Help Your Patients Get the Benefits They Deserve

By Eric A. Shore, J.D. and Pia Horton

Everyday your patients trust you to care for their health. Many of your patients find themselves unemployed and therefore, uninsured. While some will find work eventually, those with physical and/or mental limitations may not. This is especially true for those approaching retirement age (50-65 years). You can help.

Patients who are unable to sustain work due to their health may be eligible for Social Security disability benefits, therefore making them eligible for Medicare or Medicaid. Although treating your patients is obviously your primary concern, taking a few steps to encourage patients to apply and obtain Social Security benefits may be necessary for them to afford the care you provide.

Physicians play an instrumental role in helping their patients obtain the Social Security disability benefits they need.  Social Security disability claims are evaluated by determining whether your patient suffers from a severe physical and/or mental impairment that has lasted and/or will last for twelve (12) months, and/or result in your patient’s death.  Judges and attorneys review your medical records, looking for your specific documentation of your patient’s physical and mental limitations and how those limitations are caused by your patient’s impairments.  To be most helpful, your medical records should also indicate how those limitations prevent or restrict your patient’s ability to function on a daily basis.

The severity and duration requirements can only be proven by obtaining proper medical evidence, as medical evidence is key to any successful Social Security Disability claim.  Social Security cases are often built and won on the strength of the medical records provided by a client’s treating physician.    Therefore, detailed progress/treatment notes, an accurate accounting of your patient’s subjective complaints, referrals to specialists, and referrals for objective testing are necessary to build a winning claim.

Your treatment notes are an important part of building the strength of your patient’s case.  Consistent treatment should be documented with detailed narratives that include the following: specific dates of treatment, your diagnosis, the nature of your patient’s illness, its etiology, severity, and to what degree the impairment limits your patient’s ability to perform day to day activities, function on a job, and/or maintain full time employment.

For example, if your patient has COPD and experiences severe dyspnea, chest pains, wheezing, and fatigue upon minimal exertion, indicate all in your treatment narratives.  Further indicate that medium and heavy exertional level activities are not recommended for your patient, and document specific functional restrictions and/or precautions that your patient should exercise on a daily basis.   Also, note why your patient should not partake in specific exertional activities.  For example, “due to Chronic Obstructive Pulmonary Disease, my patient’s lung volume capacity is severely compromised.  My patient should not lift any weight over ten (10) pounds frequently; never climb ladders; never walk for more than five (5) minutes; avoid vacuuming, dusting, mopping, and standing for more than thirty (30) minutes at a time; avoid all exposure  to dust, chemicals, or other environmental hazards.”  Also indicate what adverse effects your patient will experience if he or she partakes in any of the restricted activity

Your patient’s subjective complaints are extremely important to record upon every visit to your office.  Often, subjective complaints suggest the true severity of your patient’s impairment and how the impairment limits his or her ability to function.  Subjective complaints of chronic and severe pain should prompt further objective testing, physical therapy, and/or referrals to specialists.

The results of objective tests offer concrete evidence that cannot be disputed.  Making timely and accurate referrals for CT scans, MRI’s, and X-rays can strengthen your patient’s case and provide and further confirm your diagnosis.  In addition, timely referrals to specialists and physical therapists document the severity of your patient’s impairment and can significantly increase the chances of winning the claim by indicating your patient’s need for ongoing care and treatment.  With the proper referrals, your patient can build a well documented treatment history, which will in turn bolster your patient’s credibility and increase his or her chances of success.  Moreover, timely objective testing can show permanent impairments, helping to satisfy both the severity requirement and the twelve (12) month duration requirement.  For example, frequently a patient who suffers from severe asthma and/or airway restriction disease is referred for a  Pulmonary Function Testing (PFT).  The results of an initial PFT may only show a mild impairment.  However, over the course of time, your patient’s complaints and symptoms may worsen requiring you to refer them for further testing.  Subsequent tests can document how your patient’s illness has progressed from tolerable to disabling.

Often times, physicians note that their patient is applying for disability benefits, but do not indicate whether they have observed whether their patient is disabled.  Therefore, your observations of how your patient’s impairments affect them should be documented, as well. For example, noting that your patient walks with a limp, experiences frequent falls, has difficulty getting on or off of your examining table, was short of breath walking a short distance, heard voices, could not focus during your exam, could not walk from the waiting room to the treatment room without assistance, winces in pain to your touch, or requires assistive devices to ambulate, can benefit your patient’s claim. When your observations are consistent with your patient’s subjective complaints and objective test results, the strength of your patient’s claim increases substantially.

Moreover, completing simple questionnaires or residual functional capacity (RFC) forms indicating how your patient’s impairments limit their ability to function can be invaluable to your patient’s claim.  Residual Functioning Capacity (RFC) forms and/or Medical Source Statement (MSS) are of great importance to any Social Security disability claim.  The forms help Social Security to evaluate the functional limitations caused by your patient’s impairments by giving us insight into how those impairments limit the ability to perform work related activities.  The form consists of a list of physical or mental activities allowing the treating physician to assess their patient’s ability to perform work related activities by indicating how the patient’s ability to function is limited by his or her impairment.  More importantly, the form contains sections that allow you to further comment on your patient’s limitations in a brief narrative.  In a sense, the form gives you an opportunity to be present at your patients hearing. A supported RFC form completed by you may be the most influential piece of evidence in the case and may actually determine whether your patient will receive the benefits they need.  We know completing forms and copying records for legal matters are not a primary concern. However, because your assistance can be the deciding factor in whether your patient will obtain Medicare/Medicaid and the cash benefits needed to afford transportation to your office, helping patients with their Social Security disability and SSI cases is different.

The Social Security Administration must consider all medical evidence of record in your patient’s claim including your records and opinions, and give great weight to all evidence submitted by you, the treating physician.  Therefore, your observations, recommendations, referrals, and treatment plans are crucial in assessing your patient’s case and achieving the favorable outcome your patient needs and deserves.

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The Law Offices of Eric A. Shore, P.C. (www.1800cantwork.com) focuses on matters of Social Security Disability and SSI benefits.  They can be reached at 215.627.9999.