Disability Determinations and Placards

[TeslaCoil]

To my understanding pain medicine physicians are not supposed to determine disability. This is what is says in Benzon's text and I've also been told this by multiple mentors in the past. I've been told that this is because chronic pain is not considered a disability, legally speaking. What about disability placard paperwork? How do you handle these requests in your practices? thanks

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[Ferrismonk]

To my understand pain medicine physicians are not supposed to determine disability. this is what is says in Benzon's text and I've also been told this by multiple mentors in the past. I've been told that this is because chronic pain is not considered a disability, legally speaking. What about disability placard paperwork? How do you handle these requests in your practices? thanks

Chronic pain CAN legally be a reason for disability, but I would argue it is not a good one (at least not alone). There is no reason that any physician cannot determine disability, and I would argue that a pain specialist may be more qualified than a PCP.

That being said, I make it a point that I do not personally evaluate functional status. I send them for a FCE first then base my disability paperwork on the formal FCE. A placard for the car is a single sheet of paper and isn't a big deal if you're okay with that. Doesn't need specifics.

 

[paindoc007]

Chronic pain CAN legally be a reason for disability, but I would argue it is not a good one (at least not alone). There is no reason that any physician cannot determine disability, and I would argue that a pain specialist may be more qualified than a PCP.

That being said, I make it a point that I do not personally evaluate functional status. I send them for a FCE first then base my disability paperwork on the formal FCE. A placard for the car is a single sheet of paper and isn't a big deal if you're okay with that. Doesn't need specifics.

You do disability paperwork? Sounds awful

 

[Ferrismonk]

You do disability paperwork? Sounds awful

lol. Only if forced. Usually the FCE requirement (which costs cash), the professional fee for the paperwork, and the wild-card that I may not agree they need disability scares most away. In my experience, people only want very sympathetic providers to fill out their disability paperwork.

 

[lobelsteve]

I do disability paperwork all of the time. It must be the physiatrist in me. But I also tell people they are not disabled most of the time because they are not disabled. I believe it is part and parcel of the role of physiatry to determine disability. A painter Zishan teaching that we’re not supposed to do paperwork is lazy sack.

 

[Agast]

It’s a handicapped placard, not a disability placard. You can be handicapped without being disabled from gainful employment. A mental disability of schizophrenia does not mean you need to park near the front of the store either, but may prevent you from obtaining employment.

 

[Ducttape]

i dont do disability paperwork per se (i may have filled out an SSI form specifically for the patient's purposes of showing that they are being seen.

i tell patients that a primary goal of pain management treatment is to make people more functional. declaring a patient disabled physically and mentally justifies them being less functional.



i also avoid handicapped stickers. too much abuse going on with them.

 

[myrandom2003]

I send the patient for an FCE and write see FCE on the forms. I send my progress notes, I charge for short term leave forms as well as temporary handicap parking forms.
I never do anything permanent because nothing i do is permanent.

 

[chibadriver]

But I also tell people they are not disabled most of the time because they are not disabled.

Perception/reality mismatch is pain clinic 101.

 

[bedrock]

My perception as a PMR/Pain physician is that 99% of the patients asking for permanent disability or handicapped placards are not particularly disabled. Back pain, mental issues, do not quality for either, and that is 99% of the people asking for it.
I know many patients after a major stroke, amputation, or spinal cord injury who still work full time, and I do not believe that back pain or mental illness qualifies them to live off all of our taxes forever.
My initial patient paperwork, that all patients must sign, states they understand that my office does not do paperwork for permanent disability or permanent handicap parking. If a patient doesn't remember that, they are reminded if they ask for either item and that is that.

I do fill out temp disability forms which are unfortunately unavoidable.

 

[cowboydoc]

My perception as a PMR/Pain physician is that 99% of the patients asking for permanent disability or handicapped placards are not particularly disabled. Back pain, mental issues, do not quality for either, and that is 99% of the people asking for it. I know many patients after a major stroke, amputation, or spinal cord injury who still work full time, and I do not believe that back pain or mental illness qualifies them to live off all of our taxes forever.
My initial patient paperwork, that all patients must sign, states they understand that my offices does not do paperwork for permanent disability or handicap parking. If a patient doesn't remember that, they are reminded if they ask for either item and that is that.

I do fill out temp disablity forms which are unfortunately unavoidable.

We may think that, but our unfortunate reality is that over half of those collecting SSDI is for a diagnosis of MSK pain or mental health issues. Sen. Coburn led a study on this years ago, IIRC something like 40% didn't seem to appropriately qualify for benefits as current laws are written. The system is a mess!

Sen. Coburn Introduces Bill to Reform SSDI

 

[SSdoc33]

handicap placards take a total of .8 seconds to fill out

LOLs with stenosis qualify

 

[bedrock]

We may think that, but our unfortunate reality is that over half of those collecting SSDI is for a diagnosis of MSK pain or mental health issues. Sen. Coburn led a study on this years ago, IIRC something like 40% didn't seem to appropriately qualify for benefits as current laws are written. The system is a mess!

Sen. Coburn Introduces Bill to Reform SSDI

Agree. I would be happy to help anyone in the federal government wanting to reform this. I think more than 40%, more like 80% don't qualify for permanent disability and should have to work just like the rest of us.

It is funny just how many people are capable of working when their choices are working, or not having any money. If you give them free & undeserved money, then they just can't find the will to work.

This is why I am clearly not a democrat.

 

[Laryngospasm]

I do handicap tags for quite a few patients. I have lots of people that I don’t understand how they get up everyday and just survive. If I can help them make it into the store or whatever building a little easier I’m glad to do that. Don’t do disability paperwork though..

 

[Ferrismonk]

Agree. I would be happy to help anyone in the federal government wanting to reform this. I think more than 40%, more like 80% don't qualify for permanent disability and should have to work just like the rest of us.

It is funny just how many people are capable of working when their choices are working, or not having any money. If you give them free & undeserved money, then they just can't find the will to work.

This is why I am clearly not a democrat.

Can they do the greeter at Walmart gig? If so, not 100% disabled.

 

[Agast]

This commercial is amazing. I once had a patient who had a light empty box land on his head and he really did act like he needed his arm in a cast and an ACDF

 

[NJPAIN]

90+% of those filling out disability paperwork have not a clue about what disability really means. They think that if working makes you symptomatic that's 100% disability. This especially holds true for PCPs. It's a combination of ignorance and a misconception that helping a patient become declared disabled equates to being a patient advocate.

 

[bedrock]

90+% of those filling out disability paperwork have not a clue about what disability really means. They think that if working makes you symptomatic that's 100% disability. This especially holds true for PCPs. It's a combination of ignorance and a misconception that helping a patient become declared disabled equates to being a patient advocate.

Agree. 95% of patients applying for disability are not truly 100% disabled. They might not be able to lift rocks anymore, but they could certainly work in a variety of other capacities, including front desk, MA, etc at a doctors office, Walmart greeting, and many other non physically demanding jobs.

This is why I have never permanently disabled a patient. I’ve never met one worthy of it in PP, though I did see several during my PMR residency.

 

[NJPAIN]

Agree. 95% of patients applying for disability are not truly 100% disabled. They might not be able to lift rocks anymore, but they could certainly work in a variety of other capacities, including front desk, MA, etc at a doctors office, Walmart greeting, and many other non physically demanding jobs.

This is why I have never permanently disabled a patient. I’ve never met one worthy of it in PP, though I did see several during my PMR residency.

Yet another subject poorly taught in pain fellowship especially for us anesthesiology folk. I received some (more than most but still inadequate) instruction in this as we had an inpatient program with PM&R, vocational rehab, etc. An important subject in pain medicine as It comes up CONSTANTLY in patients with chronic pain but no one cares because it’s not a procedure.

 

[geauxg8rs]

The last few patients who I thought could actually be disabled didn’t want to be disabled. “Just help me get to my pension/retirement date doc.” Those are the rare patients though

 

[oreosandsake]

I do disability paperwork all of the time. It must be the physiatrist in me. But I also tell people they are not disabled most of the time because they are not disabled. I believe it is part and parcel of the role of physiatry to determine disability. A painter Zishan teaching that we’re not supposed to do paperwork is lazy sack.

disability is a mindset.


that message doesn't go over well in a society that is looking for the easy way out

 

[oreosandsake]

folks
just FYI

they aren't "handicapped parking placards"

they are accessible parking placards.