There is no such thing as "Permanent Disability" for programs that pay disability benefits whether it is from private insurance companies or Social Security Disability (SSD & SSI). Unlike workers' compensation, Veterans' benefits, and other specialized programs, insurance and Social Security only agree to pay benefits as long as you are disabled.
Because of that, your medical condition will be periodically reviewed to see if you remain eligible to continue to receive benefits, i.e., whether or not you still meet the plan's definition of disability. This usually involves periodic questionnaires to you and/or your physician or even a review of your medical records.
Added to that, thanks to the information/Internet age, there is now a new source of information, and insurance companies are taking full advantage of the new opportunities to check on what their claimants are doing. Social Security hasn't yet extensively gotten involved in this, but that may change someday soon.
While this should not be a cause of worry for persons receiving benefits who are still unable to do any gainful employment, it must be kept in mind that insurance companies are profit-making organizations and have a financial incentive to pay as little out in claims as they can. While they may claim that their goal is to only pay benefits to "eligible" claimants, unfortunately, too often they will expand minor issues until they become "proof" that a claimant can work and benefit payments should be stopped.
If you are unable to do either your old job or any suitable employment (based on the disability definition of your disability plan), you need to be aware of the fact that, in addition to the expensive and only rarely used method of following and videotaping you, insurance companies are now able to follow claimants' activities quietly and inexpensively thanks to the popular trend in social media.
One of the first steps an insurance company uses in reviewing a claimant's activity is to search the claimant's name on a web browser such as Google, Safari, or others. One claimant was listed as a member of the board of directors on a small non-profit organization's website. Even though that involved only attending one two-hour board meeting a month, it led the insurance company to open a full-scale review of the claimant and an attempt to terminate his benefits. The attempt was unsuccessful, but only at the expense of a lot of stress and several months without income.
Then there is the social media, Facebook, LinkedIn, Google+, MySpace and many others. These have grown to the point that, according to one study, 22% of the time people in the U.S. spend on line is spent using some form of social media.
These are the sites where people post their photos of their latest vacation, pictures of family activities, and hobbies. Again, while these are usually innocuous descriptions of a person's activities, taken out of context they can be used to support a claim of ability to work. One client and his spouse posted pictures of a trip to Argentina. What they failed to show was that they were visiting the spouse's family with the goal of possibly moving there to stretch their limited disability income. It also didn't show the careful planning that went into the trip, making sure there was adequate medication with proper documentation for customs, limiting time spent traveling and apartment hunting during the day to allow sufficient time for rest.
Some of these media sites allow members to limit access to their sites, however, many members don't bother to engage such limits. Even then, the barriers aren't foolproof. Also, many people when asked to link to another, often link up without knowing or remembering for sure if they actually know that person or not. They just don't want to offend them if they should know them. Insurance companies won't try to link under the company name, but instead use an individual's name.
Again, the purpose of this is not to help healthy people hide their abilities in order to continue to obtain benefits, but to alert disabled persons entitled to benefits that someone may be watching and may try to take information out of context that can trigger a stressful review and possibly even a termination of benefits.
Below is a brief review of other methods insurance companies and Social Security use to review claimants' eligibility to continue receiving benefits.
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.
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 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 email@example.com, or through his Web site at www.helpwithbenefits.com.