When and How to Check the
Status of Your Social Security Disability (SSDI) or
Supplemental Security Income (SSI) Claim Status for
Benefits
“Questions You Can Ask
Your Disability Examiner When You Periodically Check the Status
of Your Disability Claim”
Checking the status of
your disability (disabilty,
dissability) claim at the right time can be crucial in
helping you speed up processing of your application.
This is because when you call in to get a status check, it
forces the disability examiner to take a look at your folder or
electronic record, and s/he can then tell you what else is
needed for processing, or at least where the claim is in the
sequence of steps that are involved in its
development.
So when should you ideally check the status of your disability
claim? Having worked as a disability examiner for three years,
here are my suggestions for when you should check the status of
your claim based on the various case development stages of
initial claims.
1)
You should call your disability examiner (DE) in the state
Disability Determination Services (DDS) office or the
Disability Adjudication Services (DAS) office 30 days after you
have completed your application
. If everything has gone as it should, by then the DE has
written to all the doctors/hospitals listed on your application
to request your “medical evidence of record” or MER (as it is
called internally). The examiner has given these medical
providers two to three weeks to get the records turned in.
Because the worker makes these requests within days of
receiving a new claim for processing, all of your MER should
have been received in the first 30 days if your
doctors/hospitals staff have been able to and cooperative in
sending the records in.
Medical records are the backbone
of your claim. If there is no medical
evidence to support your claim, you
really have no claim, and your claim will
ultimately be denied. The DE can set up a
consultative examination (CE), which
allows you to see one of Social
Security’s participating doctors so that
he or she can do a medical exam to
provide the missing information. But the
bottom line is that the more medical
records the examiner has to review, the
easier it is to prove your claim for
disability based on objective medical
findings.
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Unfortunately, most DDS offices have a list (either in writing
or in fact) of medical facilities that are notorious for either
not providing medical records in a timely matter (if at all) or
providing records that have been known to be totally useless in
giving the information necessary to decide a
claim.
In my experience, medical records from the Veterans
Administration, while usually voluminous, generally have little
substance unless there are x-rays or other objective test
results located in the file.
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Some states send out second
notices automatically to medical
providers who fail to respond to a first
request for records, and this system
helps the examiner tremendously because
the first notice may have been misplaced,
lost in the mail, etc. North Carolina is
one state that does not do this as a
matter of course, so the chances are that
your medical records may be incomplete if
you do not follow-up. Of course the
examiners are expected to make this
follow up request manually, but this may
or may not happen depending on how many
cases s/he may be managing at any one
time.
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So to recap, the reasons you are checking the status of your
claim at day 30 is to ask the DE:
A)
“What is the status of my claim?”
If the worker says something like “It is still pending.” or “No
decision has been made,” then your next question will
be:
B)
“Have you gotten my medical records from all of my
providers?”
If they tell you that one or more doctors have not sent in
records, then you should
C)
Ask for the names of the doctors or hospitals that have not
provided records to date
. Then,
D)
You should, if you are able to or have someone
who can, offer to assist the DE in getting those
missing medical records
. How?
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 them 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 don’t 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
records.
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E)
When you do your 30-day status check, 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.
Note: Again, depending on the state you live
in and apply for benefits, how the DE collects information may
vary. In GA, adjudicators are trained to primarily 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 you doctors, hospitals,
psychologist, counsellors and 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, 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. 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).
But because the DDS offices are often understaffed, a case may
end up getting no action on it for months after all the info
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.
Some Disability Examiners have
the designation and are certified as “Single
Decision Makers” which means that in some types
of 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.
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