Today, it is very important for your treating physicians to take the time to complete update forms and other reporting of medical conditions in a clear, specific and concise manner. Insurers look for very detailed information concerning restrictions and limitations and when they don’t get it, requests for medical info keep coming.
While insurers are looking for better information to approve benefits, doctors, spoiled by TeleHealth perhaps, are not taking enough time to complete medical forms in supportive ways, at least not good enough for private disability anyway. Treating physicians tend to regard “paperwork” as a nuisance not worth their time. The problem is, what they write, usually, “Patient cannot work”, is not good enough for benefits to be approved.
There are several criteria that must be reported on medical forms such as: 1)Primary and Secondary Diagnoses including ICD-10 codes, 2)Restrictions and Limitations, 3)Prognosis, 4) Treatment Plan, 5) Statement about allowable activity, 6) Maximum Medical Improvement statement, 7) Appropriate Care statement, and 8) Pending surgeries and hospitalizations. Statements such as: “Patient is totally disabled”, or “Can’t work” won’t be sufficient enough to pay benefits, and the report is not acceptable as validation of disability.
To this day, newer physicians are unaware of the lingo and the drill of reporting on patients for private disability. Some assume disability reporting is the same as Workers’ Compensation and Social Security, when in fact, private disability has its own unique criteria. Workers’ Comp relies on percentages of whole body disability, private disability insurance relies on R&Ls and the inability to perform one’s own occupation or job. It’s not the same thing. Social Security adds Training, Education and Experience to the mix of one’s history and functional capacity.
Another difference between other benefits and private disability is that physicians often DO NOT CONNECT THE DOTS between medical impairment and the inability to perform one’s occupation or job. Private disability is all about “the inability to work” and R&Ls must always be related to why patients are not able to work. Clear statements on forms such as, “patient is unable to work as a secretary because she is currently restricted from prolonged keyboarding.” This is just one example of how physicians can “connect the dots” to private disability.
I’ve had physicians tell me that “filling out disability forms isn’t my job. I’m in the business of patient care.” Clearly, that’s true. Still, the insurance industry continues to demand medical certification in order to receive disability benefits, and without it, no benefits are possible. Whether they like it or not, treating physicians are the only persons in the review process who can validate disability.
Unfortunately, patients/insureds are often too timid to tell their physicians what they NEED from them. And, I get it. Big physician facilities with physician groups are very intimidating, even the doctors themselves are intimidating these days, but they aren’t mind readers and should be given information about the kind of reporting required. Treating physicians who consistently give you a lot of grief, should be replaced with more supporting doctors who are willing to listen.
It is important for insureds to discuss disability reporting with their physicians. The more detailed the reporting is, the less often he/she will be bothered with future requests. Please share the 8 criteria I’ve outlined with your doctors and ask for their help. You’d be surprised how much better your forms will be when you share what you need in order to support your claim.