insurance companies will ask for your medical records when a claim is
filed, and these records are the primary source used to determine if you
meet their definition(s) of disability.
process, Social Security, and frequently disability insurance
companies, will also send you, the claimant, questionnaires once a claim
has been filed. Some are for specific reasons or conditions such as
pain, fatigue, or questionnaires concerning diabetes.
will send a questionnaire asking about your ability to function
generally. Although it may have a different name in some states or from
some insurance companies, regardless of the title, it is designed to
ask how your medical condition affects your daily life and your ability
counselors how much they influence the disability decision, this is
your opportunity to let the examiner go beyond the medical information
and numbers and see just how your medical condition affects your daily
life and the problems your symptoms cause you.
illustrate changes due to fatigue, pain, cognitive limitations, and
other “subjective” symptoms. Whether they give much credence to the
questionnaire or not, it is worth your while to complete it fully, if
only for you to see how dramatically your life has changed. Be warned,
however, it’s not usually a happy picture when you list all the changes
your disease has caused over the years.
you are going to write, so it’s a good idea to make a photocopy of the
questionnaire to make notes on, or to put trial answers on a blank sheet
of paper before completing the actual questionnaire.
Make a list of them. Some people have been dealing with some symptoms
for such a long time and have learned to accommodate them so well that
they have forgotten about them as symptoms. Put your list somewhere it
will be seen frequently, like the kitchen counter, in the TV room or
or two you should recognize yourself doing tasks differently than you
used to. Often this is due to a symptom you accommodated so well that
you forgot about it. Do you take longer to groom? Did you change your
hairstyle for convenience not looks? Do you short cut on meal
preparation? Do you ration how often you go outside or upstairs or
doing errands? Have your reading, TV or computer habits changed? Do you
nap regularly? Note these shifts in habits on your sheet along with
your symptoms. After two or three days, you will be ready to draft
answers to the questionnaire.
Regardless of how the questions
are worded, they want to know what adjustments you have had to make to
accommodate your symptoms and what problems you still have even with
Print or otherwise make sure
you write legibly. No points are given for neatness, so don’t worry
about strikeovers or cross-outs, but make sure what you write is
- Consider using a
computer. It will be much easier to read. Be sure to include every
question, preferably typed in bold to distinguish it from your answer.
NOTE: Sometimes, when you use a
computer, your completed questionnaire looks “too good for a disabled
person to complete.” However, you know how many hours and how many
separate sittings you spent getting it to look like it does. If the
questionnaire looks “too good” upon completion, note at the end of the
questionnaire just how much time you spent completing it as well as any
symptoms exacerbated by it. If someone assisted by writing, typing, or
reviewing, acknowledge that as well.
Don’t leave any blanks. If there is nothing to say, write “N/A” or “None” to let them know you didn’t overlook the question.
Avoid one-word answers even
if you are only asked to check “yes” or “no.” Expand on why you
answered as you did, and, when possible, give an example or anecdote
that illustrates your reply.
Don’t be intimidated by
small space for answers. If you require more space, simply note “See
Attached Sheet,” and put the answer on a blank sheet of paper. Make sure
you put your name and Social Security or Claim number on every sheet,
and number the answer to match the question.
Activities Questionnaire may vary slightly, but they generally cover
the same areas in various degrees of detail:
What are your living
arrangements? Do you live alone? Is there someone to help with the
chores? Do you live in a house or apartment? Give appropriate details.
For example, if you live in a two-story dwelling, comment on how you
limit your trips up and/or down stairs due to pain/fatigue/etc., and on
any accommodations you made in your living arrangements.
- Describe what you do on
an average day. Start with what time you get up and why you get up at
that time. How long does it take to groom yourself? What do you have
for breakfast and who prepares it, or is it just cold cereal or
something else easy? How do you typically spend your morning—resting,
running errands, going to the doctor?
What do you have for lunch? What do you usually eat? What shortcuts are taken in preparing lunch?How do you spend the afternoon? Do you read, watch TV, nap, do some housework? If so, for how long?What about dinner? Who fixes
it? What is it, if you prepare it? How is this different from when
you were healthy? Again, note all shortcuts that you use in meal
preparation and clean up. What time do you go to bed? How well do you
- Do you need help
completing your housekeeping tasks? Here you can explain who helps or
does the housekeeping, cleaning, laundry, yard work, and meal
preparation. If you do these yourself, be sure to explain how you have
adjusted to accommodate these tasks to your condition, i.e., whether
you do them more slowly or not as often or in brief periods.
Again, as you answer this
question, indicate how your health condition has affected your ability
to complete your chores. For example, “I used to be able to change the
sheets on the bed, but now I get so dizzy when I bend over that my
husband (or friends) do it and the sheets only get changed twice a
Personal Care. This gives
you the opportunity to tell how your grooming habits have changed, that
it takes longer to complete, or that you don’t groom as carefully or as
often as before. What special adjustments have you made due to your
condition? One client who had memory problems said: “I keep all my
grooming needs in a basket and take them out as I use them so I will
know when I have done everything.”
Hobbies and interests.
Reading and TV viewing habits. It is more important in this section to
contrast your current interests and habits with those when you were
healthy. Depending on the symptoms, many people are no longer able to
engage in many of the physical activities they enjoyed when they were
healthy. They also often find that because of fatigue or loss of
cognitive ability, they don’t read novels or watch heavy dramas but
favor lighter and shorter fare. It’s OK to say you go to the gym,
especially if your doctor recommended it and your workout is lighter
than it used to be.
Errands and transportation.
They usually will ask about your driving ability or how you get around.
They will also ask about shopping, who does it or, if you do, how
often. Again, it is important to note any changes in your routine that
you have made to accommodate your symptoms. Do you limit your driving
to the neighborhood and daytime only? Do you buy smaller amounts so
they are easier to carry or does a friend or spouse help with the major
that aren’t directly addressed in the questions, but they show ways
that your disability has affected you and your life. If there is no
“Remarks” question at the end, add a sheet labeled, “Additional
patience or the way in which you deal with your family or with others,
be sure to note that. If you have gone from being socially active to a
more reclusive lifestyle, tell them about that as well.
that illustrates the change you are describing. For example: Name the
TV show you turned off because it was too complicated to follow; tell
about the stool or small table you placed just outside your door to set
items on while unlocking the door; describe what tools and assists you
purchased or created to make certain tasks easier on you; describe how
you leave some groceries in the car and take them in at a later time.
This is the only opportunity
you have to show how the medical condition has affected your life and
your ability to function, so be sure to give all details of your
changes, limitations and accommodations. It is important to explain it
in detail. Do not assume that the analyst will assume anything; explain
it thoroughly. In addition to showing how you are unable to work
because of your condition, it will also give the analyst a more vivid
picture of the human being that is suffering—something that can’t be
learned from reading the medical facts.