Tips to Help Your Patients File Successful Disability Applications

Paperwork pertaining to patient disability is a time-consuming, difficult, and often wearisome process for primary care physicians and other providers. The difficulty has its foundation in the multiple disability types, varying documentation requirements, and differences in who serves as the final arbiter of disability. The aim of this article is to review individual cases and, utilizing a step-wise framework,¹ provide examples of how to efficiently, accurately, and confidently complete various types of disability paperwork to aid patients in their disability applications.

It is common for patients to come to the primary care office with some sort of disability question or concern. Many people request Family and Medical Leave Act (FMLA) paperwork be completed for their employer in order to take some time off of work due to illness or accident, or to take care of a family member.² For long-term and short-term disability, the physician’s assessment and supporting documentation can facilitate insurance determinations through processes established by private insurance companies and workers’ compensation claims, whereas Social Security disability determination is specifically and only the prerogative of the Social Security Administration judge.

The definition of “disability” is not the same across these legal domains. The Social Security disability definition depends on both medical and vocational aspects related to a person’s impairments. Functional limitations that affect an individual’s ability to sustain full-time, competitive employment are key. Sustainability, capacity for full-time work, and ability to do competitive work are the three legal components of this definition of “disability.” This definition does not contemplate employability, percentage of impairment, or the ability to return to a previous job. However, non-exertional limitations, typically involving mental health signs/symptoms, are far more difficult to corroborate; the medical source statement summarizing the physician’s opinion of the patient’s physical and mental limitations is crucial and may help determine a finding of “disabled.” Primary care clinicians are considered acceptable medical sources, which means that judges, lawyers, and other people reviewing disability applications will use clinicians’ statements as evidence of disability or impairment.