Functional Assessment for Adults with Disabilities (2019) / Chapter Skim
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8 Review of Selected Disability Benefit Programs
8 Review of Selected Disability Benefit Programs
Pages 335-368
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; and two private disability insurance providers, Prudential Financial and Sun Life Financial. This chapter also provides information on additional benefit programs, including the Washington State Department of Labor and Industries (L&I)
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OVERVIEW OF SELECTED BENEFIT PROGRAMS Selected Federal Disability Benefit Programs Veterans Benefits Administration The VBA, one of three administrations forming the VA, provides benefits and services to service members, veterans, and their families. The VBA's mission "is to serve as a leading advocate for Servicemembers, Veterans, their families and Survivors, delivering with excellence Veteran-centered and personalized benefits and services that honor their service, assist in their readjustment, enhance their lives, and engender their full trust" (VA, 2017b, p.
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. In 2018, monthly CPP disability benefits start at $485.20 and, depending on the individual's previous CPP contributions, increase to a maximum of $1,335.83, with a monthly average of $971.23 (Government of Canada, 2018d)
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. Sun Life Financial Sun Life Financial is a financial services company that helps "clients achieve lifetime financial security and live healthier lives" (Sun Life Assurance Company of Canada, 2018)
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DISABILITY DETERMINATION (ADJUDICATION) PROCESSES Selected Federal Disability Benefit Programs Veterans Benefits Administration The Compensation program "provides tax-free monthly benefits to Veterans in recognition of the effect of disabilities caused by diseases, events, or injuries incurred or aggravated during active military service" (VA, 2017a)
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During this step, the VA may ask the claimant to complete a compensation and pension exam, which helps determine whether the disability is service connected, the level of disability, and whether the current condition should receive a higher rating because it is worsening. Disability Benefits Questionnaires (DBQs)
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Canada Pension Plan The CPP disability benefit is "a taxable monthly payment that is available to people who have contributed to the CPP and who are not able to work regularly because of a disability" (Government of Canada, 2018e)
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. In the first of these components, the claimant's medical condition is defined as the prime indicator in determining whether a disability is "severe" and "prolonged." Multiple factors are considered in assessing the medical condition, including the nature of the condition and whether it is progressive, functional limitations due to the condition, the impact of treatment, statements/opinions expressed by the health professional and client, the existence of multiple medical conditions, and personal characteristics (Government of Canada, 2018b)
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Disability Support Pension (Australia) To be eligible for DSP, applicants must be "between 16 and pension age; meet residency requirements; meet income and assets tests; and have a permanent and diagnosed disability or medical condition or get a Department of Veterans' Affairs special rate disability pension due to total and permanent incapacity" (Australian Government Department of Human Services, 2018a)
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DSP uses 15 impairment tables to determine an impairment rating. These tables include functions requiring physical exertion and stamina; upper-limb function; lower-limb function; spinal function; mental health function; functioning related to alcohol, drug, and other substance use; brain function; communication function; intellectual function; digestive and reproductive function; hearing and other functions of the ear; visual function; continence function; functions of the skin; and functions of consciousness (Australian Government, 2011)
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If an individual is unable to return to previous work activity, the job analysis provided by the employer is used to identify modified duties (Fisher and Smulyan, 2018)
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. Selected Private Disability Insurance Providers Prudential Financial Prudential's group disability insurance provides both short- and longterm disability benefits, return-to-work services, absence management, and health and productivity data analytics and consulting.
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If the information is sufficient, Prudential will have a clear understanding of functional capacity and can make a determination. Sun Life Financial Sun Life Financial's disability claims management process consists of a thorough assessment, starting with a comprehensive analysis of information related to the claimant's injury and absence from work (Sun Life Assurance Company of Canada, n.d.)
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. COLLECTION OF FUNCTIONAL INFORMATION Selected Federal Disability Programs Veterans Benefits Administration The VA uses DBQs to collect functional information related to the impairments described in Chapter 7, including back conditions, heart conditions, mental disorders, and traumatic brain injury (TBI)
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The section collects information on the veteran's current level of functional status for 10 facets of TBI-related cognitive impairment and subjective symptoms: memory, attention, concentration, and executive functions; judgment; social interaction; orientation; motor activity (with intact motor and sensory system) ; visual spatial orientation; subjective symptoms; neurobehavioral effects; communication; and consciousness (VA, 2011)
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that have a high probability of meeting the eligibility criteria for CPP disability benefits. The form also provides examples of functional limitations by physical abilities, behaviors and emotional abilities, communication and thinking abilities, and other daily abilities.
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For Table 1 on functions requiring physical exertion and stamina, the introduction indicates that the table should be used "where the person has a permanent condition resulting in functional impairment when performing activities requiring physical exertion or stamina" (Australian Government, 2011, p.
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. Selected State Workers' Compensation Programs Chesapeake Employers' Insurance Company Chesapeake collects functional information using a job analysis form and functional capacity evaluation.
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, the IME Doctor's Estimate of Physical Capacities, the Functional Capacity Summary, and the Job Analysis Summary. The APF collects information on work status, including when the worker was released to the job where injury occurred, whether the worker can perform modified duties, whether the worker may work limited hours, and measurable objective findings related to work ability (L&I, 2018b)
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. Selected Private Disability Insurance Providers Prudential Financial Prudential provides multiple forms for use by physicians to collect medical information, including the Capacity Questionnaire, Mental Status Examination, Behavioral Health Capacity Questionnaire, Kurtzke Functional Systems Scores, Visual Capacity Questionnaire, and Psychiatric Work Readiness Assessment (Prudential Financial, 2018c)
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Sun Life Financial For both long- and short-term disability benefits, Sun Life provides questionnaires for the claimant, attending physician, and employer to complete. The Attending Physician Statement (APS)
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Annex Table 8-1 also shows that the VBA, the CPP, and Sun Life Financial collect information on ADLs to assess functioning. The VBA's residuals of TBI DBQ collects information on whether subjective symptoms mildly or moderately interfere with IADLs.
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State workers' compensation programs (e.g., Chesapeake Employers' Insurance Company, Washington State Department of Labor and Industries) and private disability insurers (e.g., Sun Life Financial, Prudential Financial)
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8-5. Prudential Financial, a private disability insurance company, has several goals when a claimant applies for assistance, including un derstanding all of the medical conditions impacting the employee, identifying functional capacity and restrictions and limitations, iden tifying prognosis and when and whether return to work is expected, and using vocational rehabilitation resources to facilitate a safe return to work.
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. Australian Government Department of Human Services.
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2018. Functional assessment of adults applying for disability benefits.
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2018. Medical report for a Canada Pension Plan disability benefit.
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conditions disability benefits questionnaire. https:// www.vba.va.gov/pubs/forms/VBA-21-0960M-14-ARE.pdf (accessed April 4, 2019)
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Assessment Questionnaires and Forms Consider Physical • Back Conditions • Medical report • Impairment tables Abilities Disability Benefits Questionnaire • esiduals of TBI R Disability Benefits Questionnaire Consider Mental • Mental Disorders • Medical report • Impairment tables Abilities Disability Benefits Questionnaire • esiduals of TBI R Disability Benefits Questionnaire Consider • esiduals of TBI R • Medical report Activities of Daily Disability Benefits Living Questionnaire
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• Functional • Activity • Capacity • Attending capacity Prescription Form Questionnaire Physician evaluation • Independent • Visual Capacity Statement • Job analysis medical Questionnaire • Job Demands examination (IME) • Kurtzke Functional Questionnaire doctor's estimate Systems scores of physical capacities • Functional capacity summary • Job analysis summary • Functional • Mental Status • Attending capacity Examination Form Physician evaluation • Behavioral Statement Health Capacity • Activities of Questionnaire Daily Living • Psychiatric Questionnaire Work Readiness • Job Demands Assessment Questionnaire • Kurtzke Functional Systems scores • Activities of Daily Living Questionnaire continued
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366 FUNCTIONAL ASSESSMENT FOR ADULTS WITH DISABILITIES ANNEX TABLE 8-1 Continued Federal Disability Benefit Programs Veterans Benefits Canada Pension Disability Support Administration Plan Pension (Australia) Impairment • Back Conditions • Impairment tables Specific Disability Benefits Questionnaire • Heart Conditions Disability Benefits Questionnaire • Mental Disorders Disability Benefits Questionnaire • esiduals of TBI R Disability Benefits Questionnaire NOTE: TBI = traumatic brain injury.
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REVIEW OF SELECTED DISABILITY BENEFIT PROGRAMS 367 State Workers' Compensation Programs Private Disability Insurance Chesapeake Washington State Employers' Department Insurance of Labor and Prudential Company Industries Financial Sun Life Financial
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