Forms, lies, and advocacy

Issue: BCMJ, vol. 56, No. 5, June 2014, Page 213 Editorials

This time of year many patients bring me the disability tax credit form to fill out. Advised by their helpful accountant, they are sure they qualify for preferential treatment due to their chronic hangnail or halitosis. Many of my patients haven’t even read the form; to summarize, for an individual to qualify for this tax credit they must have a prolonged, severe disability that markedly restricts one or more activities of daily living. Physicians are asked to answer basic questions such as, Can your patient hear? Can they speak? Can they see? Basically, if you can understand that your accountant wants you to take this form to your physician and you can manage that task on your own, you don’t qualify. Refusing this request often puts me in a position of conflict with my patients.

I often have the same experience when patients request a disability parking permit. To qualify, an individual should be unable to walk 100 metres without risk to health or be unable to move, period. I have patients with sore backs and ankles who ask me for a permit. I have patients who are obese and find it difficult to be mobile due to their girth who want a permit (these are the individuals who should actually park farther away and walk more). I even had one active senior who wanted a permit just because she is old. When I told her she didn’t qualify and I wouldn’t fill out the request, she told me I was mean and scolded me, “Just wait until you are old one day.” Again, my refusal puts me in an awkward position of conflict with my patients.

The form currently causing me the most aggravation is the one designating persons with disabilities. If patients qualify for this designation they receive a monthly stipend, which admittedly isn’t a large amount. Many of my unfortunate patients rightfully qualify for this money, and my problem isn’t with them. The application form is long and has both a physician report and an assessor report component, the latter of which can be filled out by the physician or another allied health professional. Physicians are paid reasonably well to fill out this form. I have gone through these forms with patients, filled them out honestly, and the patients have been denied this designation. A new trend has my patients going to an advocacy group that fills out a suggested version of the report for me to transcribe onto a blank form. The problem is that these suggestions are outright lies. I have had a patient get dressed, prepare and have breakfast, climb the stairs out of their basement suite, walk five blocks to the bus, come to my office, and give me a form that says they need continuous help with dressing, grooming, and meal preparation. It also outlines how they can’t take public transportation, can’t walk a block, and are only  able to climb two to five stairs. I even had one guy who completed the Sun Run claiming he couldn’t walk a block. These forms are dishonest and, frankly, fraudulent. I understand that these advocacy groups are trying to help their clients, but lying to have people collect unjustified income supplements is just plain wrong. 

When I then complete these forms honestly my patients are often rightfully denied this designation, which again makes me the bad guy. I have even had these advocacy groups advise my patients to take the forms to an advocacy doctor who transcribes the lies, collects the fees, and ensures they qualify as disabled. 

I will continue to be an advocate for my patients, but I won’t commit fraud. I wonder why these advocate groups and some physicians are willing to do so.    

David R. Richardson, MD. Forms, lies, and advocacy. BCMJ, Vol. 56, No. 5, June, 2014, Page(s) 213 - Editorials.

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Jane Dyson and ... says: reply

Dear Editor: Re: Forms, lies, and advocacy (Editorial Vol. 56, No. 5, June 2014)

We are writing in response to your editorial in which you claim some advocacy groups help their clients complete disability forms that are “dishonest and, frankly, fraudulent” and are trying to help their clients by “lying to have people collect unjustified income supplements.”

While we share your view that it would be wrong for any organization to help people fraudulently obtain benefits, we are writing to provide you with a different perspective. The BC Coalition of People with Disabilities (BCCPD) has been assisting individuals with applications and appeals related to disability benefits for more than 25 years. We do not solicit clients. People come to us for a variety of reasons. They may have hearing or visual limitations, mental illness, or cognitive impairments. Some simply do not have the use of their hands. Many physicians refer their patients to us because they know their patients do not have the skills needed to obtain the benefits that they are legitimately entitled to.

Some clients we serve may not have obvious disabilities. Conditions involving chronic pain, chronic fatigue, or post-traumatic stress disorder come to mind. Others who come to us are experiencing complications from surgery. Some have limited English language skills or may be illiterate.
Our doors are open to everyone who may need help.

Our advocates work hard to screen clients to determine if they may eligible for the benefit they are seeking. Obviously some individuals lack insight about their limitations for various reasons, including mental health or cognitive issues. We expect doctors also encounter patients who are less than clear about their functional limitations. If someone tells an advocate they can’t walk a block or climb two stairs and it later becomes clear that they can, it is hard to understand why anyone would then call the advocate a liar.

There are good reasons why most disability benefit programs require an opinion from a physician. Doctors are in the best position to provide objective medical evidence to verify an application for disability supports. Advocates help people describe their subjective circumstances but are not qualified to give medical opinions. However, many doctors have told us that they appreciate it when their patient comes to see them with a draft of a disability form that we have helped their patient complete based on the information they provide us with. If we use this strategy, we always explain clearly to the doctor that this is a guideline only and that we are not asking the physician to copy it for their evaluation of the patient. Doctors often tell us that they are swamped with paperwork and that our work with their patients saves them time.

Non-profit organizations face intense scrutiny from their funders. Many of their advocates, including ours, are also supervised by legal counsel. With dwindling public resources, most non-profits that work with people with disabilities are overwhelmed by the demands on their services. Your editorial gives the impression that you believe organizations such as ours are unaccountable and have nothing better to do than to help people drain the public treasury with fraudulent claims. Nothing could be further from the truth.

Jane Dyson, Executive Director, BCCPD; Peter Beaudin, Senior Advocate, BCCPD

Sachit Shah says: reply

The number of disability requests that have been promoted by the advocacy groups is high.
I filled a form to the best of my ability and the patient got rejected.
Then the patient came back with the form from an advocacy group with "tall tales," which they expected me to just agree with.
I refused to fill it out and the patient was very upset. I hear another physician filled in the form for the patient.
I agree these are lies on the forms and there is nothing being done about it.

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