Disability

One of the most complicated and devastating strands within the painweb is Disability.  Disability from chronic pain ensnares the very essence of quality of life.

Coping with the pain and suffering physically and psychologically soon becomes further entangled with the individual’s painweb as they are unable to work, unable to collect a paycheck, unable to provide income for themselves and their family.  The sudden loss of income continues to weave within the painweb into the realization that their career along with the hopes of future work related growth and advancement are gone.

The devastation that disability causes within the painweb continues as the individual is faced with piling financial debt.  The increased necessary medical interventions, many times required from specialty and sub-specialty health care professionals, are not covered by health insurance.  It’s also common that many chronic pain prescription medications are brand name only costing significantly more than generic medication.

Financial debt continues to inflate exponentially as the chronic pain patient becomes financially responsible for greater percentages of necessary expenses for complicated diagnostic testing, procedures, and hospital stays.  In fact, despite the fact that as the chronic pain patient is financially responsible for more of the necessary medical care because their health insurance plan covers less, they soon discover that to keep the health insurance they have means they will have to pay for it out of their own pocket.  Eventually, loosing gainful employment means you eventually lose health insurance benefits as you are no longer considered employed.  Of course, you are given the option of keeping your health insurance coverage as long as you pay for it.

The painweb causes even more tragedy by the fact that it ensnares family members just the same.  Financial hardship hits the entire family.  The sadness continues as the loved ones feel helpless as the most they can do is watch the effects chronic pain is having on their loved one and the entire family.

How a loved-one interacts with someone living with chronic pain becomes complicated and source of stress.  What to say and do?  How to say it and do it?  When to say it and do it?  The painweb changes verbal and non-verbal communication as chronic pain changes people.  Loved-ones want to help.  They hope and pray for ways to take away, or reduce the chronic pain.  They feel the need to “take action” and to “take care” of the situation as a show of their love and heartfelt concern.

Another reaction from some involves a sense of “fear” that can arise as a loved-one and, or friend witnesses the tragic consequences of chronic pain.  They feel the best way to respond to the chronic pain sufferer is to “distance” themselves from the person.

Please take a few minutes to review the link below.  This valuable resource will help you understand someone with Chronic Pain which will help control the painweb and improve quality of life:

Understand Someone with Chronic Pain 

One of the most cruel causes of the disability strand in the painweb is the absolute hopelessness which weaves throughout the chronic pain patient as they feel utterly useless not only to themselves, but especially how they see themselves within their family and in the world.

DISABILITY; WHAT TO DO FIRST?

The disability strand is no different than any other strand within the painweb.  You must take charge of your disability.

Understanding disability and learning about what disability means and how to identify options is the first step.

Taking action will give you some confidence and momentum to help you take control of your painweb and improve your quality of life.

DEFINITION OF DISABILITY

Here is the dictionary’s definition of disability:

dis·a·bil·i·ty  noun, plural -ties for 2.

1. lack of adequate power, strength, or physical or mental ability;  incapacity.

2. a physical or mental handicap, especially one that prevents a person from living a full, normal life or from holding a gainful job.

3. anything that disables  or puts one at a disadvantage: His mere six-foot height will be a       disability in professional basketball.

4. the state or condition of being disabled

5. legal incapacity; legal disqualification.

While the dictionary’s definition of disability is clear and concise, disability as it relates to the legal status of inability to work is as complicated as chronic pain and the painweb itself.

If you cannot work because of your chronic pain, then pursue disability.  It’s your right.  At the same time, understand that the process of determining if someone is unable to work due to chronic pain is long, arduous, and imperfect.

The obvious reason is to insure that only rightful individuals who have proven incapable of working due to chronic pain are categorized as disabled.  Proving you are disabled is the task.  Regardless of what you think, and to some extent what your own doctor says, proving disability is a complicated process.

SHORT TERM DISABILITY

Check with your employer to see if Short Term Disability is provided.  Many employers offer this as a benefit.  Short Term Disability eligibility usually becomes effective after a number of consecutive days of work missed due to being disabled.  Contact your employer about filing the application (claim) while asking about other requirements of the Short Term Disability benefit.  There is also a “period of disability” which defines the maximum number of weeks benefits are paid along with an explanation of how the percentage of your pay is calculated (benefit) and when it is paid.

You must provide any medical information that your employer requires which may include documentation from your doctor(s) along with a requirement that you take an Independent Medical Examinations (IME).  The IME may be used to determine if you are disabled.

mypainweb “Forms” offer easy to use forms to organize all details required for Short Term Disability claims.

LONG TERM DISABILITY

Long Term Disability is very similar to Short Term Disability.  Long Term Disability is a continuation of the Short Term Disability benefit plan.  Check with your employer to see if Long Term Disability is provided.

An application (claim) from your employer will need to be completed for Long Term Disability by you along with a section to be completed by your doctor called the Physician Statement.

Under Long Term Disability plans you will be asked to furnish proof of your disability.  The insurance company providing the benefit has the right to investigate your claim at any time.  They also have the right to have you go to an Independent Medical Examination (IME) from time to time by a specialist at their choosing which they pay for.

Keep in mind that if at anytime you refuse to cooperate, or refuse to take requested IME’s, the insurance company may deny your claim, or stop payments.

mypainweb “Forms” offer easy to use forms to organize all details for Long Term Disability claims.

WORKER’ S COMPENSATION

In the event your disability was the result of an injury suffered while on the job, then you may be eligible for Worker’s Compensation.  Worker’s Compensation is similar to Short Term and Long Term Disability in which there is a disability carrier involved.

An application (claim) for Worker’s Compensation is filed through your employer.  You will be required to furnish all medical information pertaining to the disability in addition to be required to go to Independent Medical Examinations (IME’s) as directed by the Worker’s Compensation Board.  Failure to cooperate with such requests the Worker’s Compensation Board may result in a denial of your claim, or stopped benefits.

Upon approval of your claim, the Worker’s Compensation Board will award payment to you of a percentage of your normal weekly earnings.  This award will be mailed to you according to a payment schedule determined by the Worker’s Compensation Board.

The Worker’s Compensation Board will instruct that all your medical care related to your claim be approved by them first.  This includes diagnostic tests, treatments, surgeries and prescription medications.  The Worker’s Compensation Board has the right to deny any requests for medical treatment(s) determined necessary by your doctor.

The Worker’s Compensation Board has an appeals process which include the request for a hearing.  The hearing gives you the opportunity to get the denial overturned in your favor.

It may be necessary for you to seek the services of a Worker’s Compensation attorney to insure you receive all Worker’s Compensations benefits you are entitled to.  Worker’s Compensation attorneys can also provide you the necessary leverage to insure timely medical approvals, paid benefits, and to fight unjust denials for medical treatment requests.

You may be entitled to reimbursement of other out of pocket expenses directly related to your claim like vehicle mileage to and from your medical appointments along with any parking fees.  Only those medical appointments directly related to your claim are allowed.

mypainweb “forms” offer easy to use forms to organize all details for Worker’s Compensation claims.

SOCIAL SECURITY DISABILITY

“Disability” under Social Security is based on your inability to work.  You will be considered disabled if you are unable to do any kind of work for which you are suited, and your disability is expected to last (or has lasted) for at least a year or to result in death.

TO LEARN MORE ABOUT SOCIAL SECURITY DISABILITY:

*Click on the website below for an informative Non-Legal Translation of Disability:

Social Security: Definition of Disability

*Click on the website below to learn about Social Security Disability from the official Social Security Administration website:

Social Security: Government Definition of Disability

HOW DO I APPLY FOR SOCIAL SECURITY DISABILITY (SSD)?

The process starts by filling out the SSD application which you can obtain on the official website (SSA.gov), or in person at your local Social Security Administration office.

I recommend that you fill out the SSD application.  The application is straightforward.  It’s relatively simple if you have been using and keeping current the mypainweb “forms”.

Here are some of the SSD application sections to be completed:

  • Basic information about you
  • Information about your injuries, or conditions and how they affect you
  • Information about your work
  • Information about your medical records (doctors/treatments)
  • Information about medications
  • Information about medical tests
  • Information about your education / training
  • Information about any vocational rehabilitation
  • A remarks section where you can add any additional details

It’s imperative that all information provided is truthful and accurate.

Social Security Disability will advise you of an appointment for an interview which may be by telephone, or in person at your local Social Security Administration Office.  You will also be instructed whether to bring your completed application with you or mail it ahead of time.

Completing the SSD application is another way for you to take charge of your painweb.

Another option for completing the Social Security Disability application in the event you are unable, or choose not to complete the application, is to hire an attorney specializing in social security disability.

Once your application has been submitted and the first interview conducted, it is likely you will be notified as to when your Independent Medical Evaluation (IME) will be.  This process takes time.  You will be assigned a Social Security Disability associate who will be able to answer any questions you may have, or provide further clarification about this process.

It’s possible your Social Security Disability approval process my involve several interviews, by phone and / or in person, along with additional Independent Medical Evaluations (IME’s).

Upon completion of their review, Social Security Disability will notify you of their decision.  If approved, Social Security will advise you of the particulars  of the award.  Be sure to ask about any retroactive time you may be eligible for.

In the event Social Security Disability denies your claim, don’t be discouraged.  Most claims are denied the first time.  While frustrating, try to look objectively at the application you submitted to be sure you answered all sections fully, and that you didn’t inadvertently omit any requested information.

Upon resubmitting you Social Security Disability application be sure you updated any current medical information to reflect continual medical care.  It’s likely you had further medical treatment(s), doctor appointments, and medications since the date you submitted your initial Social Security Disability application.

EVEN IF YOUR ARE APPROVED…

Disability insurers, whether short term, long term, worker’s compensation, or social security, state certain conditions that you must continue to meet even after disability benefits are approved.  Failure to meet these conditions may deny the approved claim and stop benefits.  Some of these conditions may include:

  • You are not able to perform, for wage or profit, the material and substantial duties of your occupation, or any job for wage or profit.
  • You are under the regular care of a doctor
  • You fail to respond to periodic requests for current Physician’s Statements (to be completed by your doctor) and Claimant Statements (to be completed by you)

When your disability insurer requests you send information via mail be sure to retain copies of each document being sent.  Particular attention needs to made to adhering to due dates.  I recommend mailing these documents certified return receipt requested to avoid any “we never received it” frustrating situations.  The post office will send you notification as to when the documents were received, and who signed for them.  This matter of record is most helpful if it’s suggested you did not send the requested information.

INDEPENDENT MEDICAL EVALUATION (IME)

The Independent Medical Evaluation (IME) is of particular importance.  It’s use is weighted heavily in determining your disability for Short Term Disability, Long Term Disability, Worker’s Compensation, and Social Security Disability.

IME’s are controversial, frustrating and used as the basis for determining your disability claim.

When a question of disability is met with the expectation of receiving disability compensation, the disability insurer has the right to have a doctor of their choice examine you.

In theory, IME’s make sense.  They are designed to clarify medical restrictions and limitations.  Having an independent doctor examine you along with your medical records and then rendering a report to detail findings should help insure you are receiving the best health care.  Anyone would welcome another set of expert “eyes” reviewing their complicated medical situation.

The heated controversy arises out of the complaint that, in practice, the IME is a risk management tool paid for by the disability insurer to deny your claim.

The existence of an IME physician network comprised of IME physicians that perform hundreds of IME’s at a cost of $1200 to $5000 per IME raises questions.  Do IME physicians have an unfavorable opinion or feeling formed before they even examine the patient?  Critics claim that IME physician results favoring the insurance company creates a lucrative business of performing several hundreds of IME’s for the doctor.

The fairness of these IME’s are scrutinized as the IME physician already knows the expectation of the insurance company along with receiving all of your medical information sent along with your claim prior to you ever walking into the exam room.  Some question the IME physician adds to the controversy by drawing conclusions and writing reports using their knowledge of the disability workings and lingo to satisfy the insurance company’s agenda.

It doesn’t take long to witness this controversy.  Comparing the credible opinion of your treating doctor with the opinion of the IME physician creates yet another strand with the painweb.  While the IME physician’s conclusion is contrary to the medical opinion of your doctor, the language used in the IME’s report may lead some to think the claimant is dishonest.  The outcome, some would say, is favorable to the insurance company as it would likely result in an easy claim denial.

WHAT CAN YOU DO ABOUT IME’S?

There are a few things you can do to help prepare for your IME:

  • know your medical history and be consistent with telling your story
  • make sure your attorney, if you have one, is aware of your IME
  • take someone with you to the IME
  • if you are interested learning about the IME physicians’s credentials you can use mypainweb doctorfinder.
  • don’t attempt to exaggerate symptoms overreact
  • don’t ask the IME physician for advice about your medical situation and treatment.  The IME physician is not your doctor.  Only answer questions you are asked.
  • if the IME physician hurts you during the course of the exam, say so. If the IME physician should manipulate you physically hurts you to the point of pain call for assistance; an ambulance if necessary.  The person with you will be able to help and recount the events if necessary.

While you can’t avoid IME’s, doing these few things to help you gain some control over the disability strand within your painweb.  IME’s can have an emotional effect making you feel defeated.  Try your best to walk into your IME being yourself and being honest.

Regardless of the outcome of any IME report, you will gain a sense of confidence as you take an active role in your disability.  In the process, you will also be taking control of your painweb.

 

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