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“Questions You Can Ask Your Social Security Disability Examiner When You Periodically Check the Status of Your Disability Claim”


Excerpt--This is Step 3 -- a sample chapter from the Ebook Entitled Getting Social Security Disability: Your 9 Step Guide

 

How You Can Assist the Claims Examiner in Getting Medical Records:

                            
You can place a call in to your doctor’s office and explain that you have applied for disability and the claims office (DDS of DAS) is waiting to receive records from their facility. Tell the doctors office – in larger medical facilities, you would be speaking to someone in their “medical records department” – the date the DDS requested the records. (The date the examiner requested the records can easily be gotten from the DE during you first 30-day status check telephone call).

   Then ask your doctor or medical facility to, if they are able, fax the information in to the DDS, explaining that it has already been three weeks since the date of the initial request. If they are not able to fax, then try to get a commitment from them that they will mail the records in within the next few days. Then, you should follow up with your medical provider after a few days to see if they have done it.


In one of the states that I handled disability claims, it was the stated policy of the agency that the DE would not request assistance from claimants in obtaining medical records in SSI claims. I do not know the full logic behind that rule. Still you should know that the more current objective medical records that the DE has to evaluate, the clearer it becomes as to the degree of your functional abilities or disabilities, so if you are applying for SSI, and are able, you should also offer to assist the DE to get medical records.

 

  

E)              When you do your 30-day status check on your claim, and the DE tells you that s/he has received all the MER from all the doctors / hospitals you listed, ask if anything else is needed before s/he can issue a decision.  If the examiner responds that s/he are also waiting on you to return anything that was sent to you, such as a questionnaire or if s/he says they are waiting to receive an ADL (activity of daily living) form from your aunt Mary or whoever else you listed as a person who knows about your condition, then you should follow up with your aunt Mary to ask her if she has received the form and encourage her to complete it and return it as soon as possible. 

  

Note: Again, depending on the state you live in and apply for benefits, how the DE collects information may vary. In GA, adjudicators were trained primarily to collect info via questionnaires sent to you; in NC, the DEs may prefer to call you for the information. Regardless of the method, your job is to check to be sure the examiner has gotten the information requested from your doctors, hospitals, psychologist, counselors, friends, spouses or any other third parties.

 

If the information is not received from your treating doctors, from you or from your third parties, the DE will not have the time (or the inclination) to do follow-up and baby sit any party to the claim. They will merely move on to the next step in development, because contrary to popular notion, DEs are evaluated for timeliness in case processing, and begging for MER from a non cooperating doctor will only slow the process down. So you can be sure that if you are not working to obtain the missing records, chances are that your DE is not working on getting the records either. 

  

Finally, during your 30-day status check call, after you have asked if all the medical records have been received, and if all questionnaires have been received, and if the answer is yes, then you can ask the DE if s/he has had a chance to review your claim or write it up. (DEs in most states are charged with summarizing your case record to be reviewed by in house medical consultants, i.e. physicians or psychologists).

 

The answer may be “No.” If the claims examiner says "I need to review it to see if any additional information or tests are needed," tell them that that is fine, and then ask, “When can I call back to see if anything else is needed?” 

  

Note: In the ideal world, after all MER and questionnaires are received, the DE would immediately proceed to reviewing all of your medical records, then write up a case summary for review by the staff medical doctor and/or psychologist for concurrence (depending on whether you alleged a physical impairment, a mental impairment or both).

However, because the DDS offices are often understaffed, a case may end up getting no action on it for months after all your information has been received. Your phone call to the DE can trigger such a review and if you promise the DE worker that you will call back in two weeks for an updated status, this action may cause him/her to make a note to review your case before those two weeks are up. 

 

This is done primarily because getting calls from claimants and having to explain why no action has been taken is sometimes harder than going ahead and reviewing and summarizing the case and putting it in the medical consultants' cue for review, especially if the worker can see that the case is going to be a denial.

 

Cases that look as though they will be a denial often sit on an examiners desk the longest while approvals are generally processed first by an examiner.

 

 


Some Disability Examiners have the designation and are certified as “Single Decision Makers” which means that in some types of physical disability cases, they can make the final decision on a claim without any feedback from a MC (staff physician). If this is the case with your claim, you could have a decision within two weeks of such an initial status check phone call.


 

Claims alleging only a physical disability might not have to be forwarded to a medical consultant for review if your examiner is experienced, and while this may speed up the processing of your claim, it should be noted that one disadvantage to you as a claimant is that if an examiner, who is generally not a medical doctor, makes the final decision on your claim without input from a licensed medical doctor, then you can see how that might not be in your best interest. 

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