the case. However, after I explain SSA’s definition, the physician agrees the patient is disabled and unable to work! The key to obtaining your physician’s support is how you frame SSA’s definition of disability. Tip# 4 Discussing SSA’s Definition of Disability with your Physician To obtain the support of your physician, I believe the following is an effective approach. First, never tell your physician you are “disabled” or have a “permanent disability.” Why? Because those expressions are terms of art our society uses but are totally irrelevant to a social security disability claim. Remember, your physician will usually save those labels for only their most seriously ill patients. You probably don’t “look” like one of those patients. Instead, ask the following questions. First, tell them you have filed a claim for disability benefits because you are “unable to sustain full time work.” Ask your physician if they also believe you are “unable to sustain full time work at the present time.” Notice that I did not use the words “disabled” or “permanent” in either question. If your physician agrees with you then ask for their support for the next 18 to 24 months. Why such a short time? For one, this will get you past SSA’s requirement that you be unable to work (or you are expected to be unable to work) for at least 12 months. Second, most physicians believe disability is a “permanent” condition and once your claim is approved, you will never return to work. Countless physicians have told me they don’t want to be put in the position of saying a patient is permanently disabled. You would not want to be put in that position either. So…don’t put them in that position. However, almost all physicians will agree that a patient is unable to work for a period of time. Your physician will feel more comfortable supporting your disability claim when they know it is for a limited period of time and that you want to return to work after a period of recuperation If after 18 to 24 months you are not able to return to work, then address the issue again with your physician. If your physician does support your claim, ask them to please write into the medical record that you are unable to work and to document the reasons why. Conclusion If you approach your physician in the manner discussed in this article I can assure you that you will have more success. I know this to be true because I use it every day when I talk with a physician about supporting a client’s disability claim.