Disability benefit systems can be dizzyingly complex. Here’s help.
Evaluating patients’ ability to work is another task front-line physicians are often asked to perform even though, for many, it is often something for which they have little training or expertise. During a recent webinar, experts highlighted the following scenario that is commonly seen in practice:
“You have a patient who walks in and hands you [disability paperwork] and tells you what they want to have done —and the question is: Is that the right medical decision for that patient?” said Les Kertay, PhD, a psychologist and advisor to the AMA Guides Editorial Panel.
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Kertay is the co-author of the AMA Guides® to Navigating Disability Benefit Systems: Essentials for Healthcare Professionals, which was written for physicians, psychologists and other front-line health professionals. It addresses the issues of work ability, promoting health by promoting work, and communicating with patients, employers and insurers and the attorneys of each party.
“If you don't have any familiarity with the process or the system, sometimes the easy thing to do is fill out the form the way the patient wants it—and that may turn out to be a really bad thing for the patient in terms of their health,” said Kertay, senior vice president for behavioral health at occupational health provider Axiom Medical. “That's why we wrote the book.”
During the webinar he summarized best practices found in the book, which is available for sale as an e-book in the Guides Impairment Section of the AMA Bookstore, from Amazon, and other sellers.
Co-chair of the editorial panel, Douglas W. Martin, MD, also spoke during the webinar, and he described the creation of the book as “monumental” as it organizes information from multiple disability systems all in one place.
“My experience is fairly similar to most in that I had no idea what this meant in medical school,” said Dr. Martin, immediate past president of the American College of Occupational and Environmental Medicine.
“I had no introduction to it in my family medicine residency, and only learned about these things once I was out in practice, which of course is not the best way to learn things,” he added. “I made a lot of mistakes along the road. I don't mind admitting that.”
The book also highlights the importance of the physician’s role in the disability-determination process and how doctors can make a make a difference in people's lives, said Dr. Martin, medical director for the Center for Neurosciences, Orthopedics and Spine Occupational Medicine in Sioux City, Iowa.
“Being out of work has terrible health consequences,” Kertay said, adding that there is also a huge economic cost in terms of absenteeism and lower worker productivity.
“We’re now approaching a trillion dollars a year,” he said. “This is not a small impact on the economy.”
One reason the issues can be confusing is the complexity of multiple, overlapping benefit systems that include Social Security, workers’ compensation and the Veterans Benefits Administration, to name only a few on a long list.
These different systems can use different terminology or have different definitions for the same terms, Kertay said.
In the context of Social Security or some private insurance carriers, if a person has a “disability,” it means they are unable to work. But, in the context of the Americans with Disabilities Act, “disability” means “you have a condition that, when accommodated, allows a person to work,” Kertay explained.
“Same word, but it has very different applications in those in those two systems,” he added.
Dr. Martin also praised the book’s chapter on communication.
“As physicians, oftentimes we don't understand how important it is to involve all the stakeholders in the communication process,” he said. “It's incredibly important to make sure that all players understand what's going on and oftentimes, the physician is looked at as the quarterback of that team.”
Interested in learning more? A recording of the webinar will be available on the AMA Ed Hub™.
For more than 50 years, the AMA Guides have served as the authority on the evaluation of permanent impairment. Adopted by more than 40 states and several foreign countries, the AMA Guides provide a rigorous methodology to enable fair and consistent evaluation of patients who have suffered an illness or injury that has resulted in a permanent loss of function.
Previously, the AMA Guides were released in a printed textbook format, but updates will now be available at AMA Guides Digital, where a 25-year archive of the AMA Guides® Newsletter can also be found.
The panel holds monthly virtual meetings that the public can view and participate in.
The 13-member Guides Editorial Panel draws experts to present the most current science for making impairment evaluations. Panelists include physicians, allied health professionals and regulatory and legal advisors.