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Social Security DisabilityDec7-Texture Format[1]
Transcript of Social Security DisabilityDec7-Texture Format[1]
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Social Security Disability
Evaluations
C Donald Williams MD
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Course Plan
Define SSD Exams and how they differfrom other evaluations
Review criteria used by SSA to determinequalification for benefits
Outline how to conduct the exam
Review a sample exam
Sign up instructions
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Social Security Disability
SSA evaluates applications for SSDI
SSA contracts with state agencies named DisabilityDetermination Servicesthat contract for and scheduleexams
Determinations are based on impairments
SSDI (Insurance) based on quarters paid into FICA--amount of award proportional
SSI is needs based--like welfare
Criteria include severity and duration
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S.S. Disability definition
The inability to engage in substantialgainful activity by reason of a medically
determinable impairment which can beexpected to result in death or which haslasted or can be expected to last for 12
continuous months. Impairments must be severe
12 months anticipated duration or longer
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Differences from other IMEs
Social SecurityImpairment only
Workers compensationImpairment and
causal relationship to work injury Fitness for dutyImpairment performing
the essential tasks of a specific occupation
Personal injuryDetermine the nature anddegree of impairment with specific tortcause
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Entry to organizational and
occupational psychiatryAll psychiatrists have
Minimum necessary skills to start
The opportunity to work in this area
SSD exams provide psychiatrists
Income
On the ground exposure to the relationshipbetween work, organizations and institutions,and psychiatric health and illness
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Other benefits
Concentrated practice in efficientassessments of wide variety of patients
Refine conceptualization and writing style Efficient way to fill gaps in schedule
Entre to performing other types of
disability exams because of communityexposure
Service to public sector with few problems
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How to become an examiner
Telephone contact information for all states www.ssa.gov/disability/professionals/procontacts.htm
Or type disability determination services in Googlesearch engine
States have continuing need for new examiners
Review the SSA-DDS suggested outline for
examiners
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The psychiatric evaluation
Review the medical records
Evaluate applicant face-to-face
Follow the outlinechild and adults
Provide specific observations
Present a data driven MSE
Use DSM-IV multi-axial diagnoses
Show respect to the examinee
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Sample assignment letter
The claimant alleges depression, anxietyand substance abuse. Provide a full
mental status exam detailing objectivedata, hour by hour activities of a typicalday, range of interests, degree of ability torelate to others, to care for personal
needs and capability to manage ownfunds. With treatment, what degree ofimprovement can be anticipated and thetime required?
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The form of the evaluation
Use standard format
Adult outline
Child outline
Employ economy of language
Answer the questions
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The conduct of the evaluation
Applicant signs disclosure forms
Advise of limitations on confidentiality
Advise that you are not their doctor
Do not criticize their medical providers
Record primary data, including directquotes
Avoid unsupported generalities
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The place for templates
Create your own templateof categories, notresponses--using the SSA format
Saves time--promotes efficiency You (or your transcriptionist) fill in the blanks
with original content
Consider using voice recognition software Requires a fast computer with 512 MB memory and a
USB DSP microphone (Plantronics)
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An evaluation template
Review sample report template in yourpacket....turn to packet
Statement of Non-Confidentiality:The claimant was advised that this interview was forevaluation purposes only and that a copy of theevaluation report would be provided to the SocialSecurity Administration. The claimant was further
advised that no doctor-patient relationship wasestablished and claimant agreed to continue with thisevaluation with that understanding.
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Professional conduct
Treat examinee the way you would like your relatives tobe treated by a professionalgolden rule
Provide an evaluation, not value judgments
This is harder than it seems on occasion--examples Countertransference awareness is helpfule.g. fear of being like
the claimant can lead to devaluation or rescue-with loss ofobjectivity
Be SAFE! If situation does not appear safe, in any respect, cancel the
evaluation Some evaluations should only be conducted in a secure facility
or in a public clinic setting
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When the unexpected happenstransparently document the incident
You dont realize until the exam has begun thatyou have known the claimant in anothercontexte.g. waitress at a restaurant--giveclaimant the choice not to proceed
The claimant is demanding and wont leave theofficedocument what was said and done
The claimant becomes threatening andcomplaininguse your skills and call security
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Summary
SSD Exams are good IME practice, andyou can start next week
Good entre to Organizational andOccupational Psychiatry
Obtain a feel for the interface between
work and psychiatrybuild a mentallibrary of professional experience
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Where to get more information
www.aoop.org andwww.cdonaldwilliamsmd.com have many
links as well as prior courses on line Link to Social Security Bluebook
www.ssa.gov/disability/professionals/bluebook/
Contact your local professional relationsunit for Disability Determination Services
http://www.aoop.org/http://www.cdonaldwilliamsmd.com/http://www.cdonaldwilliamsmd.com/http://www.aoop.org/ -
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Your response and questions
Questions
Comments
Criticisms