Medical “proof of claim” is perhaps the most important information required for disability benefits. In fact, for twenty years I’ve always told people, “no medical, no claim.” However, in today’s terms (after COVID), the tendency for physicians is “the shortest distance between two points” to complete disability forms within a 15 minute office visit. Sorry, but that’s not good enough.
It has been reported by physicians that up to a third of their practice is filling out disability forms.You can imagine, then, that physicians just want to make the problem go away. Medical for disability reporting purposes should be specific and detailed enough so that the insurance company will accept the doctor’s conclusions as cause for disability and pay benefits.
Here is my list of what a good update form should report, signed by your doctor. By the way, your physician can add additional pages to insure all of the information is recorded.
- Documentation of a primary and secondary diagnosis including ICD-10 codes. There does not have to be a secondary diagnosis, but if there is one, it should be listed.
- Detailed Restrictions and Limitations should be written. Please note that because disability claims are payable for the “inability to work”, R&Ls should also be written with that in mind. Example, “This patient is unable to work in any sustainable or consistent job in which he/she would be unsuccessful.” Or, “this patient is unable to return to work in his/her own occupation pending further treatment, testing, and consultation.” Phrases such as, “Can’t work”, or, “out of work” won’t help you get your claim paid.
- Statement that R&Ls are consistent with the diagnosis and that your symptoms have worsened, stayed the same, or that you are at Maximum Medical Improvement “MMI”.
- Statement that your frequency of treatment is considered “to be regular and appropriate care” given the history of your diagnoses, severity of your diagnosis, and is required as ongoing consultation.
- A full discussion of the doctor’s TREATMENT PLAN and allowable daily activity recommended.
- A list of medications, prescriptions and dose.
- Date of next visit.
- In the signature section at the end, the doctor should list all of his/her Board Certifications and Specialities.
A few physicians are refusing to fill out the FUNCTIONAL CAPACITY” section of disability forms because they say, “we don’t evaluate physical capacity”, which is true. However, insurance companies don’t expect the physicans’ responses to be the same as an FCE, just an OBSERVED WORK FUNCTIONAL CAPACITY BASED ON OFFICE VISITS. Still, because disability is inter-connected with the ability to work, the Functional Capacity part of the form really is a RESTRICTION section indicating the patient’s ability to sit, stand, walk, in an 8-hour workday. Some physicians just don’t get it, and refuse to fill out the section.
As I said, physicians are now filling out the forms hastily and, of course, supportive claim information is not included. Insureds should ask their physicians to do a good job with the forms. It will save him/her from getting multiple requests for the same information.
If you would like to explore coming on board as a client, please feel free to visit my website for more information at: http//www.disabilityclaimssolutions.com. Or, send me an email to: lindanee.dcs@gmail.com
Tel: 207-793-4593. I am here to help you and look forward to speaking with you.
