Disability Eval

[finalpsychyear]

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So i am getting some new patients asking if i can fill out this paperwork. What is a fare charge for such service and what are things that I need to be aware of before I even consider doing something like this?

Thanks to all the wise out there.

 

[erg923]

So i am getting some new patients asking if i can fill out this paperwork. What is a fare charge for such service and what are things that I need to be aware of before I even consider doing something like this?

Thanks to all the wise out there.

sincerely believe they are unable to work....which is very high threshold of psychiatric impairment.

 

[Shikima]

I know this isn't what you're asking, but I tell them I don't fill it out because I believe they can be meaningful in society.

 

[birchswing]

I know this isn't what you're asking, but I tell them I don't fill it out because I believe they can be meaningful in society.

There's a different way of looking at this, where you do whatever is necessary to integrate every person into society, which could require additional assistance (and which may necessitate declaration of disability). I can't speak, though, to whether you are seeing people who do need assistance with integration in society.

 

[tr]

I do these (short term disability) if I think the time off work will be helpful. I'm salaried so don't have input on a service charge but I fill out the paperwork collaboratively with the patient during their regular appointment time. That way it's not unpaid labor for me, they can provide accurate historical data, and we can do Folstein or any other silly assessments required by the formage that aren't a regular part of my work.

 

[erg923]

I do these (short term disability) if I think the time off work will be helpful.

thats not the definition of "disability" as defined by SSA or most all commercial STD policies.

 

[wolfvgang22]

I have a patient with avoidant personality disorder who has been on short term disability for almost two years. I know, right?

 

[splik]

I have a patient with avoidant personality disorder who has been on short term disability for almost two years. I know, right?

hes an entitled narcissist i dont believe in avoidant personality disorfer there is a school of thought (quite convincing if you ask me) that these patients are just covert narcissists - envious of others, wear their inferiority on their sleeve, silently seething with rage as they see others have what they believe is owed to them, preoccupied by grandiose fantasies, crippled by the fear of failure they subsist off the state, working (or not) well below their potential, intelligence and educational level. Ihsve a really strong negative countertransference towards these patients

 

[splik]

So i am getting some new patients asking if i can fill out this paperwork. What is a fare charge for such service and what are things that I need to be aware of before I even consider doing something like this?

Thanks to all the wise out there.

its unethical to charge patients for disability evsluations. if a new pt is coming along with disability paperwork its a red flag they dont want to get better. i discuss the difference between treatment services and disability and ask them to choose.

for existing patients who are requesting disability i simply provide the medical records and nothing else. If SSA wants additionsl information then they will pay for this - where i was before the state paid $231. for private disability they will either have their own rate or you can tell them your fee. There is no objectivity if the money is coming from the evaluee which is why its unethical to accept money from them as opposed to a third party.

If the patient really needs disability its unethical to charge as they probably couldnt afford to pay and if it is in their interests then you should be supporting their application if you believe it would be beneficial to their mental health (which is a big if).

 

[PsyDr]

SSA defines disability as total inability to perform any job. The examiner in my area used to have an examinee putting a rubber band around a newspaper and then opine that they were not disabled according to ssa guidelines. All your patients that are working, by definition, are able to work.

Federal law requires that a job study be performed and that the examiner use those guidelines to determine disability. It's illegal to opine without a job study.

And ssa has examiners for this. Most people seeking their treatment provider's opinion is either misinformed by people directing their legal proceedings or are seeking a perceived favorable opinion. If the ssa has a service for this, and an attorney is making money off this; why are you the only one doing this for free?

Providing an opinion in such a forensic matter while maintaining a treating relationship is likely creating a dual relationship according to the forensic psychiatry literature. So there's that.

Private disability insurances have their own guidelines. And examiners.

Again, one should probably know the full SSA rules and/or IME rules for your state.

 

[PsyDr]

It is complicated though as the courts tend to privilege the treating physician's opinion despite the massive conflict of interest and the fact than impartial evaluator without a doctor-patient relationship would be better. Historically (and this continues to be the case), the maxim is that the treating physician's opinion should carry the most weight. This of course makes no sense and puts us in an awkward position. Also from the DSHS perspective, they are quite happy to have the treating doc weigh in for free rather than pay someone for the eval... i have had patients who have gotten disability (including huge back pay to spend on coke etc) just from submitting my notes even though I dont assess disability in clinical assessments and don't write anything about it. Go figure. the system is broken. I have no idea how some of my patients have gotten disability. Those are the ones who complain it isnt enough and ask me to help them appeal. I tell them "I have no idea how you got any money. The amount of payment is not related to your disability but your work history, and I don't think you are disabled so you really do not want me saying anything in this case."

I agree. It's widespread iatrogensis, based upon opinions that conflict with the natural history of most psychiatric illnesses.

There's also a large group of legal professionals who know better than to put psychiatrist into this position, but are happy as hell to exploit you guys for their own benefit.

 

[splik]

It would be much more sensible to just have a universal basic income. And if that isn't palatable then a negative income tax for the poor (which is actually a conservative idea, Milton Friedman advocated for it, noting that there are some things that markets cannot do).

 

[nexus73]

If you think they can work tell them so and advise them your opinion will hurt their application. If you think they can't work, schedule an appointment time to do the paperwork with them in the office so you're not working for free.

 

[tr]

thats not the definition of "disability" as defined by SSA or most all commercial STD policies.

Then the state or private insurance entity is free to reject the claim. My job is to recommend what is clinically indicated to help the patient get better, not to play Cerberus for the insurance company. They've got enough actuaries who are paid to figure out how to reject claims.

 

[tr]

It would be much more sensible to just have a universal basic income. And if that isn't palatable then a negative income tax for the poor (which is actually a conservative idea, Milton Friedman advocated for it, noting that there are some things that markets cannot do).

Absolutely. I wish they'd do this already to get rid of the perverse incentives to avoid all work for fear of jeopardizing one's disability or welfare benefits.

 

[Ceke2002]

There's a different way of looking at this, where you do whatever is necessary to integrate every person into society, which could require additional assistance (and which may necessitate declaration of disability). I can't speak, though, to whether you are seeing people who do need assistance with integration in society.

This is pretty much why my Psychiatrist agreed to fill out a disability assessment form for me early on in therapy. It was the only way I could access programs that would've helped me return to employment after a lengthy period of absence from the workforce. Of course our equivalent of welfare agencies in the US made it nigh on impossible to even complete the application, so I eventually gave up and decided I would work on becoming stable enough to return to full time study, and then hopefully employment that way instead. 🙂

 

[erg923]

Then the state or private insurance entity is free to reject the claim. My job is to recommend what is clinically indicated to help the patient get better, not to play Cerberus for the insurance company. They've got enough actuaries who are paid to figure out how to reject claims.

My point was, if that's your approach, then you are not actually answering the question being asked of you. If you think your patient can work, then why would you opine that they cant (that's what you are being asked by SSA forms and most commercial STD forms?)

 

[Shikima]

I think those that would qualify for disability would be in a state hospital and have no sense that they ought to be filing.

 

[PsyDr]

Then the state or private insurance entity is free to reject the claim. My job is to recommend what is clinically indicated to help the patient get better, not to play Cerberus for the insurance company. They've got enough actuaries who are paid to figure out how to reject claims.

I imagine we can all agree that one should have the requisite knowledge before engaging in a practice area. Since SSA proceedings do not have opposing counsel, it would be safe to say that further education would be warranted in this instance.

 

[tr]

My point was, if that's your approach, then you are not actually answering the question being asked of you. If you think your patient can work, then why would you opine that they cant (that's what you are being asked by SSA forms and most commercial STD forms?)

I didn't say I fill out the forms falsely. I provide the clinical information that is requested. Usually there is something along the lines of 'why can't this individual do their job' which I answer with (depression, anxiety, impaired focus) or whatever is accurate.

 

[tr]

I imagine we can all agree that one should have the requisite knowledge before engaging in a practice area. Since SSA proceedings do not have opposing counsel, it would be safe to say that further education would be warranted in this instance.

That's quite a lot of unnecessary verbiage to say you don't think I know what I'm doing. I'll add that I have never been presented with an SSA claim (meaning unable to work for a year or more). Almost all of the disability applications I've supported have been for women with postpartum psychiatric disorders who need to extend their miserable few weeks of maternity leave so they can gather themselves into something resembling a functional condition before they have to suit up and get back in line making widgets for Big Brother. I think the state of maternity leave in the U.S. is a travesty and frankly I think very few women are in a condition to do any kind of work with a newborn at home almost regardless of their mental health status. I certainly am not going to tell a weeping new mom with a six week old and a whopping case of postpartum depression that if she can put a rubber band around a newspaper then she damn well ought to get back to work.

 

[wolfvgang22]

No, you are wrong! They are all just lazy and should get back to work and Make America Great Again. It will be tremendous, trust me.

 

[PsyDr]

That's quite a lot of unnecessary verbiage to say you don't think I know what I'm doing. I'll add that I have never been presented with an SSA claim (meaning unable to work for a year or more). Almost all of the disability applications I've supported have been for women with postpartum psychiatric disorders who need to extend their miserable few weeks of maternity leave so they can gather themselves into something resembling a functional condition before they have to suit up and get back in line making widgets for Big Brother. I think the state of maternity leave in the U.S. is a travesty and frankly I think very few women are in a condition to do any kind of work with a newborn at home almost regardless of their mental health status. I certainly am not going to tell a weeping new mom with a six week old and a whopping case of postpartum depression that if she can put a rubber band around a newspaper then she damn well ought to get back to work.

If your professional psychiatric opinion is that the person cannot work in accordance with the guidelines required by their private insurance company, then that's great work. Forensics includes disability evals according to apls. Current guidelines indicate that one should avoid areas in which ones personal opinions prevent bias. Go ask one of the thought leaders or a legal professional what they think about including personal political opinions in ones work.

 

[tr]

If your professional psychiatric opinion is that the person cannot work in accordance with the guidelines required by their private insurance company, then that's great work.

Correct.

Forensics includes disability evals according to apls. Current guidelines indicate that one should avoid areas in which ones personal opinions prevent bias. Go ask one of the thought leaders or a legal professional what they think about including personal political opinions in ones work.

Indeed. It kind of seems like your political opinion that we should all just work till we drop in the traces from exhaustion might be coloring your approach to people's reasonable requests for recovery time from illness. 🙂

 

[WisNeuro]

Indeed. It kind of seems like your political opinion that we should all just work till we drop in the traces from exhaustion might be coloring your approach to people's reasonable requests for recovery time from illness. 🙂

I think he is urging caution and education in this area. For those of us who do forensic type work (e.g., capacity/competency assessments), knowing the actual statutes and "deposition-proofing" your evaluation and report is important. Just pretend that everything you put down on paper/EMR can be cross-examined in court. Because, it can. There are many times that my personal opinion does not gel with the state and federal statutes. My professional opinion stays in line with the law.

 

[tr]

I think he is urging caution and education in this area. For those of us who do forensic type work (e.g., capacity/competency assessments), knowing the actual statutes and "deposition-proofing" your evaluation and report is important. Just pretend that everything you put down on paper/EMR can be cross-examined in court. Because, it can. There are many times that my personal opinion does not gel with the state and federal statutes. My professional opinion stays in line with the law.

Sure, that makes sense for forensics. I'm still somewhat in the dark as to how an accurate clinical representation, provided as requested on a form specifically designed for that purpose, is somehow being interpreted as 'gaming the system' or not in line with the relevant legislation.

 

[WisNeuro]

Sure, that makes sense for forensics. I'm still somewhat in the dark as to how an accurate clinical representation, provided as requested on a form specifically designed for that purpose, is somehow being interpreted as 'gaming the system' or not in line with the relevant legislation.

Depends on what they want you to write. If you are just saying "so and so" has a diagnosis of depression" and that's pretty much it, sure. If you are saying "so and so has a diagnosis of anxiety and needs immediate accommodations for telework" that's a different story. I've seen plenty of physician letters that could easily be litigated. Do what you want, but I try to keep myself out of court proceedings unless I am retained as an expert and paid well to do so.

 

[PsyDr]

It kind of seems like your political opinion that we should all just work till we drop in the traces from exhaustion might be coloring your approach to people's reasonable requests for recovery time from illness. 🙂

I don't really have a political opinion about private disability. My work ethic is my own, and I don't believe my choices are the best. What I do have is a fair amount of experience in forensics in general and disability in specific. I've seen expert witnesses impeach themselves by speaking about personal opinions to include vegetarianism, religion, politics, etc, many times. While everyone is entitled to their own personal opinions, the federal rules of evidence, professional guidelines, fry/daubert standards require one to confine themselves to professional opinions created by professional methods.

 

[Shikima]

My favorite quirk - Can (blank) do their job?

How the hell should I know?! I haven't observed them for any lengthy period of time.

I leave it blank.

 

[splik]

i have no idea why forensic psychologists coming on here to warn about the hazards of providing a note for a cat or filling in disability. most disability paperwork is conpleted by the patients doctor and this is pretty mich expected by everybody even though there is a massive conflict of interest. But seriously its not typically "forensic work" and nothing bad is going to happen to you for expressing a good faith opinion even if it's stupid.

 

[st2205]

No, you are wrong! They are all just lazy and should get back to work and Make America Great Again. It will be tremendous, trust me.

Though this may be the conventional assumption, it's the opposite of what his revealed plan is.

 

[tr]

i have no idea why forensic psychologists coming on here to warn about the hazards of providing a note for a cat or filling in disability. most disability paperwork is completed by the patients doctor and this is pretty mich expected by everybody even though there is a massive conflict of interest. But seriously its not typically "forensic work" and nothing bad is going to happen to you for expressing a good faith opinion even if it's stupid.

Yeah I get the feeling the forensic psychologists here must have a very different sort of disability form in mind. (Extended/long-term/SSD I guess.) I don't believe I've ever been asked to 'express an opinion' about whether the patient is so globally impaired they are unable to work at all. It's never come up. Typically there are a bunch of boxes to fill in that include the diagnosis, start of impairment, dates seen in clinic, maybe something about the treatment plan, often a bunch of essential job functions/skills where you have to estimate the degree of impairment (from 'none' to 'severe'), the intended RTW date, etc. I don't think I usually write as much as a full sentence on any page of the form for most of these.

 

[smalltownpsych]

i have no idea why forensic psychologists coming on here to warn about the hazards of providing a note for a cat or filling in disability. most disability paperwork is conpleted by the patients doctor and this is pretty mich expected by everybody even though there is a massive conflict of interest. But seriously its not typically "forensic work" and nothing bad is going to happen to you for expressing a good faith opinion even if it's stupid.

With this and the cat thing it is probably more about how our own APA interprets our ethics code with its emphasis on avoiding dual relationships and classifying these types of forms or letters as requiring a forensic evaluation. I don't know if I always agree with how rigid we are with some of this to the point that I think it makes us look a bit unreasonable at times. In the past, I have filled out the forms and wrote the cat letters using my own clinical judgement with supervisors signing off on it, but these days the APA has made it clear that would be unethical. Of course, a few years ago they said that I could participate in torture if i wanted to, but apparently signing off on letting my recently widowed patient keep her cat is a major ethical breach.

 

[WisNeuro]

Meh, my main disagreement with emotional support animals isn't dual relationship ethics or the like, it's more that it's usually just bad treatment and counterproductive. But yes, regarding the other stuff, when we do these evaluations (e.g., capacity), there's usually a legal process already in the mix or it's assumed that things are heading that way.

 

[chicagochildpsych]

I treat a great deal of severely disabled autistic patients with concurrent MR. I'll do that paperwork for free, otherwise I ask them to schedule a 40 min appt dedicated to the paperwork that I answer with complete honesty and charge $100 document fee.


Sent from my iPhone using SDN mobile app

 

[Shikima]

a guy shows up, says that he doesn't want to work with his psychiatrist because he's on too many medications. At the end of the interview during treatment planning, doesn't want to change medications despite him saying that he doesn't like how he feels on them.

Oh by the way, I need some disability paperwork completed.

Gotta love doctor shopping.

 

[PsyDr]

Yeah I get the feeling the forensic psychologists here must have a very different sort of disability form in mind. (Extended/long-term/SSD I guess.) I don't believe I've ever been asked to 'express an opinion' about whether the patient is so globally impaired they are unable to work at all. It's never come up. Typically there are a bunch of boxes to fill in that include the diagnosis, start of impairment, dates seen in clinic, maybe something about the treatment plan, often a bunch of essential job functions/skills where you have to estimate the degree of impairment (from 'none' to 'severe'), the intended RTW date, etc. I don't think I usually write as much as a full sentence on any page of the form for most of these.

If you are filling out those boxes, you are expressing an opinion. Those terms have very specific meaning. If you ever wrote the patient is disabled on an SSA form, then you should know what the SSA means when they say "impairment" and "disabled". The terms are defined differently than the definitions provided by the WHO, statisticians, DSM, etc. If you ae offering a percentage, the I hope you are using the AMA's guidelines of permanent impairment; using the edition your state's laws require (hint: it's not always the most up to date one). If you are using the terms RTW, then the AMA has specific guidelines for that and the determination is extremely specific. If you are speaking about their work conditions, then there are federal laws about what is required and what you can and cannot say about this. If you are talking about causation, then I hope you are following the AMA guidelines thereof.

But I'm sure anyone who filed in those forms has at least read the 3 guidelines published by the AMA, and knows the definitions of the terms asked, before engaging in that practice area.

 

[Armadillos]

Sometimes I don't think non-MDs realize how much society forces us to sign off on random stuff so our patients don't suffer unnecessarily. Additionally a lot of the forms require us to give an opinion on something we can't directly observe or truly objectively evaluate.

For example, the forms for sending a patient to a nursing home, RCF, stretcher transport, getting someone home health, return to work, etc. all ask stuff that to completely accurately answer I would need shadow the patient in whatever environment the form is referring to. But instead,we have to make the best good faith judgement on whatever neccesarily incomplete info we have.

 

[OldPsychDoc]

Seems like you might have Sadistic Personality Disorder. You should talk to your psychiatrist about that.

Felt that this was leading us into a Pharma ad...