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Short-term disability

These are a real pain. Unlike FMLA, they actually want concrete medical information. Only fill this out if you are qualified to do so.

The framing that helps: short-term disability is a private insurance contract or an employer benefit, not a legal entitlement. There is no state disability program in North Carolina, which surprises patients who moved here from California or New Jersey. The policy’s own definition of “disability” governs, the insurer decides, and your job is to describe accurately — not to advocate, and not to guarantee an outcome.

  • If someone just had surgery, the operating surgeon owns the form. We have specialists in town who never fill out paperwork like this. Don’t make that your problem. The surgeon is obliged to send records to the insurer when requested, and if needed the insurer will have an independent surgeon review them.

  • Hospital discharge paperwork — six weeks in the ICU with sepsis, then three weeks at a SNF — will land on you anyway. Ten or more physicians were involved, most of whom haven’t seen the patient in weeks. If you’d only be copying facts out of the discharge summary, attach the discharge summary and write “see attached.” There’s no reason for you to be an intermediary. The insurer can bug the hospital for more.

  • Don’t guess at residual functional capacity. These forms often include a long section asking how long your patient can sit, how far they can bend an index finger, how fast and how far they can walk, for what duration and frequency. I never fill that section out. The insurer is trying to save the cost of proper testing. I attach a page that reads:

  • Dear Mega-Corporation: on your form, you request detailed information regarding residual functional capacity. Proper assessment, known as a Functional Capacity Evaluation, would take a physical therapist with the training, space, and equipment about three hours to complete — none of which I have. Any answers on my part would be guesswork. Below is a list of medical practices in my area that do provide functional capacity evaluations, should you wish to send the patient there.
  • Long-term disability is the same animal with sharper teeth. Watch for two things. First, the definition of disability in most LTD policies shifts at 24 months from “can’t do your own occupation” to “can’t do any occupation” — patients are blindsided when benefits stop at two years. Second, LTD carriers send peer-review letters that summarize your records and ask you to sign agreement at the bottom. Read every word before signing; the summary is frequently not what you said. It is always acceptable to write “I disagree with this characterization” and return it. Carriers may also arrange an independent medical examination or surveillance; neither is your problem.