ability as opposed to the SSA definition. Frequently, reference is made to the character of the patient: that he is a good person or she is an excellent mother. Mental health professionals may discuss the patient’s fragility or provide background information that is irrelevant to the matter at hand. Disability determination is not based on deservedness; it is based on qualification. For SSD, the following questions are considered: has a person worked sufficiently to qualify for benefits? Does that person’s impairment meet the standard of SSA? Can the claimant perform past relevant work? Can the claimant perform any work in the national economy? For SSI, does the claimant meet the financial limitations as well as the disabling conditions? Clearly, the provision of additional documentation in support of patients’ disability claims represents one more burden on the helping professional. Health care professionals are already being required to do more for less compensation than ever before. However, the cost to the health care provider is less than the cost to the disabled claimant. It is therefore incumbent on the helping professional to establish practice policies that facilitate compliance with Social Security Disability requirements and serving patient needs while minimizing the hardship to the professional and his practice. One way of accomplishing this task would be providing copies of progress notes to patients at the time of service, advising the client to create a file in the event that they must see another health care provider or demonstrate disability. The client should be advised to create a checklist documenting their diagnoses; diagnostic criteria; diagnostic procedures utilized (with dates); pain level; range of motion restrictions; limitations for standing, walking, lifting and carrying; prescribed medications; and, if a psychiatric case, Global Assessment of Functioning scale (GAF). The incorporation of such a list would be beneficial to both the professional’s documentary process and the patient’s claim. Another consideration would be to spend a few extra moments with patients to determine their potential for needing Social Security Disability benefits and preparing for the process. This can be accomplished by creating a narrative report addressing the onset of symptoms and equating them with the appropriate Medical Listing. The narrative should include an assessment of residual functional capacity: how many hours out of a competitive 8-hour day can the claimant sit, stand/walk; how much can he/she lift/carry; will he/she require unscheduled breaks and 30 THE FORENSIC EXAMINER® Summer 2009
for what duration; how often will he/she likely be absent as a consequence of impairments or their treatment, etc. Responding to the demands of the Social Security Administration, managed care, and other mandated agencies is not addressed as part of the professional’s education, but it is as relevant and necessary as meeting any other professional standard of practice. It is in the best interests of helping professions, society, and the disabled for healthcare professionals to become educated in the policy and language of Social Security Disability. If we accept that helping professionals have a primary duty to “first do no harm,” then we must consider the effect of non-compliance with respect to requests for documentation in support of legitimate applications for Social Security benefits or for charging unreasonably high fees for such cooperation. Certainly, to reduce the claimant’s opportunity for a favorable decision and to thus contribute to the claimant’s distress, impoverishment, and denial of adequate medical relief, is to do harm in the most fundamental way. Fully educated and informed helping professionals will hopefully result in greater compliance with the claimant’s requests. Health care providers have a duty to not only support their clients and patients by providing the highest standards of care, but to provide advocacy and social support as well. Disabled people who legitimately receive appropriate benefits will likely be a lesser burden to society and will have the ability to live out their lives in dignity.
References Code of Federal Regulations. (2007). Title 20, Vol. 1, US Government Printing Office. Eckholm, E. (2007). Social Security disability cases are taking longer: Most win social security benefits —if they persist. The New York Times, December 10, 2007. FY 2006 DIODS. (2006). Social Securiaty disability denial rates. Retrieved from http://www.ultimatedisabilityguide.com/ssdi_ssi_denial_rates.html Kelly, F. (2007). A long, painful wait: Too sick to work, many face delays for help from disability judges. Some die waiting. Retrieved October 5, 2007, from http://www.charlotte.com/local/story/251546.html Social Security Administration. (2004). Annual statistical report on the social security disability insurance program, 2003. Retrieved December 30, 2007, from http://www. ssa.gov/policy/docs/statcomps/di_asr/2003/index.htm Social Security Administration. (2007a). Listing of impairments. Retrieved December 30, 2007, from http://www.ssa.gov/disability/professionals/bluebook/ AdultListings.htm Social Security Administration. (2007b). Representing claimants. Retrieved December 30, 2007, from http://www.ssa.gov/representation/index.htm Social Security Administration. (2007c). Substantial gainful activity. Retrieved December 30, 2007, from http://www.ssa.gov/OACT/COLA/sga.html Social Security Administration. (2008). What’s new in 2008? Retrieved December 30, 2007, from http:// www.socialsecurity.gov/redbook/eng/whatsnew.htm United States Department of Health and Human Services. (2007). Federal poverty guidelines. Retrieved December 30, 2007, from http://www.workworld.org/ wwwebhelp/poverty_federal.htm United States Department of Labor. (1992). Dictionary of occupational titles. Author. Legislative Counsel of California. (2008). Health and safety code section 123100-123149.5. Official California Legistaltive Information. Retrieved from http://www.leginfo.ca.gov/cgibin/displaycode?section=hsc&group=123001124000&file=123100-123149.5 n Earn CE Credit To earn CE credit, complete the exam for this article on page 31 or complete the exam online at www.acfei.com (select “Online CE”).
ABOUT THE AUTHORS
Randy Noblitt, PhD is currently Professor and Core Faculty Member in the Clinical PsyD Program at the California School of Professional Psychology at Alliant International University in Los Angeles. He was an Air Force Institute of Technology Scholar and was awarded a PhD in Clinical Psychology by the University of North Texas in 1978. He has 28 years of practice as a clinical psychologist in the USAF and in private practice. Dr. Noblitt is the principle author of Cult and Ritual Abuse: Its History, Anthropology, and Recent Discovery in Contemporary America (Rev. ed., 2000). He is also the co-author and editor of Ritual Abuse in the Twenty-first Century: Psychological, Forensic, Social, and Political Considerations (2008). He has been a consultant and expert witness in both criminal and civil cases involving the victimization of children and allegations of cult and ritual abuse. Pamela Perskin Noblitt spent 23 years as practice administrator for the Center for Counseling and Psychological Services in Dallas, Texas. She is co-author of Cult and Ritual Abuse: Its History, Anthropology, and Recent Discovery in Contemporary America (Rev. ed., 2000) and co-author and editor of Ritual Abuse in the Twenty-first Century: Psychological, Forensic, Social, and Political Considerations (2008). She was recognized as one of Eckerd’s 100 Women of 2000 for her victim advocacy efforts. She is currently working for a national Social Security Disability Advocacy firm, Binder & Binder, where she is a nonattorney representative. Dr. and Ms. Noblitt are also collaborators in their personal lives and have been married for 38 years. They have 2 children and 5 grandchildren. www.acfei.com