Saturday, May 09, 2009

Disability Evaluation - a new job with new challenges

I have been working an extra job lately on some Saturdays, performing physical exams for a company that contracts to the state disability determination services. Clients apply for disability, get an interview with an intake person, supply various supporting documents, and then get scheduled for a physical exam. I receive electronic records ahead of time, whatever the state has received to date, and I am given 30 minutes to talk to the client and examine them. After a very full day of appointments (last Saturday I saw 15 clients) I dictate a report on each client. My instructions are to "provide a complete history and physical" to the people who take it from here. The next steppers will review all the records, including my report, and make a decision about whether the client is disabled and, if so, how disabled.

Thankfully, the final decision is not mine. It's hard enough making some kind of statement about how each "allegation" (the official term for the medical condition that is affecting the client or claimant) impacts the health and functionality of the client. Many cases involve pain, which is very hard to objectively document.

Naturally, I can't mention specific cases here, at least not in enough detail to be able to identify anyone. I have already seen a huge variety of medical problems, from amputations to aneurysms, back pain (lots of that) to bipolar disorder. Plenty of suffering. Everyone suffers. But are they suffering enough? Enough to get a government handout? If a man has been a plumber all his life, and can no longer crawl and kneel, what should he do? Should he be required to learn a new skill after all these years? Should he kick back and live on disability payments? What about the young person who has years of productive life ahead of them? Should a car crash that leaves them with occasional or even frequent back pain ground them for life?

I don't know the answers. I do know that some of the people I examine seem very disabled, and some don't. Are there scammers in the lot? Probably. There are also frustrated hardworking people, embarrassed at their unintended impotence and wishing they were back on the job this minute. There are also bewildered disenfranchised folks without health insurance who are hoping to access health care through this particular back door into the system.

No doubt I'll have more to say on the subject with time. I'm learning a ton.


Paul Elam said...

I certainly don't envy you in this position. I would be so afraid of the results of my findings. Not so much that an undeserving might get some unearned benefits, but that someone who is really struggling won't get any help.

Peg Spencer said...

That is certainly possible, Paul, in fact likely. I think most of the people I see will end up not qualifying for disability. That brings up a whole new set of questions. Who deserves public support? Who decides? What are the criteria? These are ethical, social, financial and political questions. It's difficult to just perform my little piece of the process without wondering about the rest.

Thanks for visiting and commenting!

Margie said...

I would question the very idea of who has earned or deserves the right to receive the disability benefits.

Whether the benefits are the result of Social Security Disability Insurance or a private disability policy, in most cases the person covered worked and paid into a system they thought/hoped they would never need, but expected would be there for them if they did end up needing it.

I can only believe that the vast majority of us would have a very tough time wrapping our minds around the idea moving from being "able bodied" working person to "disabled" former working person in need of coverage. Especially with the attendant disdain and distrust that somehow we were trying to scam a system when in fact we were just trying to access benefits we thought we were supposed to have.

These are very tough times we are going through and many people are struggling just to try to get through to the next day some sense of hopefulness.

I can't begin to know just how difficult it must be for you to have to evaluate these patients and how scary the whole process must be for them. May you receive the grace you need to help you with this challenge.

Peg Spencer said...

Margie, your compassion and idealism are refreshing. I agree that those who have put in should be able to take out. But it's often not a simple equation, alas. Sometimes the person is young, with a life of potential contribution to society ahead of them, if they are able to overcome their physical difficulties or work around them. Is it really doing them a favor to facilitate decades of dependency and inactivity?

Margie said...

The situations you must be evaluating seem specific if the expectation is that once the person receives the initial approval they will be eligible for "decades of dependency."

I have direct experience with someone who received benefits as a temporarily, and not permanently, disabled person. It's the vantage point from which I write.

Since I have known someone who was considered eligible for disability coverage while undergoing a specific health related treatment and knowing that they stopped receiving benefits as soon as they were able to resume work makes me feel that there must be other cases were someone is able to view the situation as a bridge to prevent personal and financial ruin and not an endless "handout."

Perhaps it is idealistic (and I'll admit somewhat naive) to believe in the dignity of work and that most people would choose to be productively earning a living rather than receive disability benefits they are not entitled to?

I admit my view on the subject isn't very objective.

I'll also admit that discussions related to health care benefits are a hot topic for me. Having spent the majority of my life working with organizations that deal with uninsured and under-insured populations and the general lack of access to health care these people face, I'm somewhat sensitized to the subject. People who are categorized as the "working poor" are often the ones who suffer the most as they are caught in the middle. This is something you are even more aware of than I and I don't mean to sound (or be) preachy.

My hope is that our current political leadership will have the ability to deal with these issues.

In the meanwhile I hope to remain idealistic and compassionate long enough to see real systematic change and an end to these times of scarcity.

Thanks for allowing me to blather on! I'm supposed to be writing a grant right now...

Paul Elam said...

I see this topic is sparking some interesting conversation. I think it is a really tough one to tackle. It always seems to boil down to philosophical perspective, and, of course, money.

From a personal standpoint, I think it is unthinkable that any person in this country who cannot work would be left in the cold. For that reason, I also think it is imperative that some sort of real effort is made to determine whether they really are disabled.

We unfortunately live in a world where not everyone is honest. I can well guess that in your profession, Pegs, people who don't tell the truth, or who greatly embellish are not uncommon.

I'd hate to see benefit money going to them when there are so many who really need it.

Peg Spencer said...

Paul said:

I think it is unthinkable that any person in this country who cannot work would be left in the cold.I agree. Absolutely. And Margie, I agree that most people prefer to work if they can. The question that is so difficult to answer is Can they work? If someone worked doing heavy lifting for 20 years, and is now unable to do that work because of a back injury sustained during work, should he find a different kind of job at the age of 45? Or should he get his disability benefits now? Is it better for him in the long run to be forced to find another job and thus keep his productivity and self esteem intact?

What about the guy who sustained a bullet wound in the course of illegal gang behavior? Does he "deserve" benefits?

What about the gal who had a car crash 10 years ago and gets only occasional neck pain?

The problems are not straightforward, alas. It's not a matter of being either able bodied or disabled.

I don't know the answers. I'm just discovering the questions, and there are many, believe me.

Paul Elam said...

Being the harsh man that I am, I go with "if you can work, you must work."

And if course, it is not that simple. I have a friend with Hep C and cirrhosis. It was from a blood transfusion many years ago.

He has periods where he does well, then the ammonia builds up in his system and he becomes confused, completely unable to work.

He has struggled greatly with this for three years now. He is working at the moment, but that could change overnight. It is a rough place to be.

oggelthorp said...

Peg, Laurie from Paul's blog. You speak to me directly as one who's been on disabilty for nearly ten years. After decades of working in coporate America, earning a very decent income, the diagnosis Bi-Polar Disorder came way too late for me.

By the time I was in my forties, long spiraling out of control, unaware, I found myself in the basement of myself. No longer able to support myself, in any job. I had to resort to applying for disabilty. I felt shame but had no other choice. I was that ill at the time.

On good days, I managed getting through the paper work but when it came to dealing with Social Services, the persons, I discovered I was not being taken seriously as one in need, a potential client. I was getting no where. Desperate, I came up with a creative though frankly unethical decision to make calls on my own behalf.

I announced myself as being the Case Manager who was working on behalf of L.P's case. Plenty of expert paper pushers in New York State so I was able to squeak by. I have no regret having to use this measure. Otherwise, it's unlikely I'd be posting here today.

My doctor wrote a letter to the state psychiatrist, in haste, sure it was a fruitless prospect for me. That a disorder other than the physical would dis-qualify for disability.

My last stop...meeting with the state psychiatrist.

I sat before him and asked him one question. "If I had been in a car crash and lost one of my right limbs, would I be eligable for disability?" He replied without hesitation "Yes"

I then said "Well, I have a car crash in my head every single day. He listened. And we discussed stigmitization. The stigmatized system and the stigmatized person.

Yes. I qualified after all efforts.

So, this is my story. But I will end, here, saying that I have nothing but pure contempt for those persons attempting to "pass off" for a free ride. They are usually nailed and this leaves people like myself up for scrutiny. Unable for deserved assistance.

Peg Spencer said...

Laurie - thanks so much for sharing your story. What a struggle you had! Mental health disabilities are often the most difficult to evaluate, as you obviously know. Thankfully you had the strength to stand up for yourself and keep at it until you got what you needed.

Laurie Palmer said...

Thanks, Peg

It sure was a challenge being that I was in the thows of mania and then in the "crashing". Now,these days, people have more access to Advocacy Services so hopefully those with "unseen" disabilities won't have to wing it on their own. Was a very bumpy ride! Laurie

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