Disability/Return to Work?

[Nonphysiologic]

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How are you guys handling it when a Patient comes in and dumps a bunch of forms for you to fill out for their employer and requests you put them in disability? Is there any good objective systematic way to go about this?

Thanks.


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[lobelsteve]

Charge $50 or more for paperwork. Send for FCE. Or state you do not complete disability forms.

 

[hyperalgesia]

Yep. It's in my consent to care agreement that every pt signs.

Find a place in your area that does fce and and refer them.

This is often not a covered benefit but it's not your problem.

 

[pastafan]

I tell patients that I am not trained/certified to perform disability ratings. I refer them for FCE or they can go see occupational medicine doctor/ortho for disability rating.

hyperalgesia: Interesting idea to include this in initial patient forms. How exactly do you word this? Simple "we do not provide disability ratings"? Do patients actually read and remember that it was included?

 

[Ferrismonk]

I charge $50 for any FMLA paperwork/etc assuming it's simple like they want one day off a month for flareups. If they want disability filled out, more extensive FMLA, or a letter written, I charge $250. If disability or long term FMLA is what they want I send them for a FCE and I inform them my recommendations are based on the FCE. I've only ever had 2 people do the FCE and only one go through to completion. Usually they'll find some other candyman to authorize their lifestyle choice.

 

[Ducttape]

Big sign in front of secretaries:

This office does not complete disability paperwork.

 

[SSdoc33]

ill complete the disability paperwork when i deem it to be legitimate. this is maybe 2% of cases. if someone has a legitimate disability, ill fill out the short-term disability form. not an impairment rating, and there is a lot of answers that I put "unknown" or "not applicable". takes maybe 2 minutes.

id like to know how we are supposed to guess when a patient will be able to return to work. thats always a mystery to me

 

[emd123]

How are you guys handling it when a Patient comes in and dumps a bunch of forms for you to fill out for their employer and requests you put them in disability? Is there any good objective systematic way to go about this?

Thanks.


Sent from my iPhone using SDN mobile

A huge percentage of these involve patients asking you to commit fraud and claim there's no way they can do any kind of work, who absolutely will work afterwards, but under the table, for cash. Official office policy: Dr. EMD123 does not do disability paperwork. Period. Don't sign them. Send them to their PCP or for a functional capacity exam.

This is how the conversation usually goes, if you're honest about it:

Patient: "I can't do heavy lifting due to Pain."

You: Well, how about light duty, no lifting or bending?

Patient: "Even standing hurts too much, I can't do that either."

You: How about seated work?

Patient: "No, unbearable. Even sitting is torture, I can't do it."

You: How about doing something like telemarketing work where you lay down in bed, with a blue-tooth headset and remain motionless, not moving your arms or legs, and sip soda and ensure through a straw and watch TV between calls, like a quadriplegic patient of mine does?

Patient: "No, even that's too much pain."

You: Wait. You can't do heavy work, stand, sit or lay down? How the hell are you going to stay at home and be disabled?


There are few things in life as unrewarding as filling out disability paperwork.

 

[kamilo6]

Temporary partial disability and temporary light duty we endorse pretty frequently (just the regular note in the chart with follow-up plans). Handicap plates need renewal every few years.
Full permanent disability request is sent to a PT who does FCE and compares against job description. They charge $800 to $950 for FCE report with statement of disability from the occupation (I think less if going through VA). If completely unemployed then I send to a lady who does “vocational assesments”. Her reports are sad to read. Lots of psych disease comes out. The patient might also get referral to 1 of 2 attorneys that I know. I just tell patient that the process is “specialized and has to be done right”.

 

[Ferrismonk]

I also frequently state that "Pain isn't a reason for disability". Ends the conversation quickly.

 

[Gauss]

I also frequently state that "Pain isn't a reason for disability". Ends the conversation quickly.

not clear in OP but this may not be purely pain/psych
need more info
wcomp? how long have you been treating it and have you maxed out treatment? are they stable or as good as they're gonna get?
whats the diagnosis? If you're PM&R this becomes harder to avoid. Neurodegenerative, myelopathy, TBI, or autoimmune (RA, HLA) is fair game

 

[clubdeac]

What do you guys do in the scenario where the patient says their employer won't let them work in any capacity until they are fully cleared to perform all of their job duties? A lot of times patients tell me this saying that if I put no "repetitive lifting, bending or twisting and no lifting > 25 lbs" their employer will not let them work at all. It's an all or none thing.

 

[drusso]

We asked what the local disability law firms do and adopted the best practices: We have various form fees ranging from $25 - $500 depending upon the length, complexity, level of analysis, etc. Some times a chart review is required to complete the form and that's an additional fee. Patients pay cash and we'll take installments, but not turn in the form until the full fee has been paid. Over the years we've created various templates for most of the forms so that my RN can fill out about 80% of them and I can review and sign it. Patients appreciate knowing up front how much each specific form costs to complete and how it works into their budget. From time to time I'll see a new form I've never seen before, then it reverts back to my usual and customary hourly fee.

 

[drusso]

Big sign in front of secretaries:

This office does not complete disability paperwork.

Ever notice that the disabled are the last group left that it is still politically correct to discriminate against? Addicts and the disabled. They're such pain in the assess with all their so-called "paperwork." And, I hate how much space their wheel chairs take up...

 

[VA Hopeful Dr]

Ever notice that the disabled are the last group left that it is still politically correct to discriminate against? Addicts and the disabled. They're such pain in the assess with all their so-called "paperwork." And, I hate how much space their wheel chairs take up...

If only there were some entity that we all paid into, almost like a government, that would do those disability exams as needed...

 

[nvrsumr]

Unfortunately the 95% bad apples seeking disability in a pain clinic ruin it for the 5% that are legitimate...

I am curious after the hundreds of dollars spent by the patient to get the forms filled out how often the physician conclusion is -zero disability. My guess is not often.

 

[Ducttape]

Ever notice that the disabled are the last group left that it is still politically correct to discriminate against? Addicts and the disabled. They're such pain in the assess with all their so-called "paperwork." And, I hate how much space their wheel chairs take up...

It is not discrimination to not perform a task for which one is not qualified (even if it is on purpose). (Sorry about all the negatives in that statement)

Similar to how I do not expect the run of the mill pain doctor to treat, say, pre-adolescents, or specific GI or GU conditions. Do you prescribe unique diets and/or immunologics for your UC patients? When was the last time you refilled humira?