Few doctors relish the task of completing disability paperwork. After a long day of treating patients, what physician wants to sit down and respond to a confusing questionnaire or a cryptic report? Worse yet is when the doctor’s words are misrepresented or taken out of context by the insurance company. For this type of situation in this article we show you how to Dealing With Disability Insurers.
It’s no wonder some doctors adopt blanket policies against commenting on disability. But such policies do more harm than good. The treating physician’s opinion is often the single most important factor in determining whether a patient will receive disability benefits. The loss of disability benefits can negatively impact a patient’s ability to afford medication and treatment. Thus, disability paperwork can and should be viewed as a logical extension of patient care.
Dealing with disability Insurers need not be a headache if the right policies are in place. This article will offer some practical pointers and best practices for how doctors can manage communications with disability insurance companies to limit excessive paperwork and effectively advocate for their patients.
5 Best Practices for Physicians When Dealing With Disability Insurers
1. Request that all communications be in writing.
The single most effective strategy a doctor can implement to manage communications with a disability insurance company is to require that all communications be in writing. Frequently, the disability insurer will have its doctor contact the treating doctor to conduct a peer-to-peer conversation. Often, these attempts are unsuccessful because the treating doctor is unavailable or does not return the voicemail in time. By implementing a policy that all communications be in writing, the treating doctor can avoid this back and forth.
When the disability insurer’s doctor succeeds in conducting a peer-to-peer conversation with the treating doctor, the treating doctor’s comments can be misrepresented or taken out of context. For this reason, the treating physician should request to be provided with a summary of the conversation afterward to review and sign. A better option, though, is to decline to participate in the phone call in the first place and instead request that any questions be posed in writing, with adequate time to respond.
2. Share any communications with your patient.
Another important best practice when dealing with insurance companies is to share any communications you receive with your patient and ask for their input prior to responding. Disability insurance companies are under no obligation to disclose such communications to the claimant until after the claim is denied. Yet the patient arguably has the right to know if a doctor or nurse for the insurance company has written a report about him or her. The patient is also in the best position to address any inaccuracies.
Similarly, if the disability insurance company sends you a questionnaire to complete, alert the patient and request that he or she come in for an appointment to complete the form. By engaging the patient in a dialogue, you may learn new, additional information that is relevant to the form completion. Likewise, you can work with the patient to identify ambiguities in the disability paperwork and ensure that they are not construed against your patient. If your patient is represented by a lawyer, do not be afraid to discuss with him or her, as the lawyer may have valuable insights into your patient’s disability and the insurance company’s position.
3. Request that the insurance company limit its paperwork.
While the treating physician should not refuse to complete disability paperwork, he or she can request that the disability insurance limit its requests to a reasonable amount. What is reasonable will depend on the given situation. If the patient is recovering from a surgery, then monthly disability paperwork may be appropriate. If, on the other hand, the patient suffers from a chronic condition that is unlikely to improve, the treating physician can reasonably request that form completion be limited to every six months or even annually. Requesting that an insurance company limit its paperwork requirements does not signal a lack of support on the part of the treating doctor but merely the need to prioritize patient care over paperwork.
4. Focus on restrictions and limitations.
A statement that a patient is “disabled” or “unable to work,” without more, is not usually sufficient to establish disability (though it is preferable to no opinion at all). More helpful is if the treating physician can offer specific restrictions and limitations that result from the client’s impairment(s). These may be exertional or non-exertional. An example of an exertional limitation is the inability to climb stairs due to a knee injury. An example of a non-exertional limitation is the inability to maintain regular work attendance due to episodic pain flares.
Both exertional and non-exertional restrictions and limitations are relevant for the purposes of evaluating disability. However, disability insurance companies often oversimplify matters by inquiring only as to exertional restrictions and limitations, while neglecting to inquire about non-exertional limitations. In such instances, the treating physician should elaborate as to why the patient cannot work, either in an office visit note or in a letter to the insurance company, with reference to both exertional and non-exertional limitations.
5. Emphasize objective medical evidence, where possible.
Restrictions and limitations must be medically supported. Insurance companies like to discredit restrictions and limitations by asserting that they are “disproportionate” to the medical evidence. Where possible, emphasize abnormal clinical findings and/or diagnostic studies that corroborate your patient’s complaints. If such findings do not exist, as is the case with some impairments (e.g., fibromyalgia, migraine headaches, etc.), emphasize the duration and frequency of treatment, medications attempted, visible pain behaviors, the limitation of daily activities, and the consistency of the patient’s self-reported symptoms.
Insurance companies will sometimes distort matters by emphasizing a lack of “severe” clinical findings when even “moderate” findings are sufficient to give rise to disability. In such circumstances, draw upon your medical expertise to make it clear why the insurer’s complaints are irrelevant.
Dealing with disability insurers we know it can seem complicated. Disability plans are conflicted by design, in that they both evaluate and pay claims. See Metro. Life Ins. Co. v. Glenn, 554 U.S. 105, 112 (2008). If you or your patient determines that communications with the disability insurance company have become adversarial, the attorneys at DeBofsky Law can intervene to ensure your patient’s rights are protected.