Checking the Status of Your Disability Claim Part 1-Social Security Disability Claims ESP

Social SecurityDisability Claims

E xaminer S peaks P lainly

Free Disability Claims ESP Newsletter ... Get it Here!

<< Previous [1] 2 Next >>

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.

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.

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.

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.

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.