Pt looking for long term disability

[liquidshadow22]

I have a pt I saw a few times through a telemed company. Very quick med mgmt visits. I filled out STD paperowkr and now pt is looking for LTD.

I don't know the pt that well nor was I concerned about their risk level and to be frank I'm not sure if it's merited. Uncomplicated mood DO/trauma related.

My initial impulse is to decline the request. My guess is that patient will be very pissed off as the STD request came at visit #2. Just curious as to the approach people take for LTD requests for their own outpatients. I preferably wouldn't fill one out unless I have seen the patient for a year unless they have SMI. Thoughts?

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[calvnandhobbs68]

Even for FMLA and short term disability, I tell people I’m not filling it out for a mental health reason unless they’re planning on going to a higher level of care (usually at least IOP if not PHP). If you’re so disabled you can’t work, you should be participating in more intense treatment to address why you can’t work. You shouldn’t be taking 12 weeks off for FMLA unless you’re gonna spend 4-8 weeks of that in IOP and I will certainly help the IOP justify to the insurance company why you qualify for IOP at that point.

Yes, long term disability is basically a no go for me unless you have severe poorly treatable psychosis/bipolar illness or it’s clear you actually have severe MDD (at least through ketamine/TMS, really should have done ECT at that point). Otherwise the goal is to get people as functional as possible and long term disability basically kills that..at that point I’m saying your illness is basically chronically intractable which means i should have exhausted options for treatment.

 

[PsyDr]

AMA and APLS guidelines specifically state that treating psychiatrists should avoid opining about legal and disability matters.

 

[TexasPhysician]

Would not complete with few exceptions that were so clear that a layperson could recognize obvious disability.

 

[Bartelby]

I agree with the above, long term disability determinations should be deferred to an appropriate forensic examiner (though I agree with TexasPhysician that I would fill out the paperwork in very obvious situations such as chronic severe schizophrenia).

 

[deleted1100659]

FMLA paperwork isnt a big deal to me since they arent getting paid or anything during it so im fairly lenient on it.

i dont fill out any disability paperwork. If someone was blatantly schizophrenic and it was very clear that the majority of people would not want them working with food or sharp objects, then perhaps would be more inclined to fill it out.

Disability for trauma history is highly questionable, how does one even decide who with PTSD can work vs being unable to work? Avoidance just reinforces the symptoms after all.

Typically I think not working only worsens things like anxiety/depression in most cases.

 

[comp1]

Boundaries set on this will really pay dividends for the rest of your professional career. Anyone well enough to self present and ask for disability paperwork related to mental illness, should typically be provided disability long enough to engage with a higher level of care, ie PHP/IOP with the expectation that program will continue disability for any further duration. The only time I ever completed long term disability paperwork was when a family presented with their child with schizophrenia. His prognosis was such that long term recovery to the point of gainful employment was very unlikely. This is not the case with most mood, anxiety or personality disorders. Quite the opposite, most of those are going to be severely harmed by long term disability. You can definitely pawn patients off to specialists in disability evaluations if you want, but you do have an ethical responsibility to at least offer recovery oriented options to the patient and explain the risks of seeking long term disability in recovery from their illness.

 

[robellis]

Just refer them to forensic psych or whoever does disability evals in your area that’s what they do here

 

[dl2dp2]

AMA and APLS guidelines specifically state that treating psychiatrists should avoid opining about legal and disability matters.

I don't see this. Could you provide a link? It would be helpful to know, if true.

 

[PsyDr]

I don't see this. Could you provide a link? It would be helpful to know, if true.

Not a huge fan of the "if true" comment or doing other people's work for them.

It is on page 351 of the primary text. And on the American academy of psychiatry and the law's website.

 

[robellis]

Not a huge fan of the "if true" comment or doing other people's work for them.

It is on page 351 of the primary text. And on the American academy of psychiatry and the law's website.

I trust this guy I think he’s a forensic psychologist or something

 

[dl2dp2]

Not a huge fan of the "if true" comment or doing other people's work for them.

It is on page 351 of the primary text. And on the American academy of psychiatry and the law's website.

Aha--good for you for calling me out as lazy. Here's the ACTUAL AAPL guideline

"1. Role Conflict
Although AAPL’s ethics guidelines advise, “A treating psychiatrist should generally avoid agreeing to be an expert witness or to perform an evaluation of his patient for legal purposes,” there are some settings in which this suggestion may not be observed. The SSA’s request that the treating clinician provide an extensive disability evaluation is one of several exceptions. Another is an employer’s requirement that the employee’s treating clinician provide information regarding fitness for duty or for purposes of meeting ADA or FMLA requirements."

Psychiatry Online
https://www.aapl.org/docs/pdf/C2C_Supplement-46-1_2018_Clean.pdf

Unfortunately, both scenarios are extremely common scenarios now for filing for long-term disability, as insurances now use SSA filing status to adjudicate their eligibility for their own benefits.

I trust this guy I think he’s a forensic psychologist or something

See above.

 

[PsyDr]

Aha--good for you for calling me out as lazy.

Now the other reference.

 

[Mass Effect]

Aha--good for you for calling me out as lazy. Here's the ACTUAL AAPL guideline

"1. Role Conflict
Although AAPL’s ethics guidelines advise, “A treating psychiatrist should generally avoid agreeing to be an expert witness or to perform an evaluation of his patient for legal purposes,” there are some settings in which this suggestion may not be observed. The SSA’s request that the treating clinician provide an extensive disability evaluation is one of several exceptions. Another is an employer’s requirement that the employee’s treating clinician provide information regarding fitness for duty or for purposes of meeting ADA or FMLA requirements."

Psychiatry Online
https://www.aapl.org/docs/pdf/C2C_Supplement-46-1_2018_Clean.pdf

Unfortunately, both scenarios are extremely common scenarios now for filing for long-term disability, as insurances now use SSA filing status to adjudicate their eligibility for their own benefits.


See above.

So here's my issue with these "fitness for duty" evals. I think psych is often abused in terms of requests for these and employers don't seem to understand that I am not a forensic psychiatrist nor do I have psychic ability to discern whether or not your employee is "fit for duty" as a flight attendant or a police officer. I can tell you the person is depressed and that depression has not remitted despite meds, but has improved. The patient is low risk for suicide or intentional homicide. That's all I can say, yet when I do say that, the form is always kicked back asking for my professional opinion on whether or not they can do the job. That's an absolute NO ANSWER for me. It's unreasonable for them to ask and it puts me in a tough position. I no longer fill out these forms at all. As others noted, maybe for SMI. The rest of these evals should be done by someone other than the treating psychiatrist. Every time, regardless of what the employer wants.