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Maintaining Your Disability in the Internet Age

Spring 2012

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Disability Benefits From Insurance Companies

During the initial period of a disability claim, most insurance companies send a questionnaire for you and your physician to complete quarterly and review medical records less frequently. However, insurance companies cannot be counted on to adhere to any particular "schedule."

After two years of benefits, most disability policies shift the definition of disability from "your occupation" to "any occupation for which you are reasonably suited by education, training, or experience." That change almost always triggers a medical review and is the most opportune time for them to attempt to terminate benefits.

If you continue to be disabled and unable to return to work, it is important that you actively ensure that your records continue to reflect that fact. First, instruct all of your physicians to notify you any time they are contacted by the insurance company. Ask the doctor to put a note to that effect at the front of your medical file. Also request that he/she forward to you a copy of any questionnaire they complete from the insurance company. Ideally, you can make an appointment and you and your doctor can complete it together.

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You may also want to caution your physician to be wary of questionnaires that pretend to save the "physician's valuable time" by having her/him simply check off some boxes. Such questionnaires usually don't give the physician enough choices to accurately describe your condition. The insurance company will use the statement beside the checked box as if it were a statement actually made by your physician.

If your physician is willing, she/he should return such questionnaires without checking any boxes but attach, instead, a narrative letter, which describes your current symptoms and condition and answers the questions asked on the form in detail.

Also, you should not lose track of your symptoms. That may sound strange, but many people accommodate some symptoms so well and for so long that they forget they have the symptoms. Also, most people start feeling better when they leave work, especially after completing all the necessary paperwork and establishing eligibility for all the benefits to which they are entitled. However, some improvement in how you feel because your stress level is reduced is not the same as the elimination of all symptoms, or the ability to return to work. Your medical record must reflect that.

It is important, every time you visit the doctor, that she/he enters into the medical record a list of your symptoms and some estimate of their severity. Take a list of your symptoms and their severity with you to each visit. If the doctor is busy, he/she can simply attach them to the office notes. This should be done at every visit, even if the symptoms don't change from one visit to the next.

These recommendations are especially important for the beneficiary whose symptoms are primarily "subjective," as insurance companies are reluctant to continue paying benefits solely because of symptoms that are "self-reported." If your symptoms are fatigue, diminished mental acuity, pain, or other symptoms that aren't easily measurable with a lab test, then you should make a special effort to see that a record of the continuation of these symptoms is regularly entered into your medical record.


Social Security

Social Security conducts Continuing Disability Reviews (CDR) beginning between two and seven years after the initial approval. They do this with both SSI and SSDI, this is in addition to the annual financial reviews performed on beneficiaries collecting SSI. The time interval in the disability reviews is based on the likelihood of medical improvement.

The sending of CDRs has lagged lately due to staff shortages and the greatly increased number of applications due to the slow economy, however a new wave of questionnaires is being sent to beneficiaries. There two forms they use.

The short form is an Optical Character Reader form that is reviewed by computer. If you are still disabled, the goal is simply to see if you are still being treated for your condition and if there has been little or no improvement in your condition. The long form asks for much more detail and will usually involve Social Security obtaining records from your treating physicians.

While Social Security will sometimes determine that a person is no longer disabled enough to receive benefits, that would only happen after a thorough review of current medical records and allows an opportunity to appeal the decision. You will know if Social Security is looking that closely at your medical condition since they are required to obtain a medical release from you and would ask you to complete the long form questionnaire.

Jacques Chambers, C.L.U., is a benefits counselor in private practice with over 35 years experience in health, life and disability insurance and Social Security disability benefits. He can be reached by phone at 323.665.2595, by e-mail at jacques@helpwithbenefits.com, or through his Web site at www.helpwithbenefits.com.

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This article was provided by Being Alive. It is a part of the publication Being Alive Newsletter. Visit Being Alive's website to find out more about their activities, publications and services.
 
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