In contrast to the public programs like the Social Security Administration,
private disability insurance tends to be fairly straightforward. There is an
insurance contract that spells out the benefits and qualifications. There may
also be a benefits coordinator for the patient’s employer who can be very
This doesn’t necessarily mean that getting benefits is easy. There will be
specific forms to be completed by the attending physician for each insurance
company. They may also require copies of medical records. The company may
want an independent medical exam or functional capacity evaluation done.
The attending physician and other medical care providers should cooperate
fully with the process.
Clearly it is in a patient’s best interest to receive disability benefits if the
patient qualifies for them and is disabled. Part of a physician’s duty to a patient
is making and keeping adequate medical records. The physician should not
hinder the process because he or she does not like dealing with insurance
systems. On the other hand, the physician should be cautious about being too
sympathetic with the patient. Like any other medical opinion, disability
statements should be based on a specific diagnosis and objective medical
evidence. They should not be a recitation of the patient’s complaints or
allegations. If the patient drives himself to the doctor’s office, walks in
unassisted, and waits for thirty minutes, then he clearly is able to walk fifty
feet and sit for thirty minutes. Statements that defy common sense are not
likely to carry weight with the insurance company.