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Posts from the ‘Medical Treatment’ Category

1
Apr

Regenstrief Institute to Help Improve SSA Disability Determination

Social Security disability cases may be decided faster due to electronic medical records.  Here is the press release:

Regenstrief Institute to help improve disability determination through health information technology

INDIANAPOLIS –- The Regenstrief Institute has been awarded a Recovery Act contract to help the U.S. Social Security Administration and Indiana healthcare providers shorten and improve the process of making disability case determinations through automation. Work is scheduled to begin March 31.

The process of acquiring medical information for an SSA disability claim involves numerous requests to multiple healthcare providers treating the individual seeking disability benefits. This process can take weeks or even months following an application for benefits. Physician offices, hospitals and others health care provider must gather the individual’s recent medical information and submit it via fax or U.S. mail.

The Regenstrief Institute, an international leader in heath information technology, created and operates the Indiana Network for Patient Care (INPC), a secure statewide health information exchange that providers use to help improve the quality, safety and efficiency of care that their patients receive. Improving the disability determination process complements other functions of the INPC, including surveillance for influenza outbreaks and access to a patient’s diverse medical records when providing emergency care.

“We will leverage the capability of the INPC to quickly and efficiently collect the information requested electronically by SSA, with the specific authorization of the person applying for disability benefits, and securely transfer it to the government so the disability decision process can be completed more rapidly. This will make that process more efficient – both because it will be faster and also because the medical data compiled will be more complete. It also will take the time and expense of going to many different providers, assembling the necessary records and filling out forms off the shoulders of patients and decrease the need for providers to search for and send records manually,” said Brian Dixon, MPA, project manager for Regenstrief’s SSA contract.

To effectively make decisions regarding applications for disability, the SSA needs the same kind of medical information that physicians utilize when making diagnoses, treatment, and referral decisions. Healthcare providers in Indiana rely on the INPC to securely and privately share clinical data which is utilized daily to support healthcare services throughout Indiana.

“Facilitating the processing of patients’ disability claims is another example of how healthcare providers throughout Indiana have worked together with the Regenstrief Institute and Indiana Health Information Exchange to ensure that their patients’ healthcare information is used to enhance their care,” said J. Marc Overhage, M.D., Ph.D., director of medical informatics at the Regenstrief Institute, Regenstrief Professor of Medicine at the Indiana University School of Medicine, and president and C.E.O. of the Indiana Health Information Exchange.

Disability benefits determination is a large-scale process. The SSA expects to receive more than 3.3 million disability benefits applications in fiscal year 2010, a 27 percent increase over the 2008 fiscal year. Annually, more than 15 million requests for medical records are sent to healthcare providers.

16
Oct

Why Your Nurse Pratitioner May Make Your Social Security Disability Case Sick

More and more of my clients have seen a Nurse Practitioner for their medical care.  Some like the Nurse Practitioner so much that they no longer actually see the doctor or their return appointments just keep being made with the Nurse Practitioner. The Nurse Practitioner is giving them great care, so why should they care if they see a Nurse Practitioner instead of a doctor?

Social Security divides medical sources into two categories: “acceptable medical sources” and other health care providers who are not “acceptable medical sources”. Nurse Practitioners are in the category of other health care providers who are not “acceptable medical sources”.

In Social Security Ruling 06-03, SSA explains that it makes the distinction for three  reasons: First, SSA needs evidence from “acceptable medical sources” to establish the existence of a medically determinable impairment. Second, only “acceptable medical sources” can give SSA medical opinions.  Third, only “acceptable medical sources” can be considered treating sources whose medical opinions may be entitled to controlling weight.

This means that the medical evidence from a Nurse Practitioner can not establish your medical impairment at Step 2 of the Sequential Evaluation. You must establish your medical impairment in order to win your benefits.

This means that if all of your treatment is by a Nurse Practitioner, then you have no one who can give SSA a medical opinion about how your medical impairments restrict what you can do.

In a card game, a King beats a Jack. Social Security does not even treat a Nurse Practitioner as a Jack–more like a low card. This is not good for your case!

16
Jun

Indianapolis Social Security Disability Cases Appeal Processing Time April 2009

The good news is that the processing time for appeals that go to hearing in Indianapolis has fallen when compared to the times from June 2008. The average processing time in Indianapolis measured from the Request for Hearing was 896 days at the end of June 2008. At the end of April 2009, the average processing time in Indianapolis measured from the Request for Hearing was 738 days. This is a reduction of 158 days.

The bad news is that the wait is still over two years long from the Request for Hearing. It is important that you keep seeing your doctor during your long wait so that your medical condition will be documented.

6
May

Social Security Disability and Third Party Verification

You only get paid benefits if you can prove that it is your medical impairment that prevents you from working. Many times people pursuing their Social Security Disability Benefits forget that Social Security wants to verify everything from a third party that Social Security considers reliable. They do not remember that if it is not verifiable by a third party that SSA considers reliable, then the fact does not exist. The third party that can verify your medical impairments and how they are affecting you on a particular day is your doctor.

Just because your doctor told you six months ago that there was nothing more the doctor could do for you – this is as good as it gets – does not mean that you can stop going to the doctor. If you do not have medical records (that third party verification) for those six months, the judge can say that there is no proof that your medical condition did not improve during that time or that it stayed the same, therefore you have not proved that your medical condition prevented you from working those six months. This could result in a complete loss of benefits. If you have seen the doctor in that time, then the medical records can document that you did not improve. Also, the doctor may document some facts that the doctor did not previously document. These facts may be what convince the judge that you can not work.

Another problem is that most doctors do not put in their medical records that they told you that this is as good as it gets. When you tell the judge that is what the doctor says, there is no way to verify this in the medical records. In preparing your case to win, you must assume that without third party verification of what you say that the judge will not believe you. Otherwise you are gambling that maybe you will be lucky and the judge will believe you. Why would you want to gamble on winning when you can continue to see the doctor and generate the third party evidence (medical records) that will show what your medical condition was?

5
Feb

What Is Your Level of Pain?

That is what the nurse was asking me recently as I lay in my hospital bed after my surgery. She wanted me to rate my pain from 0 to 10. I had pushed the button for the nurse and asked her for another morphine shot. I knew it was time to have it by the pain I was having, and by the doctor’s orders I could have had it sooner, but what number should I put on my pain?

I told the nurse that I hated the pain scale as I have had clients who had rated their pain at a number that the judge in their disability case thought was the wrong number for what they were describing. “What is a level 5, what is a level 8?” I asked. I was over-thinking this and the nurse just wanted to chart it, give me my shot, and move on. She agreed with me that the number was arbitrary, but that she needed to chart it. So I picked a number.

As I lay in my hospital bed, I could not help but think of the countless hearings I have been in where the judge has asked my clients to rate their pain. One judge said that a 10 was the worst pain you could imagine. What he did not say was that if you said a 10 he automatically disbelieved you as he believed that no one could be sitting there with a pain level of 10 (he never told them that to their faces). Other judges had no problem with a pain level 10.

I hate the pain scale because there is no way for us all to calibrate our measurements so that they are all the same. I have observed clients in great pain who state that their pain is a 6. I have had other clients who appeared to be in less pain that also said that their pain was a 6. So what is a level 6?

How did I want to compare the pain I had the two nights that I could not sleep from the pain to the pain that I had after surgery? There was a time I thought my pain might be a 10, but what about those I have seen who suffered more than I did those two nights I could not sleep? If delivering a baby is a pain level of 10, was my pain that bad? Since I am a man, I will obviously never know how my pain compares to the pain of childbirth.

So I started to answer the nurse the way I advise my clients to tell their medical providers about the pain. I started to describe the pain without putting a number on it. I started to give the nurse details about the pain. How it felt. Where it was. What aggravated it (at that point for me it was just shifting in the bed). What kind of pain it was ( by this I mean was it hot, cold, constant, throbbing, stabbing, electrifying ect.) How intense it was. She wrote down my description. Now a “real” description of my pain was recorded.

It is important to get a “real” description of your pain recorded into the medical records every time you visit your medical provider. This will allow the judge to read your descriptions and know how your pain was at the beginning of your disability and how the pain continued during all of the time that was disabled. If you only give a number, you and the judge may have different ideas as to what that means. The only way you could “both be on the same page” would be for you to calibrate with the judge your pain measurements on the same scale to discover that your 6 is his or her 8. The problem is that this can not happen until the hearing, and the judge will have already read the file and decided how bad your level 6 pain is. It may be hard for the judge to change his mind. If your full blown description of the pain is in your medical records, the judge will read that as he reads the file and decides how bad your pain is.

Your full blown description of the pain in your medical records is vital to your case.

7
Jul

Five Step Sequential Evaluation

Social Security uses a 5 step sequential evaluation process to decide your claim. Read moreRead more

30
Jun

Medical Impairment, Ability to Work, & Social Security Disability

I previously discussed Medical Impairments and Social Security Disability. Sometimes claimants forget that Social Security only pays disability benefits if you can prove that it is your medical impairment(s) that prevent you from working. SSA does not pay for bad attitudes (unless it is a diagnosed personality disorder that is rather severe), the factory closing, or ‘I just for some unknown reason can not work’. You have to prove that it is your medical impairment that prevents you from working.

When you are proving that it is your medical impairment that is keeping you from working, Read moreRead more

17
Jun

When Should I Hire An Attorney For My Disability Case?

I recently was the moderator of a panel discussion at the Indiana Continuing Legal Education Forum Social Security disability seminar “Persuasion at Social Security Hearings: Beyond the Mechanics at ODAR Hearings”. During another part of the seminar, an attorney was asked when he would begin representing clients in their Social Security Claim. He responded that he would not represent a claimant until they had been turned down at least once. I used to do it that way.

When I first started representing claimants in 1994, I also would not take a client until they had been turned down at least once. I reasoned that if someone could be approved on their initial application without an attorney, why not let them go ahead on their own and find out if their claim could be approved. They could save an attorney fee and it would not hurt their case if they did lose, so why not wait to see who really needed an attorney to help them?

But then I started to notice something. When people applied by themselves, they were making it harder to win their case by not having an attorney at the beginning to explain to them the rules of Social Security. They were unknowingly lowering the odds for success at that stage and at the appeal stages. They were not realizing that they were making strategic decisions that might ruin their claim before some administrative law judges. They did not have someone to help them figure out what was the relevant evidence that they needed to be sure they presented to Social Security. I figured out that I was wrong-people were hurting their case by not having an attorney at the beginning of their case.

Several years ago I decided that I had to start taking claimants as clients as soon as possible. Claimants needed to be represented before they filed their claim. If I made a claimant wait until they were turned down before I would represent them, their not knowing the rules put them at a disadvantage: bad evidence was created, good evidence was not brought forward, other strategic choices were being made that could not be undone, and good claims were being unnecessarily tainted with misinformation.

Do not wait to hire an attorney. Get competent help before you file so that the job will be done correctly from the beginning. Do not hope that the attorney can tear out the bad and re-do it. Do it right the first time. It can shorten the whole disability process. Get an attorney that will represent you from the beginning of your claim. Have someone on your side that knows the rules of Social Security and can explain them to you.

11
Jun

Medical Impairment and Social Security Disability

Social Security only pays benefits if you have a medical impairment that prevents you from working. The claimant has the burden of proof -that is a “lawyer way” of saying that you have to prove you have a medical impairment and you have to prove that the medical impairment is the reason you can not work.

The best proof of you having a medical impairment is the medical records that document a doctor diagnosing the impairment. When someone has something wrong and the doctors just can not figure out what it is, Read moreRead more