1. Physician’s Guide to Documenting Disability in Social Security and Welfare Cases Presenter: Kevin Liebkemann, Esq. Chief Section Counsel Legal Services of New Jersey 100 Metroplex Drive., Suite 402 Edison, NJ 08818 kliebkemann@lsnj.org

2. What is LSNJ and how can it help your patients? LSNJ is a not-for-profit corporation committed to working for equal justice by providing free legal help to very low-income people in civil matters SSI Project: Free legal representation to some very low-income people with disabilities in their Social Security Disability claims Free legal help to low-income people with many other types of civil legal matters

3. Why is it important for physicians to document a patient’s disability? It’s very important to your patients. Low-income patients and their families can lose health insurance and access to adequate food and shelter without your assistance. Your patient needs your input to determine what (if any) employment is feasible. Proper and timely documentation can prevent the need for further documentation during appeals.

4. What are the main Social Security Disability Programs? Supplemental Security Income (SSI) provides a modest monthly cash benefit and Medicaid HMO coverage to some very low-income adults and children with disabilities in New Jersey. Social Security Disability Insurance (SSDI) provides a monthly cash benefit and (after a waiting period) Medicare insurance coverage to people with disabilities who have a sufficient earning record.

5. What is the disability standard for Social Security? The main disability standard is whether a person can do “substantial gainful activity.” That usually means sustaining a full-time work schedule for adults. Some part-time workers can still be eligible for benefits. Disability must be expected to last 12 months or result in death. “Listing of impairments”

6. How do physicians document disability for patients in Social Security cases? Treatment notes and records Document functional limitations in medical records Complete a report form Provide a narrative report

7. Tips for report forms List claimed limitations that are reasonable and consistent with the patient’s medical condition. Be specific as possible on frequency, duration, and severity of limitations. Where possible, provide a medical basis understandable to a lay person. These forms typically gauge function in terms of ability to sustain the activity over a full-time work schedule, 8 hrs. per day, 5 days per week.

8. Elements of good narrative reports, Part 1 Length of treatment & frequency of examination Specialty and experience Diagnosis and prognosis Specific signs and symptoms Opinion on whether relevant “listing” requirements are satisfied http://www.ssa.gov/disability/professionals/ bluebook/AdultListings.htm http://www.ssa.gov/disability/professionals/ bluebook/AdultListings.htm

9. Elements of good narrative reports, Part 2 List of claimed physical and mental limitations that are consistent with medical condition Medical basis for opinion Expected duration For more information and samples, see http://www.nosscr.org/ssas/Documenting Disability.pdf http://www.nosscr.org/ssas/Documenting Disability.pdf

10. What if there is not enough information to report disability? Document the limitations that are established. Indicate if further information is needed before an opinion can be rendered. Indicate if other physicians should be consulted, especially if there are multiple treating sources. In New Jersey, consider referral to DVRS if able to work: http://lwd.dol.state.nj.us/labor/dvrs/DVRInde x.html http://lwd.dol.state.nj.us/labor/dvrs/DVRInde x.html

11. What is Work-First New Jersey? Work-First NJ is New Jersey’s welfare program. Provides medical insurance, a very small cash benefit, & some other last resort “safety net” benefits like food and emergency housing, to very low-income New Jersey residents and families. General Assistance (GA) is for adults without children. Temporary Assistance for Needy Families (TANF) for families with children.

12. Why is disability status important in these welfare programs? GA and TANF programs require adult recipients to work or seek appropriate work unless they are “medically deferred.” Treating physicians are asked to fill out the MED-1 form to document whether their patient should be medically deferred from working while receiving GA or TANF benefits.

13. Why is it important for physicians to complete the MED-1 form? If an impoverished patient cannot in fact work, and cannot get a MED-1 completed by her physician, she will likely lose the GA or TANF benefits essential to maintaining health coverage, food, and shelter. GA and TANF caseworkers often demand that patients get the MED-1 completed and returned on short notice, and cut off essential benefits if they are late.

14. Tips on filling out the MED-1, Part 1 Some counties have slightly different versions. List primary diagnosis and other diagnoses. For mental conditions, list all areas of functional mental limitation. The form asks about ability to perform full- time work or part-time or work training activities. Be thorough in listing limitations even if you believe patient can do some work.

15. Tips on filling out the MED-1, Part 2 If substance abuse is the only diagnosis, the patient is not considered incapacitated. Estimating duration of disability, keep in mind a new form will be due at the expiration of the period.