Medical Aspects of Disability and Case Management Flashcards

Which federal program provides disability income benefits to workers who become unable to work due to a severe, long-term medical condition?

Answer: Social Security Disability Insurance (SSDI)

SSDI provides monthly benefits to disabled workers who have sufficient work credits and cannot engage in substantial gainful activity (SGA).

What is 'substantial gainful activity' (SGA) in the context of SSDI?

Answer: Work performed for pay above SSA's monthly earnings threshold

SGA is work activity that involves significant physical or mental effort performed for pay above a set monthly earnings threshold, used to determine SSDI eligibility.

Which condition is typically addressed in a 'pain management' program in disability case management?

Answer: Chronic musculoskeletal, neurological, or complex regional pain that persists despite standard treatment

Pain management programs target complex, persistent pain that has not responded to standard medical care and affects function and work capacity.

What role does an 'attending physician' (AP) play in a workers' compensation case?

Answer: Providing ongoing treatment, certifying disability, and guiding the medical management of the claim

The attending physician provides treatment, documents functional limitations, certifies work ability, and directs ongoing medical care in the workers' comp claim.

In disability management, a 'peer review' differs from an IME because peer review:

Answer: Is a medical record review only, without direct patient examination

Peer review involves a physician reviewing medical records and clinical documentation without physically examining the patient.

Which term describes the degree of permanent physical impairment expressed as a percentage of the 'whole person'?

Answer: Whole person impairment (WPI) rating

Whole person impairment (WPI) is a percentage derived using the AMA Guides that quantifies the impact of a permanent impairment on the individual's overall functioning.