When patient's ask you to complete FMLA or disability Forms

[trunksvegeta]

Hi all,
This is regarding forms (disability/fmla forms/request for health aide/parking tag)

Fortunately it is not often that patients ask for these forms to be completed.

However, occasionally I will get a patient that I've not really treated for more than a few months, is functional, but honestly I get the sense to be are IMO "milking the system"

These are the type that may be a slip in fall in front of a city owned building or suing their landlord because they slipped at home. The pathology on imaging is usually moderate and does not justify the request. Some may be using their commercial insurance at the request of a lawyer to bolster a litigation case behind the scenes. I usually try my best to tell them I haven't had enough time to see if the treatments and recommendations have worked etc

Usually its when the office visit is almost over when they slip the "hey I got this form, yada etc"

I do not wish to do these forms nor do I wish to charge for the forms for these patients. I can usually make my assessment whether the patient is truly in need of disability forms or handicap parking etc but its the small subset of genetic outliers that bug the office or turn a 15 minute f/u consult into 45 minutes

Any advice on how to deal with the persistent patient that makes a request for forms, disability, fmla that in your opinion is not medically justified? Please share your TIPS...!

Thx so much in advance

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[lobelsteve]

Say no. No. No. No. easier than yes.

 

[trunksvegeta]

Say no. No. No. No. easier than yes.

Tru! Sometimes they use the "well who do I get it from, you're treating me for my so and so pain etc" Its during these conversations I basically tell them to go to their primary or find another provider that may be able to evaluate him/her to determine their eligibility etc. Better than filling out the paperwork but I guess it's just awkward for me when the patients become persistent. I need to work on saying No. =)

 

[hyperalgesia]

I tell them my job is to make them NOT disabled. I WANT them to walk farther in the parking lot. Signing such a form is an admission of failure. Your pcp may think it's a good idea but I don't.

 

[Agast]

I fill out the forms when it is appropriate. When it’s inappropriate I tell them I’ll fill out their form but I don’t think they’re disabled, so that is what I will be putting on the form. Problem goes away.

 

[painfree23]

I often times have the same issues. But then I put myself in their shoes - if I get injured and can’t stand to do my procedures for a few months..who’s gonna fill out my forms? That being said ..I never fill out forms but I always wonder if the karma will come back to bite me one day

 

[deleted131481]

I don't do disability. I offer to do referral for FCE but that's it. I will do FMLA if appropriate.

 

[DOctorJay]

I don't do disability. I offer to do referral for FCE but that's it. I will do FMLA if appropriate.

this is what our group does as well. we will refer out for FCE but we don't evaluate for disability. if FMLA is required for a patient to keep their job so they can attend appointments/procedures I'll do that for them.

 

[Ducttape]

go on a long winded soliloquy regarding how you are responsible for managing their pain and improving their functionality and work responsibility is a part of functionality and it is hypocritical to espouse improving functioning while concurrently writing for disability etc.

usually after a couple of minutes of this, 99% of patients are bored to death or actually physically asleep. get good sneakers so you can quietly leave.

 

[geauxg8rs]

go on a long winded soliloquy regarding how you are responsible for managing their pain and improving their functionality and work responsibility is a part of functionality and it is hypocritical to espouse improving functioning while concurrently writing for disability etc.

usually after a couple of minutes of this, 99% of patients are bored to death or actually physically asleep. get good sneakers so you can quietly leave.

I love the five page form from the lawyer to fill
Out for disability. Uhhh, no.

 

[jonnylingo]

Hard pass on disability forms.
Tell patient they can find a PT to do an FCE.
Sometimes fill out FMLA, always in person. Bill at least 99214 on time.
Handicap placard, rarely fill this out. When I do it's for the little old lady who is ready to fall even with use of walker. For all others (morbid obese 50 yo) I frankly tell them they need to park at the end of the parking lot and get the exercise. These patients usually give me great reviews.

 

[Baron Samedi]

Hard pass on disability forms.
Tell patient they can find a PT to do an FCE.
Sometimes fill out FMLA, always in person. Bill at least 99214 on time.
Handicap placard, rarely fill this out. When I do it's for the little old lady who is ready to fall even with use of walker. For all others (morbid obese 50 yo) I frankly tell them they need to park at the end of the parking lot and get the exercise. These patients usually give me great reviews.

Gotta love all my disabled 30 year old veterans who drive giant pickup trucks with handicapped tags on their way to their crossfit workouts.

 

[SSdoc33]

Gotta love all my disabled 30 year old veterans who drive giant pickup trucks with handicapped tags on their way to their crossfit workouts.

saw this ALL THE TIME at walter reed

 

[PainRehabMD]

Gotta love all my disabled 30 year old veterans who drive giant pickup trucks with handicapped tags on their way to their crossfit workouts.

90% service connected. Trying to get that last 10%.

 

[SandmanMD]

I fill out the forms when it is appropriate. When it’s inappropriate I tell them I’ll fill out their form but I don’t think they’re disabled, so that is what I will be putting on the form. Problem goes away.

This is what I do as well. “I’m happy to fill out the form, but I will say that they are not disabled and that will become part of the record for any potential litigation”.
The ones that are trying to manipulate the system are just so happy that I even hand them form back to them.

 

[deleted875186]

I fill out the forms when it is appropriate. When it’s inappropriate I tell them I’ll fill out their form but I don’t think they’re disabled, so that is what I will be putting on the form. Problem goes away.

As a graduating fellow I think I’m going to do this approach, I agree that there are some people who I honestly feel for and do qualify for disability. The rest .... milking the system, need to go back to work.

 

[deleted875186]

Just had a security officer throw out his back a few weeks ago, asked for a note to be out of work till his facet injection, told him he probably doesn’t even need the injection but he was insistent, wants to be out of work for 3 weeks. These people don’t want to get better.

 

[geauxg8rs]

Remember that Disability is a legal term/decision
Not a medical one. Tell patients that judges determine disability, they are of course welcome to my records to assess that. That will shut them up.

It’s part of my hands being tied approach. I would love to give you all the meds in the world but my hands are tied. I would love to “give you disability” but I am just a doctor not a judge

 

[cowboydoc]

Remember that Disability is a legal term/decision
Not a medical one. Tell patients that judges determine disability, they are of course welcome to my records to assess that. That will shut them up.

It’s part of my hands being tied approach. I would love to give you all the meds in the world but my hands are tied. I would love to “give you disability” but I am just a doctor not a judge

Works for ssdi, not private short and long term disability, which is insurance. Previous advice is more appropriate for the insurance forms.

 

[ateria radicularis magna]

“You need an occupational physician because they are the ones who understand disability and workplace issues; you don’t want someone like me filling these forms out for you.”

 

[deleted185747]

Gotta love all my disabled 30 year old veterans who drive giant pickup trucks with handicapped tags on their way to their crossfit workouts.

Some of these guys are service-connected for PTSD and murderous rage. It’s probably best not to approach them

 

[NJPAIN]

Remember that Disability is a legal term/decision
Not a medical one. Tell patients that judges determine disability, they are of course welcome to my records to assess that. That will shut them up.

It’s part of my hands being tied approach. I would love to give you all the meds in the world but my hands are tied. I would love to “give you disability” but I am just a doctor not a judge

Similarly, I say that I can only state that you are unable to work if working will cause you harm or you could potentially harm the public. If pain is the reason you cannot work this is not a disability but rather it is a “ work problem”. In other words, YOU report that that pain caused by working is more than you care to endure. In that case, I can merely state that the known pathology you have is significant enough to potentially cause the symptoms that you report.

 

[Ferrismonk]

"Disability is a measure of function, not pain. I don't formally evaluate functional status. If you'd like me to complete the paperwork, I'd be happy to (for the established fee), however I will base my recommendations on a formal Functional Capacity Evaluation. Would you like a referral?"

 

[Doctodd]

Tell them you charge what the attorneys charge. Seriously....if they are truly disabled then fill it out. Usually it’s the same form every 6 months. I only do it for my established patients.

 

[Ligament]

I don't put people on disability long term. If they need FMLA for medical care I'll do it and I charge by the page.

 

[painfree23]

I don't put people on disability long term. If they need FMLA for medical care I'll do it and I charge by the page.

How much per page?

 

[Ligament]

How much per page?

Whatever is worth your trouble. I think I charge $35 per page.

 

[bronchospasm]

I have no expertise on disability. I want you to work hard and give me a ride in your Bentley in a few years. My goal is for you to get better. They will deny you if I fill out your paperwork.

 

[painfree23]

I have no expertise on disability. I want you to work hard and give me a ride in your Bentley in a few years. My goal is for you to get better. They will deny you if I fill out your paperwork.

Be careful, they may ask to test drive urs first

 

[equios]

"I'm sorry, that is not a service I offer, you will need to talk to your PCP about that"