Do I need a physician statement for my disability claim?

Disability claims involve a mountain of paperwork. With or without an attorney, there are numerous forms, worksheets, and reports to complete. One common form is a physician statement.

Physician statements can be very helpful for disability claims with the Social Security Administration (SSA) and with short-term disability (STD) and long-term disability (LTD) insurance claims. They are not required for SSA disability claims, but they usually are required for STD and LTD claims. A strong physician statement will not guarantee success on a claim, but it will improve your chances.

What is a physician statement?

Disability claims stand or fall based on medical records. Most medical records are made as a part of ordinary office or hospital visits. Because these records usually don’t say much about the patient’s ability to work, there is a particular form used to evaluate that ability. A claimant’s ability to work is sometimes referred to as “functional capacity.” Both SSA and disability insurance companies are interested in a claimant’s functional capacity.

SSA calls its form a Residual Functional Capacity (RFC) assessment. SSA makes two copies of this form available: one for physical impairments (https://secure.ssa.gov/apps10/poms/images/SSA4/G-SSA-4734-U8-1.pdf) and another for mental health impairments (https://secure.ssa.gov/apps10/poms/images/SSA3/G-SSA-392-SUP-1.gif.pdf).

Insurance companies also require physician statements for STD and LTD claims. Each insurance company has its own physician statement forms. They typically resemble the SSA forms, but they can be unique. (If you need a copy of an insurance company’s particular STD or LTD form, feel free to contact our office.)

A physician statement can also simply be a letter or other written opinion. Although SSA and insurance companies prefer their particular format, it is still helpful to have a statement — even if it is not in the perfect format.

What does the physician statement need to say?

More than anything, a physician statement should explain why a claimant’s functional capacity is limited. SSA and insurance companies do not take seriously physician statements that simply say “My patient is 100% totally and permanently disabled.” Both SSA and insurance companies believe that they get to decide the answer to that question – not the treating physician.

It is crucial that the physician statement provides an explanation of why the person is unable to work and unable to perform certain activities. For example, the best physician opinions explain exactly why their patients are prevented from certain types of activity (sitting, standing, walking, carrying, lifting, pushing, pulling, and handling).

In mental health cases, it is even more important for the psychiatrist’s opinion or psychologist’s opinion to carefully explain the reason for the patient’s loss of function. For example, in cases involving anxiety and depression, it may be difficult to interact frequently with customers or co-workers. In cases involving cognitive disabilities, the conditions may prevent complex problem solving. The best physician statements explain these limitations.

In Social Security disability claims and in STD and LTD claims alike, it is important to support opinions with so-called “objective” evidence. In cases involving physical disabilities, imaging (MRI, x-ray, CT testing) and labs are good examples of objective evidence to support a doctor’s opinion. Exam findings about strength, range of motion, and reflexes are also helpful. In cases involving mental health, a mental status examination and psychological testing are the most helpful.

SSA and insurance companies give very little to a claimant’s complaints unless they are supported by objective evidence. Making your complaints known is important, but it is vital that the records also contain objective evidence.

What if I can’t get a physician statement?

In the Kansas City area, there are many facilities that have policies against completing disability paperwork. This includes physician statements and doctor letters. Physicians are busy, and it can be difficult to find a way to bill for the time involved in the process. For that reason, you need to know your physician and how their practice works. If they are willing to complete a Family Medical Leave Act (FMLA) form, that can sometimes be the next best option.

In most physicians’ practices, you are much more likely to have success getting an SSA or STD/LTD form completed if you take it in during a personal visit and exam with the physician. This will also make the doctor’s opinion more credible from the viewpoint of SSA or the disability insurance company.

But sometimes there is no way around a facility’s policy against completing disability paperwork. In those cases, it may be worth getting an independent opinion. There are a number of physicians in the Kansas City area who will complete disability paperwork and physician statements.

Physician statements are an important part of the disability process – whether with SSA disability claims or STD and LTD claims. If you have questions about physician statements or any part of the disability claims process, we invite you to contact our office. We are centrally located in North Kansas City and serve Missouri and Kansas residents alike. We welcome your phone call or text to 816.844.3401.