Saturday, November 3, 2012

The Ithaca Doctor/Lawyer: Avoiding the Two Biggest Mistakes in Making a Disability Claim


I have represented, treated, and testified for thousands of disabled people over the span of 26 years. First as a Chiropractic Physician in Florida, and then as an attorney in NJ, FL, NY, and PA. I have rated them for impairment and disability, have evaluated and diagnosed them physically, and helped them obtain money to compensate them for their losses. Claims for disability can be made in many different areas, circumstances, and times. It is more common to become disabled than most people may wish to believe or think about.

Understanding TWO main ideas about disability claims will go a long way to ensure that yours is good.

First, Dis-ability means just that, UN-able to WORK at a JOB.

Disability is NOT impairment, disability is NOT your injury, disability is NOT your condition or your disease.
It is always job related or job specific. How specific a job is the first question for all claims?

Under an auto policy it just means the job you are doing prior to your car accident. So if you were employed at Burger King prior to your injury then not being able to flip burgers means you are disabled.

Under Social Security Claims the government has set a line in the sand at 50 years of age to make a job determination. If you are 50 or older (I am) then the last 6 years of your work life are your baseline "job." In other words, if you can't perform that type of work (the one from the past 6 years) you are 100% disabled. If you are less than 50 years of age (at least to the government) then "any" work you can physically and mentally do is the baseline. So being 100% disabled and being under 50 is a big deal to social security.

Under a private disability claim policy from a company you work for or self pay you must read the policy. It may specifically state what is and what is not disabled based upon time and job. Some policies are called "own" occupation, which means the occupation you are trained, experienced, and educated for. Other policies have looser definitions of work and employment. They might state "any" job, so your being trained as an engineer BUT being able to tear tickets at the local movie theater means that you are NOT disabled.

Second, Disability is NOT determined by YOU.

This is by far the biggest MISTAKE I see most people make. You cannot wake up and decide I can't work and then make a claim. Your doctors, and your healthcare providers (Physician Assistants, Nurses, etc.) MUST make that DETERMINATION.

Disability is always a DETERMINATION for a professional to make after an ASSESSMENT. Ongoing disability requires ongoing (continuing) evaluation and assessment. Ongoing claims need to be substantiated (shown, proven, validated) with SUBSTANCE (objective findings, testing, treatment, care).

That is why it is vitally important that you tell them all of your symptoms, problems, and limitations. A record must be made and kept to make any claim for compensation. They put you on or off disability. They continually monitor and evaluate you as time goes by. Making a record and establishing connections between your injuries (diseases, conditions, etc.) and your INABILITY to Function and to WORK is everything. Complete, detailed, and validated documentation of a disability claim will help everyone in the process. Giving claims examiners all the reasons for the disability and then the documentation makes your's stand up to any scrutiny or potential contest (challenge as to authenticity). In other words, is your claim REAL? Real claims have real documentation, causal connections, and continuity.

These two things are true regardless of:

Whether the claim was for personal injury disability against an insurance company for a car or truck accident.
Whether the claim was for a worker's compensation claim.
Whether the claim was for social security disability against the government administration.

Understanding these two truths about claims will help you make your claim for compensation stronger.

Dr. Lawrence Newman

Doctor of Chiropractic
Attorney and Counselor at Law

504 North Aurora Street
Ithaca, NY 14850