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Hope for the Best; Plan for Otherwise

Jacques Chambers, CLU,
Benefits Consultant

Posted November 18, 2013

Everyone who deals with a chronic condition that may be progressive hopes that they will be blessed with continued health and energy. We in California have earthquake survival supplies; growing up in Oklahoma, we had a tornado shelter, yet we all hoped they would never be needed. However, they were there, if needed.

The same can be said when dealing with a chronic, possibly progressive medical condition such as HCV. Don’t plan on becoming totally disabled, but just in case……

The most important part of preparing for ”…..just in case,” is having the full support of your treating physician(s). That doesn’t mean just getting your doctor to agree to fill out the paperwork should you need to file for disability benefits.

The key to getting disability benefits is really in the hands of your doctor. Whether you are applying for Social Security Disability or private disability insurance, it is your medical record, more than anything else that will be used to determine if you meet the definition of disability.

Unfortunately, many physicians mistakenly believe that if they write a letter declaring you to be disabled, and then your claim for benefits will be approved. NOT TRUE!!!

Whether it is private disability insurance or Social Security Disability benefits, each has its own definition of “totally disabled” and you must meet that definition before you will be eligible for benefits, regardless of your physician’s opinion of your condition. Because “totally disabled” has a very special meaning in the context of the benefits you are applying for, they ignore such opinion statements from your physician. They want to know why your doctor considers you disabled and whether those reasons are enough to meet their definition of “totally disabled.”

To do that, you should first know, generally, what it takes to be considered totally disabled. With that knowledge, you can work with your medical providers to see that the medical record reflects that…..just in case.

Social Security has an overall definition of disability that is less than helpful:

“We consider you disabled under Social Security rules if you cannot do work that you did before and we decide that you cannot adjust to other work because of your serious, documented medical condition(s). Your disability must also last or be expected to last for at least one year or to result in death.”

The important thing to note in that definition is that they don’t consider you disabled unless you are not only unable to do your regular job, but are also unable to do or any other type of work which you might be suited and/or trained for.

You can get a better idea of what Social Security expects by looking at the Listing of Impairments, also called the “Blue Book.” You can find it at:  http://www.ssa.gov/disability/professionals/bluebook/  

You should look at the long listing for §5.05 Chronic Liver Disease, but ALSO look beyond that. Read the sections at the start of §5.00 Digestive System. Also, under §5.05; you will find references to other sections of the “Blue Book.” Check them out also. By becoming familiar with what Social Security is looking for, you can work with your doctor to make sure they find it in your medical record. Note that I am not speaking of “padding” your record or putting anything in it that isn’t true. However, the record should be complete, and this will help you make sure it is.

Private Disability (both Disability Income and Long Term Disability) defines total disability in their contracts. Typically, there are two definitions: one that applies to the initial claim; the other applies after the claim has continued for two or more years.

They say:

You are totally disabled if, due to a medical condition for which you are under treatment of a physician, you are unable to perform the material and substantial duties of your regular occupation (meaning the job you were performing when you became disabled).

Or:

You are totally disabled if, due to a medical condition for which you are under treatment of a physician, you are unable to perform the material and substantial duties of any occupation for which you are reasonably suited by education, training, or experience.

As you might imagine, the second definition makes it much easier for the insurance company to claim you are not disabled.

It should also be noted that the younger you are when you file for disability, the further beyond your regular type of work they will look to find other work you can “adjust” to or for which you can be trained.

What does this say about building your medical record? Disability examiners are looking at your ability to function or lack thereof. A diagnosis is important because it explains why you have the symptoms you do, but it is the symptoms themselves that prevent you from working and that is what they want to see. They are what should be highlighted in the medical record.

More and more doctors are moving to electronic recordkeeping; in fact, it is now mandated under the Affordable Care Act. Electronic records are good in that they can be easily transmitted to other physicians when needed. And they are a great change for anyone who has tried to read many physicians’ handwriting. More than once I have encountered doctors who could not read their own handwriting.

However, electronic records present weaknesses, too. They tend to deal in numbers, test results, etc. They are also designed to ask questions of the doctor that can be answered briefly and quickly. All very objective but not helpful in describing symptoms, especially subjective ones, restrictions, or limitations in the ability to work.

Unfortunately, too many doctors now spend more time looking at their computer screen and answering the questions asked by their Office Visit template than listening to the patient and recording it. It is certainly understandable. Completing the records is time consuming, and the system constantly pushes doctors to see more and more patients in less time.

Another problem is that many ongoing symptoms are typical of the condition, and some doctors don’t feel they need to write “tired”, “fatigue”, “pain in xxx” at every visit, especially when there is really nothing the doctor can do to change these symptoms. It is much easier to type “no change” or “doing fine.”

This is where your input becomes extremely important. Starting now, you need to take responsibility for seeing that your medical record truly reflects your condition.

Between visits, make a list as symptoms arise that affect your ability to do things. Did you beg off from an evening out because your pain was too severe? When you buy groceries or run errands, do you take a nap afterwards? This includes symptoms that you have had for some time as well as new symptoms. Try to put them in context. Rather than just listing “fatigue,” state what caused you to list it. Did you skip an event, have to leave the store before you finished your shopping, spend the day in bed?

Take the list with you when you go to the doctor. Show him or her the list, and politely note, “You know, if I ever have to file for disability, they will want to know about my lab tests and numbers, but, more importantly, they will need to know what keeps me from doing things, like my job duties. Would you please make sure these are entered into the record? It will be a big help to you and me in the future if my condition gets worse.” If possible, wait while your list is entered. Also, consider asking your doctor to enter his or her own observations of you and your condition.

I am asking you to do something everyone else probably discourages, look at what your disease is doing to you. While it is less stressful and upbeat to focus beyond your condition and dwell on what you can do, you need to have a medical record that documents your problems as well.

This can be emotionally difficult, and, if it gets to be too much, take a break for a while. Make sure the doctor notes that in your record too.

However it could be very important in the future to make sure there is continuous, ongoing documentation of how you feel and what you can and can’t do…..just in case.

 

Confused about applying for disability? Click here

[Jacques Chambers, CLU, and his company, Chambers Benefits Consulting, have over 35 years of experience in health, life and disability insurance and Social Security disability benefits. For the past twelve years, he has been assisting people with their rights, problems, and other issues concerning benefits and disability. He can be reached at jacques@helpwithbenefits.com or through his website at: http://www.helpwithbenefits.com.]

 

Copyright November 2013– Hepatitis C Support Project - All Rights Reserved. Permission to reprint is granted and encouraged with credit to the Hepatitis C Support Project.

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