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How do I prove depression as a cause of absence for my unemployment claim?
November 3, 2010 10:29 AM   Subscribe

Recently, I successfully applied for unemployment benefits in New York. My former employer has filed an appeal. They are claiming I was discharged for misconduct, specifically, absenteeism and tardiness. I am claiming that my absences and latenesses were due to illness, specifically, depression. How do I prove my case? Will a letter from my therapist suffice? Do I need a letter from my psychiatrist (an M.D.)? Do I need the therapist/M.D. to verify that my illness was the cause on each of the dates in question, or is it enough to provide a general statement that my illness was the cause of this pattern of behavior?
posted by flotson to Law & Government (6 answers total) 1 user marked this as a favorite
 
Call the unemployment office you're working with. They'll tell you how to go about disputing the appeal.

I'd also recommend contacting legal aid in your jurisdiction, as having a lawyer's assistance in collecting and verifying your evidence is going to be invaluable.
posted by valkyryn at 10:43 AM on November 3, 2010 [1 favorite]


Here is a sort of handbook for how to deal with these kinds of issues in New York. I'm not vouching for the advice in the document, but page 11 seems to address your particular reason.
posted by OmieWise at 11:49 AM on November 3, 2010


I'd contact a group like the Unemployment Action Center. It's staffed by law students, but backed with more experienced professionals. It's also completely free. I used an advocate from their group when a former employer also filed an appeal (he never showed up to the case - a whole other story) but they were great throughout.
posted by jourman2 at 12:16 PM on November 3, 2010


Thanks, these are all helpful suggestions.

FYI, I called the Unemployment Action Center and they're unable to speak with me until my hearing date has been scheduled. Unfortunately, according to the documents sent by the DOL, they may not notify me of my hearing date until a few days prior.

I'll write again with any updates.
posted by flotson at 1:55 PM on November 3, 2010


When you took the absences, did you document why you were absent, and did you receive any treatment or see a Dr. at that time? Just getting a letter from an MD saying you were depressed (and good luck getting one to actually sign such a letter) might not be all that helpful without any back-up materials.
posted by Ideefixe at 4:13 PM on November 3, 2010


I need to write this and get it posted just in case the Fingermen come and black bag me.

You want to file a psychiatric disability claim? If you want the practical tips, scroll to "III." I'm going to give you the backstory so you understand what you're up against.

Say you're poor. You apply for Welfare and state Medicaid. You are obligated to try and find work or be enrolled in a jobs program in order to receive these benefits, unless you have a doctor fill out a form saying you are Temporarily Incapacitated due to medical illness. The doc will note the diagnosis, however, it doesn't matter what your diagnosis is, it only matters that a doctor says you are Temporarily Incapacitated.

You could try to get cancer or a seizure, but the easiest and fastest way to do this is to go to a psychiatrist and say you're depressed. It doesn't matter if he medicates you, or even believes you, so long as he signs the form and writes "depression." The doc can give you as much time off as he wants, and you can return, repeatedly, to get that form filled out. You can be on state medicaid and receive cash payments for up to 5 years. So as long as you show up to your psych appointments, you'll be okay.

"That's not how it works for me!" you might say, which brings us to the whole point: it's not for you. It is for the entire class of people we call poor, about whom comic Greg Geraldo joked: "it's easy to forget there's so much poverty in the United States, because the poor people look just like black people." Include inner city white people and hispanics, and this is how the government fights its War On Poverty.

In the inner cities, the system is completely automated. Poor person rolls in, fills out the Medicaid paperwork (doc signs a stack of them at the end of the day), he sees the therapist, the doctor, +/- medications, and gets his benefits.

There's no accountability, at all. I have never once been asked by a govt. employee whether the person deserved the money, the basis for my diagnosis-- they don't audit the charts, the system just is.

In theory, you can get the state medicaid/cash payments from any doc for any diagnosis, but it is easier to go to a psychiatrist.

But what happens when your five years on the dole are up?

Enter SSI, Supplemental Security Income. You can earn lifetime SSI benefits (about $600/mo + medical insurance) if you-- i.e. your doctor-- can show you are Permanently Disabled due to a medical illness.

Once again, the diagnosis doesn't matter, only that you show how the diagnosis makes it impossible for you to work. Unable to work has specific meaning, and specific questions are asked: ability to concentrate, ability to complete a workweek, work around others, take criticism from supervisors, remember and execute simple/moderately difficult/complex requests and tasks, etc.

The easiest way to do this is to claim depression, or bipolar, or some other psych illness, and have the doctor fill out the necessary form. The patient may be awarded it on the first try; he may be rejected, then get it on appeal; he may need a SSI hearing; or he may apply five times and finally get it on the fifth. Certainly there are lawyers involved, who take their fee at the end (e.g. 20% of the first year's payments). But in this method, there is a 100% chance of being awarded SSI. Again, maybe not on the first pass, but if you are persistent, you will get it.

II.

At this point you are probably wondering about abuse of the system, people lying, pretending they have psych illnesses just to get the benefits. If you think this-- a natural feeling, I'll admit-- then you need to turn off the network news and go watch Network the movie. You're being lied to, by yourself.

The system isn't flawed, it isn't easily gamed: it is set up this way on purpose. The government wants you to get SSI, because it wants you off the state budget and onto the federal budget, which, as you know, has unlimited funds because it can run deficits, print money, and invade Poland.

Last year SSI paid 8M people about $45B. 60% of those under 65 had a "mental disorder." Did many have a legitimate disorder? Sure. Sometimes genetic, sometimes environmental. And many were drug addicts, which, regardless of your political position, still makes it very hard to show up to work. But while the system ties benefits to the mental disorder, the point is the benefits, not the mental disorder.

The standards were deliberately relaxed: in 1984 it made mental disorders and subjective complaints (pain) easier to use. 1990 easier for kids. etc.

What you should be asking is why, if society has decided to give the poor a stipend of $600/month, does it do this through the medical establishment and not as a traditional social policy? And the answer is very simple: 1. you, America, would go bananas if poor people got money for nothing, you can barely stand it when they get it for a disability; 2. if you offload a social problem to medicine, if you medicalize a social problem, then you've bought yourself some time (a generation or two) to come up with a new plan or invade Russia.

Do you want riots in the streets? How much does it cost to prevent LA from catching fire again? Answer: $600/month, plus insurance. Medicalizing social problems has the additional benefit of rendering society not responsible for those social ills. If it's a disease, it's nobody's fault. Yay empiricism.

Those who are arguing about the cost of healthcare or think that poor people are lying to get benefits are completely and utterly missing the point of the system. It wants this in the hands of doctors, because no one else wants it.

And maybe these people get some meds as well. You know what counts as an outcome in inner city psychiatry? One less instance of domestic violence a month. What does that cost? $600/month + Abilify+ Xanax + Celexa.

III.

As easy and streamlined as this is process is for the inner city guy with no other resources, it is that much harder for you. It isn't for you. I know this because, by the way you phrased your question, do not own a gun and are not likely to set your town on fire when your team wins/loses. I realize you're filing a disability claim with an employer, but the idea is the same: you did work. How do you show you now can't work? It would have been easier to "prove" you can't work if you never worked. That's SSI.

The "key" to your disability claim-- and your chances are not great but consult with your lawyer-- is to show how the depression impairs your cognition. Lack of energy and suicidality may sound important, but the illness has to link directly to an impairment. Suicidality isn't an impairment. Not being able to read a paragraph or perform a simple repetitive task are impairments.

Meanwhile: do you think all those 4M psychiatric SSI beneficiaries can pack a box or stack some cans? Of course they can't. How could they? They're depressed.

IV.

I'm guessing that this probably upsets people, in both directions. Certainly I have my own opinions, but it doesn't matter what I think, what matters is what is. This is the system. If you think you can effect a huge social overhaul then feel free to vote for Hope And Change, otherwise understand how it works before you complain to your Fox affiliate. "Hi, this is Bill from Detroit, and I hate liberals." Problem solved.

The system not only pays poor people, it employs lots and lots of people. I'm not saying this is a good thing, or a desirable thing, I am simply stating a fact. Some of these are direct govt. jobs (e.g. staff down at the SSI office) and some are pretend private sector jobs. If you're a psychiatrist at an inner city clinic, you may think you're an independent contractor, but you're really working for The Man. That's the system. Cut SSI payments and those docs-- and nurses and etc-- don't get paid.

An inner city psychiatrist sees 20-40 people a day. 15 minute med checks, which in a city is 5 or 10 minutes. You try and pull that off in a suburban area and the Feds will be shooting your dog to roll in through your backyard. But in the city, that's the standard. The government allows it because someone has to deal with those "patients." The government doesn't have a plan for them. Fortunately, the DSM does.

Same with benzos (Xanax, Klonopin, Valium, etc) and narcs (percocet, vicodin, etc.) Once in a while some doc gets publicly arrested, but the amount of benzos being routinely prescribed in an inner city is unbelievable. Go to your doc and see how hard it is to get a Xanax script. Come to the inner city and you can get #90 on first visit. Why? Because the government isn't going to mess with eleven sandbags they have placed in each neighborhood to hold back a flood of proletariat rage. Patients want them (to use, to sell, whatever) and docs give them because if they didn't, they wouldn't come back. If they don't come back, what are they going to do? Go work for Walmart?

If you want to be rich in inner city psychiatry, you open a clinic and hire (talk) therapists, usually social workers. Medicaid will pay for 1 therapy visit per week (around $60/hr) and a 15 minute med check with the doc ($40/visit). The doc usually gets salaried but proportionally takes all of that $40. The therapist, however, gets very little-- $15/hr. The rest goes to the clinic. If the clinic serves 100 patients, the clinic can bill $24000 a month in therapy, pay $6000 to the therapists and pocket $19k a month, minus overhead and security guards. Do you know how many patients go to clinics? Thousands. Do the math.

Do all these patients need the therapy? Of course not. But they have to go to therapy if they want to stay in the clinic, and they need the clinic because that's how they're getting their SSI, not to mention the Xanax. The docs need them to come because that's how they earn their living, and the government allows this because it needs someone to deal with American poverty until either we discover cold fusion or the aliens invade. The government doesn't tolerate this, it doesn't turn a blind eye towards it, it explicitly allows it. The only thing it forbids is billing for a service not performed (e.g. ghost patient.)

The rise of psychiatry is parallel to the rise of poverty. It is the government's last resort to a social problem it may or may not have created, but has absolutely no other way of dealing with it. World psychiatry will also be the temporary solution to world poverty until the aliens return. So invest in Pfizer, it will only go up.

I apologize for the wordiness of this, I have no time to edit or rewrite, I already hear them downstairs kicking in the door. Remember, remember...
posted by TheLastPsychiatrist at 8:16 AM on November 4, 2010 [24 favorites]


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