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When applying for disability insurance benefits, one crucial requirement is having medical evidence to support your claim. Your doctor may need to complete specific paperwork to support your claim, such as an Attending Physician’s Statement (APS) or Residual Functional Capacity (RFC) form.
These forms detail your diagnoses, treatment, and any restrictions or limitations. However, some doctors may refuse to fill out these forms, affecting whether your benefit claim is approved. Understanding your rights and navigating this situation effectively ensures a smooth claims process.
Understanding Disability Forms and Their Importance
Types of Disability Benefits
Disability benefits typically fall under two primary categories: benefits provided by the Social Security Administration (SSA) and disability insurance benefits offered by a disability insurance carrier.
The SSA provides benefits under two main programs: Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). SSDI is reserved for individuals who can no longer work due to a long-term medical condition. SSI provides payments to people with disabilities who have low incomes and minimal resources.
Essential Forms for Disability Claims
When pursuing disability benefits, there are several vital forms that claimants need to navigate. The SSA-16-BK, the Adult Disability Report, and the SSA-3368, the Disability Report, are both critical for providing comprehensive details regarding an individual’s medical condition and its impact on their ability to work.
Additionally, the SSA-827, the Authorization to Disclose Information to the Social Security Administration, is essential for granting permission to healthcare providers to release medical information. Insurance companies like New York Life and Lincoln Financial also have applications and authorizations for claimants to sign.
However, the most important forms in any disability claim are those your doctors complete.
The Role of Your Doctor In Disability Claims
Your doctor plays a crucial role in supporting your disability claim. They are responsible for accurately documenting the nature and severity of your medical condition and its impact on your ability to work. Medical evidence your doctor provides is essential in establishing the validity of your disability claim and ensuring a fair assessment by the Social Security Administration or disability insurance carrier. Your doctor’s cooperation and comprehensive documentation significantly enhance the likelihood of a successful disability claim.
Reasons a Doctor Might Refuse to Complete Disability Forms
When a claimant seeks a doctor’s signature on disability forms, they may encounter reluctance. Several reasons exist, ranging from the doctor’s policies and practices to concerns about medical expertise, time constraints, and administrative burdens.
Doctor’s Policies and Practices
Some doctors may have policies preventing them from filling out disability forms. This could be due to internal practice rules, liability concerns, or simply a lack of familiarity with the process. Additionally, doctors may have personal reservations about getting involved in disability claims, especially if they have had negative experiences in the past or fear legal repercussions.
Insufficient Evidence and Unclear Requirements
Doctors may refuse to sign disability forms due to insufficient medical evidence supporting the patient’s disability claim, concerns about the accuracy or completeness of the information provided, or unfamiliarity with the specific requirements of the disability forms. Additionally, some doctors may hesitate to sign such forms if they feel uncomfortable making a definitive statement about the patient’s ability to work or if they have ethical or legal concerns about the disability evaluation process.
Time Constraints and Administrative Burdens
The time and effort required to fill out extensive paperwork can also be a deterrent for doctors. They may feel the administrative workload is overwhelming, especially if they are already juggling a busy patient load. Concerns about the impact on their time and attention and the potential ethical implications of prioritizing paperwork over patient care may lead to reluctance to complete disability forms.
Financial Reasons
Many doctors require payment to fill out forms. You may hesitate to take on additional expenses while you cannot work, but these forms are crucial for confirming your medical condition. If you have an attorney, they may cover the fee until you receive your benefits.
Steps to Take If Your Doctor Refuses To Fill Out Forms
When dealing with a doctor who refuses to fill out disability forms, it can be a frustrating and daunting experience. The law does not mandate doctors to fill out disability forms for their patients. However, there are steps you can take to navigate this challenging situation and ensure that your needs are met. By taking these steps, you can proactively address the challenges associated with a doctor refusing to fill out disability forms and work towards finding a resolution that meets your needs.
Understand Why Your Doctor Is Refusing to Sign
The first step is to discover why your doctor won’t do it. If they do not think you meet the qualifications for disability benefits, you can seek a second opinion. However, it would be best to exhaust all other options before switching medical providers.
Communicating with Your Doctor About Your Needs
Communicate openly with your doctor about your specific needs and the importance of the forms being completed. Express your concerns and the impact of not having the forms filled out on your ability to access necessary support. Outlining why the forms are essential to your well-being can help your doctor better understand the situation.
If your doctor hesitates to fill out a form supporting your claim, try giving them one of our Doctor’s Guides to Disability. These guides will help your doctor understand their role in the success of your claim:
Ask Your Doctor to Dictate a Narrative Medical Report
If your doctor is unwilling to complete the paperwork because they think it will be time-consuming, you can ask if they would be open to dictating their responses to you. This may help them see that the paperwork is not as time-consuming as they believe. Then, they would only need to sign at the end once they agree with the responses.
If you are having trouble getting your doctor to understand the importance of signing the paperwork, you may want to consult with a disability insurance attorney.
Request an “Update” Letter
Recently, a client informed us that her doctor had stated that she does not want to fill out any more paperwork for her disability claim because there have been no significant changes to report. We recommended that the doctor write an “update” letter, such as below.
Note: This is merely a suggested template and assumes no significant changes in your medical conditions. It may be modified as deemed necessary.
“I am writing to confirm my medical opinions, last documented in a letter questionnaire dated January 1, 2023. I understand the importance of maintaining accurate and up-to-date information. I assure you that my professional assessments and perspectives have remained unchanged since the above date.
As a dedicated healthcare professional, I recognize the significance of consistency in medical documentation, especially concerning ongoing evaluations or assessments. I can confirm that there have been no significant shifts or alterations in my opinions, diagnoses, or treatment plans related to the patient in question.
I am committed to upholding the highest standards of medical care and ensuring the well-being of the individuals under my supervision.
I appreciate your attention to this matter and the importance of maintaining accurate and reliable medical records.
Thank you for your understanding and cooperation.”
Consider Taking a Test That Helps Document Your Restrictions and Limitations
A long-term disability carrier or the SSA will also review your medical records. You may need to consider taking a test that will document your specific restrictions and limitations in your medical records if your doctor does not complete a form.
The most common test people use to document physical limitations is a Functional Capacity Evaluation (FCE). Physical therapists perform functional capacity evaluations. They take approximately four hours, but some may go for two days. They accurately document how much you can do physically, thus indicating whether you’re fit to work.
However, it would be best to be very careful when choosing a physical therapist to work with. Not all physical therapists are the same; some even work for long-term disability insurance carriers. Therefore, they might give you a biased report that will not help your case. Consider contacting a disability attorney to assist you in selecting the right physical therapist.
Seeking a Second Opinion or a New Doctor
If you cannot work, but your doctor disagrees, you owe it to yourself and your family to seek a second opinion from a new doctor. While perhaps you’d prefer to continue treatment with your doctor, you might want to think about how you will not get paid your disability benefits if your doctor doesn’t cooperate.
If your doctor agrees you cannot work but will not complete the paperwork for your disability claim, you might also consider finding a new doctor. Another doctor may be more willing to complete the necessary forms.
There comes a point when you must decide whether the doctor is so important to your life and health that you will prioritize continuing treatment with the doctor over securing your disability benefits. If getting your disability payment is higher on your priority list, finding a new doctor who understands your situation and is willing to provide the support you need may be the best action.
However, doing this too often can reflect poorly on your case, as it may seem like you are doctor shopping. If you switch doctors only once, it is more likely that the person handling your case will see it as simply a difference of opinion between doctors.
How To Choose the Right Doctor For Your Disability Forms
Understanding Specialties and Their Roles in Disability Claims
When seeking a doctor to assist with your disability forms, it’s essential to consider their medical specialty. For example, a primary care physician may have limited experience with disability evaluations. In contrast, a specialist such as a rheumatologist or orthopedic surgeon may be more familiar with the specific requirements of disability claims related to certain medical conditions. Choosing a doctor with expertise with your particular disability can significantly impact the success of your claim.
The Importance of Regular Care and Comprehensive Records
Regular medical care is crucial when applying for disability benefits. Selecting a doctor who can provide ongoing, comprehensive care for your condition is essential for establishing a thorough medical record. Additionally, having a diligent doctor who maintains accurate and detailed records can strengthen the credibility of your disability forms.
When selecting a doctor for your disability forms, it’s vital to prioritize their specialization and commitment to providing comprehensive care and record-keeping. This strategic approach can significantly enhance your chances of a successful disability claim.
Dealing with Delays and Denials
How to Handle Delays in Form Submission
When dealing with delays in submitting disability forms by a doctor, it’s crucial to maintain open communication. Reach out to your doctor’s office to ensure the forms were received and inquire about the anticipated timeline for completion. Polite persistence can help keep the process moving forward.
Additionally, offering to pick up the forms in person or provide a stamped envelope for return may expedite the process. It’s crucial to keep detailed records of all interactions and follow-ups in case they are needed to support your claim in the future.
What to Do If Your Claim Is Denied
If your disability claim is denied, it’s essential to understand the reason for the denial. Request a detailed explanation from the relevant authority. Once you have this information, you can take the necessary steps to address the issues and strengthen your case. Consider seeking legal advice from a qualified attorney specializing in disability claims to explore your options for appealing the decision.
Be sure to review the denial letter carefully and note any deadlines for appeals or additional information requests. Gathering thorough medical evidence and documenting the impact of your disability on daily activities can significantly bolster your appeal. Remember, persistence and attention to detail are key when navigating the challenges of delays and denials in the disability claims process.
Getting Help from a Disability Attorney
If you encounter challenges in getting your doctor to complete the necessary forms, seeking help from an attorney can be beneficial. This is especially crucial if your claim has already been denied. In such a situation, consulting with a trusted attorney is highly recommended.
A disability attorney can be instrumental when obtaining additional medical evidence supporting your claim. They can evaluate the strength of your claim and help you identify the type of testing that will best support your claim.
An attorney can also help you locate a place for additional testing, which may be necessary if your doctor refuses to fill out the forms for your disability claim. A disability attorney is more likely to know which medical providers provide unbiased assessments and can communicate with the doctor to advocate for completing necessary paperwork.
How Ortiz Law Firm Can Help
The team at the Ortiz Law Firm can support you in a variety of ways to ensure you receive the benefits you are entitled to. We assist individuals who need help with the following:
- Applying for Social Security Benefits and ensuring all steps are completed accurately.
- Appealing a denial of Social Security Disability Benefits.
- An Administrative Law Judge (ALJ) hearing for Social Security Disability Benefits and
- Appealing an existing denial of Long-Term Disability (LTD) Benefits
If you are facing any of these situations due to a disability, please don’t hesitate to reach out. Our national disability law firm can assist you. Contact the Ortiz Law Firm today for a free case review –call (888) 321-8131.
